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Limmer Education is hosting an item writing panel in Las Vegas during EMS World Expo. We are working with educators from around the country to deliver the highest quality exam preparation available.

Our item writing expert, Todd Vreeland who is the former Exam Coordinator for the NREMT, requested a few items from each contributor up front. This allowed him to start to provide some item writing feedback to assure our meeting in Las Vegas would be fruitful.

We thought we would share that feedback with you to point out some important exam writing tips. Here is a submitted question before feedback:

Your 10 year old male patient has a portion of a biscuit that is obstructing the airway.  He has no respirations but a pulse of 75.  All other foreign body airway obstruction maneuvers have failed.  Your next action should be to.

A.    proceed with direct laryngoscopy

B.    perform a surgical airway maneuver

C.   immediately begin chest compressions

D.   continue with abdominal thrusts

Many would consider this a solid paramedic level question and it may have a place on an exam in your classroom. But how would you make this question more like the NREMT?

Keep it tight

The question below is modified into a NREMT format. You will note some of the changes are expected for the NREMT format (e.g. trimming out unnecessary material and keeping the stem tight). In this question the patient’s pulse, respiratory status and the fact that clearing the obstruction thus far were unsuccessful really weren’t required for the student to come to the proper conclusion. A tight stem provides just the right amount of information without the fluff—and it is easier to read.

There is a common misconception that NREMT questions are complicated and/or use difficult terminology. In this example, the stem and distractors were made simpler—without affecting the intent of the question.

A 10 year old male has a portion of a biscuit obstructing his airway. While you are performing subdiaphragmatic abdominal thrusts, he becomes unresponsive. You should next

A.    proceed with direct laryngoscopy.

B.    perform a surgical airway maneuver.

C.   begin chest compressions.

D.   perform 5 back slaps.

Styling is key

The question is framed in the “You should” or “You should next” format which is commonly seen on the NREMT. Note the styling elements as well. When the stem ends in the incomplete sentence format such as “You should next…”, the distractors begin in lower case and end with a period since the distractors complete a sentence. Even small things can make your exams much more like the NREMT.

Strong distractors

Notice that the last distractor was changed from continuing abdominal thrusts because continuing abdominal thrusts was a weaker distractor. Back slaps were suggested because it may be more desirable to students who don’t know the FBAO sequence well and may be drawn to that choice once the patient becomes unresponsive. Do you think about the strength of your distractors when you create an exam item? One of the best things you can do to improve your exams—and make them more challenging—is to improve the quality of your distractors. In the “best answer” format, all distractors will have some relevance. Learn more about writing strong distractors.

Additional review & feedback

This question isn’t done. It will be presented to our item writing panel in Las Vegas for final review and comments before being introduced into a Limmer Education product for further evaluation. We’re thrilled about the item writing process we are using and believe it will raise the bar for quality in our products even higher.

Are you interested in being part of a future item writing panel for us?  Send us your information via the Contact Form .

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