What is a Single Best Answer (SBA) question?

Clinical scenario (stem), a single line stating the question itself (the lead in) and a list of 5 options (one correct answer and four distractors).

10 Steps to writing a good quality SBA Question

1. Identify a key domain/topic relevant to students’ curriculum to focus question on.

2.  Create a clinical scenario (called ‘the stem’) for your question based on this domain:

Describe the case in 30-100 words
Write in the present tense
Use simple language – short sentences, simple words, cut out unnecessary details
Do not use patient names
N.B. Even if your ‘lead-in’ is testing knowledge of basic sciences, a clinical stem should still be written as this gives the question a clinical context and increases face validity of the assessment

3. Write a ‘lead-in’ – a single line stating the question itself. 

Avoid negative phrasing and questions based on bad practice.

4. Create a list of 5 options:

One correct answer, four distractors
Should be homogenous in length and content (i.e. all diagnoses, investigations or treatments)
Relevant to stem and lead-in
Options ordered logically (alphabetically or numerically)

5. Perform the cover test!

Student should be able to arrive at correct answer without seeing the options
Therefore avoid statements like ‘which of the following statements is correct’.

6. Structure your question according to the ‘House Style.’

Ensures format of all questions in bank are homogenous

7. Avoid abbreviations when possible

8. Clearly state correct answer, justification and referenced relevant guidelines

9. Check you’ve not fallen into a common pitfall – see below list: WHAT TO AVOID

10.  Review, refine and edit question with experienced question writers
– why not come to our exciting Question Writing workshop on the 28th of November!

What to Avoid:

“Which of the following is true/correct”
“Which of the following is correct EXCEPT”
“Which of the following should not be done”
“Which of the following is not a feature of”
Avoid extremely long questions
– takes too much time to read!

For more information:

See video by Dr David Kluth: Click to watch

By Dr Elke Reunis

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