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Question construction in the Dermatology specialty

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Question construction in the Dermatology specialty
Rashid M Rashid MD PhD
Dermatology Online Journal 14 (12): 19

Department of Dermatology, MD Anderson Cancer Center, UT-Houston, Houston, Texas, US

As a resident, the importance of faculty prepared practice questions/tests, in-service exams, as well as journal based continuing medical education and self-assessment sections are invaluable. Also admirable, is the time taken by the authors to summarize and present key concepts for both the most experienced physicians, as well as the specialty's neophytes. These endeavors emphasize the importance of an active and involved role in teaching. Because we are all in the constant process of learning, this letter hopes to further assist in perfecting this area of scholarship.

In particular, the goal is to emphasize the NBME guidelines on question formats [1]. These guidelines are developed based on blinded controlled studies. Therefore, their role should be rather central. Yet, these guidelines are understandably rarely included in the regular readings of dermatologists. The same omission is usually true concerning research in the science of education, even for those with a long history in academia. Thus many of our question formats, from our CME to our board examination, have been less evidence based, when compared with more basic examinations like the USMLE. The most common, but surely unintended, divergence from these guidelines involves the negative type A question. In such a question, an examinee is asked to choose an EXCEPT i.e "all of the following are true EXCEPT?" or "which of the following is NOT correct." Such questions have been determined to be one of the least optimal testing formats. This format is least likely to be favored, because it fails to effectively stratify based on knowledge. Also to be avoided are: "All of the above/None of the above" answer options, as well as "true/false" questions. Ultimately, the responsibility of dermatology education and the future of our specialty fall into our hands. As such, it is critical to regularly maintain the highest standards in evidence based examination and education methods.


1. S. M. Case, D. B. Swanson. Constructing Written Test Questions for the Basic and Clinical Sciences, 3rd Ed (revised), In: edited and published by National Board of Medical Examiners; Philadelphia (PA) 2003. p.1-181

© 2008 Dermatology Online Journal