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Because students can typically answer a multiple choice item much more quickly than an essay question, tests based on multiple choice items can typically focus on a relatively broad representation of course material, thus increasing the validity of the assessment.
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The alternatives consist of one correct or best alternative, which is the answer, and incorrect or inferior alternatives, known as distractors. A stem that does not present a clear problem, however, may test students’ ability to draw inferences from vague descriptions rather serving as a more direct test of students’ achievement of the learning outcome. Students often have difficulty understanding items with negative phrasing (Rodriguez 1997).
If a significant learning outcome requires negative phrasing, such as identification of dangerous laboratory or clinical practices, the negative element should be emphasized with italics or capitalization. A question stem is preferable because it allows the student to focus on answering the question rather than holding the partial sentence in working memory and sequentially completing it with each alternative (Statman 1988).