This is the time of year that many new graduates in the health professions prepare for national certifying examinations.
I write from several perspectives: a professor with many years’ experience in medical education, an experienced test item writer who served on a national certifying board, and as the author of two medical review books.
A certifying examination is a “two-way street.”
The test item writers must be careful in constructing the stem of questions. As an example, the skilled writer tries to do the following:
a. keep the stem brief
b. include information that leads the test-taker to a diagnosis
c. include information that leads the test-taker away from a diagnosis
On the other side, the test-taker must read the stem carefully. Probably, the most common error made by the test-taker is that he or she hurriedly reads the stem, without careful attention to all details.
Let me give an example.
Question: A 57-year-old man has a three-day history of fever and cough productive of yellow sputum. For one day he has nausea and diarrhea. Blood pressure 110/70 mm Hg, respirations 22/min, oral temperature 101 F. Examination shows crackles at the left lung base. Chest radiography shows an infiltrate in the left lower lobe. Which of the following is the most likely diagnosis?
A. Pneumococcal pneumonia
B. Mycoplasma pneumonia
C. Respiratory syncytial pneumonia
D. Legionnaire’s disease
E. Klebsiella pneumonia
This is what the test-taker sees: A 57-year-old man has a three-day history of fever and cough productive of yellow sputum.
For one day he has nausea and diarrhea. Blood pressure 110/70 mm Hg, respirations 22/min, oral temperature 101 F. Examination shows crackles at the left lung base. Chest radiography shows an infiltrate in the left lower lobe. Which of the following is the most likely diagnosis?
The problem: The test-taker, in hurried fashion, ignores the nausea and diarrhea. This is the key to the question, for gastrointestinal symptoms appear to occur only in Legionnaire’s disease, not other pneumonias. Ignoring this information will lead to an incorrect answer.
The moral: Carefully read every word in the stem of the question.
Follow along here at Davis Connect for more sample questions and test-taking tips from our author, Morton A. Diamond, FACP, FAHA, FACC(E).
Our guest blogger today, Dr. Morton A. Diamond (AKA, The Professor), is Professor and Medical Director of the physician assistant program at Nova Southeastern University in Fort Lauderdale, Florida. He is the author of the F.A. Davis title, Davis’s PA Exam Review: Focused Review for the PANCE and PANRE, and also of Medical Insights: From Classroom To Patient, a Jones & Bartlett publication. He has written tens of thousands of test items over his career and was a leading item writer for the National Commission on Certification of Physician Assistants. He also has forgotten more words than you and I have ever known and enjoys stumping his publisher with them as often as possible.