Medical entrance exams are usually through competitive MCQ based entrance exam. There are inherent defects in the system that needs to be cleared before a fool proof way is evolved, particularly for large, diverse student communities in limited resource settings.

1. The Weak Link
In MCQs Based Medical Examinations

2. Current System Lacks

3. Current System Lacks
• A Standard Operating Procedure [SOP] for the
preparation, validation of MCQs
• Heard of any SOP been developed and
followed, consistently all over the
geographical boundary by all stake holders
involved?

4. Current System Lacks
• Validation of MCQs in the database by an
internal/ external panel of examiners
• Minimum qualification and experience of staff
who has been preparing question
paper/database

5. Current System Lacks
• Examiners and conflict of interest
• Training for Question paper setter to prepare
MCQs specifically for this purpose?
• Has any training program/modules been
conducted? If so the frequency of the same?

6. Current System Lacks
• How are the questions setters selected?
• Minimum requirements to be an MCQ setter
• Split of questions given for Knowledge,
competence, comprehension, application,
performance and action in each of the subject
tested

7. Current System Lacks
• Defining exact percentage of question related
to Problem Based learning decided for exams?
• MCQ distracters fixed arbitrarily without a
scientific rationale employed for the same?
• Content under representation (Under
sampling of the content) countered in these
examinations

8. Current System Lacks
• Steps to minimize construct irrelevance variance
(variables that systematically interfere with the
ability to meaningfully interpret scores ratings)
• Checking for issues related to test-wiseness such
as Grammatical & Logical cues, Word repeats,
Absolute terms, Implausible distracters,
convergence be checked and negated

9. Current System Lacks
• Minimum or no irrelevant difficulty agents such
as Vague terms, poor sequence in numeric
data, unnecessary information, unclear or
ambiguous information, >1 or no correct
answer etc., are kept to minimum?
• Has the setters provided with item/distracters
writing guidelines ?

10. Current System Lacks
• Question paper checked for concerns (Content,
formatting, style) checked after framed
• Announcement of standard textbooks
prescribed in each subject?
• Has curricular validity been checked at least
randomly?

11. Current System Lacks
• Item analysis been performed to measure the
difficulty index, discrimination index and
distracter effectiveness for each MCQ or at
least randomly to ensure inter/intra examiner
variability and consistency
• Steps to make MCQ as a measure of higher
cognitive skills

12. All it needs is a
• Standard Operating Procedure written and
followed – in spirit and word
• Will to change
• All stakeholders to be a part of the system and
not above/below it

13. Executive Organizational OutcomeConceptual
Phase 1
• Inherent errors
in the current
system of
MCQ
Phase 2 Phase 3 Phase 4
• Errors arising
during the
executing the
process
• Errors
introduced by
the examining
authority
• Failure of the
system
All These Errors Come Under
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