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Guidelines for Developing Self-Assessment Questions


  • Questions should test important concepts that are medically (clinically) relevant and should link to the learning objectives.
  • Questions must be in multiple choice format with a single best answer. 
  • Avoid questions that could have multiple interpretations.
  • An ideal question is one that can be answered without looking at the choices. Higher order questions that require interpretation, judgment, or problem-solving are better than simple recall of information.
  • If possible, it is highly suggested that you use a case-based scenario for one of your questions to help the learner to show a change in competency, not just knowledge. 

Question Stem

  • Questions should be stated as a positive (do not use "no", "not", etc.). Do not use “all of the following except”.
  • Do not use absolutes such as “all”, “none”, “always” and “never”.

Answer Options

  • Four answer options must be provided.
  • “All of the above” or “none of the above” are not acceptable choices.
  • No possible question answers should include other possible answers, e.g., “C: Both A & B” (No K Type Questions)
  • Answer choices should be in alphabetical or numerical order and approximately the same length.
  • Responses must be logical and homogenous (e.g., all IHC stains, all laboratory test results, all clinical associations).


  • A brief narrative/explanation of the correct answer must be provided. You may also include why other answers are incorrect. 
  • Focus on the specific content of the question.
  • Support the provided reference(s).
  • Limit your feedback to 1000 characters.

Sample Question

Question Stem: The patient you are seeing in consultation has metastatic non-small cell lung cancer with bone metastases but no brain metastases. When trying to decide whether/what palliative radiotherapy to offer, which of the following tools would not help you to determine short term life expectancy (the patient’s chance of living a given number of weeks or months)?

Answer Option A: Charlson Comorbidity Index
Answer Option B: Palliative Performance Scale
Answer Option C: Palliative Prognostic Index
Answer Option D: Glasgow Prognostic Score

Correct Answer: Answer Option A

Feedback: The Charlson Comorbidity Index is designed to predict 10-year survival based on comorbidities and is not well suited to guide discussions on palliative radiotherapy. All other tools listed are designed to evaluate the likelihood of survival over a period spanning weeks to a few months, which could be useful in helping to determine whether/what palliative radiotherapy is appropriate.


  1. Charlson et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 40:373-383 (1987)
  2. Simmons et al. Prognostic tools in patients with advanced cancer: a systematic review. J Pain and Symptom Management 53: 962-970 (2017)
  3. Anderson et al. Palliative performance scale (pps): a new tool. J Palliative Care 12:5-11 (1996). Stone et al. Prospective validation of the palliative prognostic index in patients with cancer. J Pain and Symptom Management 35:617-622 (2008)