El primer caso de aplicación de eutanasia activa en Colombia

Multiple-choice items represent the most widely used type of objective

test item. The stem of the multiple-choice item poses a question or a problem situation which is followed by alternative answers. One of these

responses is correct while the others, which are not, are referred to as distractors. The stem may be an incomplete statement or a question.

Examples:

The morbidity rate for pill users is highest among: A. adolescents

B. women over 35 years of age who smoke C. women 20–35 who smoke

D. diabetics

Which of the following is most frequently cited by women as a reason for requesting the removal of Norplant implants?

A. a desire to become pregnant B. infection at the implant site C. visibility of the implants D. dizziness

E. menstrual irregularity

Writing Multiple- Choice Test Items

When writing multiple-choice test items, the stem should present a clearly stated central problem and the responses should be brief. The choices should be similar in length.

The following is too general and is a poor example of a stem:

“The first step in needle disposal is. . . .”

An improved stem might be:

“When disposing of needles that have been used for the administration of injectable contraceptives, which of the following is the first step?”

Repetition of phrases or terms within the responses should be avoided (these should be in the stem). Note the improvement in the item in this example.

Example:

The following is a poor example of a stem:

A solution for high-level disinfection of instruments and other items:

A. can be prepared each day by adding chlorine to boiled water to make a 0.01% solution

B. can be prepared each day by adding chlorine to boiled water to make a 0.1% solution

C. can be prepared each day by adding chlorine to boiled water to make a 1.0% solution

D. can be prepared each day by adding chlorine to boiled water to make a 10.0% solution

An improved stem would be:

A solution for high-level disinfection of instruments and other items can be prepared each day by adding chlorine to boiled water to make a:

A. 0.01% solution B. 0.1% solution C. 1.0% solution D. 10.0% solution

Negative terms (such as no, never, none and not) should be used sparingly; if used, the term should be bold-faced and/or underlined to draw attention to it.

Example:

“Which of the following is not the. . . .”

The responses should be in chronological or numerical order if applicable. The distractors should be reasonable alternatives unless the designer is attempting to introduce a bit of humor into the test—if so, use it sparingly. Make all choices plausible.

Another form of the multiple-choice question is the scenario item. The scenario item typically presents a situation and then asks the participant a series of questions related to the situation.

Example:

Traffic flow and activity patterns are critical considerations in controlling the number of microorganisms in a designated area. A reproductive health professional arrives at a rural family planning clinic. The floor plan for instrument and equipment disinfecting, cleaning and sterilizing is shown in the diagram on the next page of this test. Use this diagram to answer questions 23 through 30.

Each response letter should be capitalized to avoid confusion between b and d, c and e. In addition, each response letter (e.g., A, B, C, D) should be the correct response an equal number of times. Also, avoid a specific pattern in correct responses, and vary the position of the correct choices. This will prevent the participant from answering an item correctly because of a response pattern.

The list of responses should be grammatically parallel. Many writers of multiple-choice test items use an “a/an” at the end of an incomplete statement to ensure that each of the responses will complete the statement correctly regardless of whether or not the first word of each response begins with a vowel.

Limit the use of “All” and “None of the above.” When used, these choices should be the correct responses approximately 25 percent of the time when four responses are given.

Multiple-choice questions are very versatile, since they can test a wide range of knowledge, ranging from simple identification through analysis of more complex questions (Table 7-2). They are easily scored and can be used to construct tests with high validity and reliability. A disadvantage is that good items can be difficult to write.

As with true-false questions, writing the directions for answering multiple-choice questions may be as important as writing the test items. The directions must be clear and must indicate how and where the participant is to respond. Is the correct response to be indicated on the test or on a separate form? What is the point value of each item?

Example:

Directions: Each of the items on this midcourse questionnaire is

followed by five possible responses. For each item, select the best response. Indicate your answer by circling the appropriate letter next to your answer. Each correct response is worth one point.

Table 7-2. Examples of M ultiple-Choice Items (in order of difficulty) Knowledge

Norplant implants provide contraceptive protection for: A. 3 months B. 1 year C. 3 years D. 5 years E. 10 years Comprehension

FSH pretreatment increases LH-stimulated testosterone secretion; therefore, FSH has a direct effect on: A. Leydig cells

B. the epididymis

C. androgen-binding protein D. Sertoli cells

E. the epithelium of the vas deferens Application

Infection prevention guidelines for IUD insertion or removal require high-level disinfection (HLD) or sterilization of instruments. When HLD by boiling is not possible, which of the following is an acceptable alternative?

A. Soak for 10 minutes in 2% glutaraldehyde solution B. Soak for 20 minutes in 8% glutaraldehyde solution C. Soak for 20 minutes in 2% formaldehyde solution D. Soak for 20 minutes in 8% formaldehyde solution Analysis

A woman is interested in using Norplant implants. During an examination it is discovered that she is diabetic. Which of the following is the most appropriate response to this woman?

A. She will not be able to use Norplant implants

B. She will need to visit the clinic on a regular basis to be sure her diabetes is controlled C. She will need to monitor herself carefully because of the additional risk of thromboses D. This situation requires no special precautions

Synthesis

Mrs. “K” comes in 2 months after having her IUD inserted and is complaining of heavier than normal menstrual bleeding and cramping. Your management of Mrs. “K” will be to:

A. give her a cycle of COCs to control her bleeding and cramping B. remove the IUD and offer her a new method

C. put her on antibiotics because she probably has pelvic inflammatory disease D. reassure her that this is normal and will usually go away after the first 3 or 4 cycles Evaluation

An advanced trainer is observing a clinical trainer conduct a training course. The clinical trainer has just given a classroom presentation and is sitting down with the advanced trainer to discuss the session. Which of the following is the appropriate step for the advanced trainer to use to begin the meeting?

A. Ask the clinical trainer to identify those presentation skills that could be improved B. Ask the clinical trainer what s/he felt were the positive aspects of the presentation C. Provide positive feedback by identifying the positive aspects of the presentation D. Describe those presentation skills that could be improved