Item Quality Improvement: What Determines a Good Question? Guidelines for Interpreting Item Analysis Reports

Medical schools strive to administer high-quality exams. These exams are often authored and graded by basic science and clinical faculty with content expertise; however, these faculty may lack expertise in question writing as well as familiarity with the psychometrics involved in item analysis. This short communication overviews the background related to multiple choice questions, proposes how to interpret an item analysis report, and makes recommendations for evidence-based grading decisions. The guidelines described here have helped ensure that faculty at one Midwestern medical school appropriately address psychometrically flawed items and make defensible grading decisions.