Writing multiple-choice test items has been typically characterized as more of an art than a science. Textbooks commonly offer advice on how to write items, but most inexperienced item writers, despite having expertise in a content area, have difficulty phrasing the stem. A technique is described that has been successfully used in several testing programs in the health professions. This technique, item shell, provides a basis for getting item writers started in the difficult process of w, iting the effective multiple-choice item.
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