practical discussion to avoid common pitfalls when constructing multiple choice questions items

This paper is an attempt to produce a guide for improving the quality of Multiple Choice Questions [MCQs] used in undergraduate and postgraduate assessment. Multiple Choice Questions type is the most frequently used type of assessment worldwide. Well constructed, context rich MCQs have a high reliability per hour of testing. Avoidance of technical items flaws is essential to improve the validity evidence of MCQs. Technical item flaws are essentially of two types [i] related to testwiseness, [ii] related to irrelevant difficulty. A list of such flaws is presented together with discussion of each flaw and examples to facilitate learning of this paper and to make it learner friendly. This paper was designed to be interactive with self-assessment exercises followed by the key answer with explanations

Patients' awareness of their medical conditions in multi-specialty outpatient clinics in Saudi Arabia

To assess the patients awareness of their medical conditions, identify the factors affecting their awareness, and assess patient's satisfaction with their doctors explanations of medical conditions. A cross-sectional study was conducted in October 2005 in the outpatient clinics of King Khalid University Hospital in Riyadh, Kingdom of Saudi Arabia. A self-administered questionnaire was used for data collection. The statistical package for Social Science was used for analysis. Five hundred and one patients were included in the study. The mean age was 45.6 +/- 16.8. Fifty-five percent were female and 29% were highly educated. Most of the patients [64.1%] knew their diagnoses. This was significantly associated with the educational level; chronicity of the disease, and the awareness of other issues related to their illness such as complications and name of their medications [p < 0.05]. Few patients [20%] knew complications of their diseases. Seventy percent of patients were satisfied with their doctors' explanation of their disease. Knowing the diagnosis [p=0.001] and the disease complications [p=0.014] were associated significantly with patients' satisfaction. These figures are less than what they should be. Physicians must be advised of the importance of proper patient education. In addition, the lack of proper education by physicians demonstrated in this study should be compensated for by an increase in non-physician based education tools

Prevalence and pattern of alternative medicine use: the results of a household survey

Alternative medicine [AM] encompasses all forms of therapies that fall outside the mainstream of medical practice. Its popularity is on the increase. Because previous surveys were limited and not generalizable, we estimated the prevalence, pattern and factors associated with use of AM in the community. A multistage cluster cross-sectional household survey was conducted among Saudi residents of the Riyadh region. Data were collected in 2003 by trained interviewers from primary health care centers using a specially designed questionnaire. Of 1408 individuals participating in the study, 39% were men. The mean [ +/- SD] age for the study population was 35.5 [ +/- 13.9] years. Sixty-eight percent of the respondents had used AM during the last 12 months. The Holy Quran as a therapy was the most frequently used AM [50.3%], followed by honey [40.1%], black seed [39.2%] and myrrh [35.4%]. The health belief model was found to be the most important determinant of AM use. Factors independently associated with AM use included perceived failure of medical treatment, the perceived success of AM, a preference for natural materials, and long appointment intervals to see physicians. There is a high prevalence of AM use in the Riyadh region and the most important determinant of AM use was the perceived failure of medical treatment. The study results call for intensive health education campaigns in the media addressing wrong beliefs regarding AM and modern medicine. The popularity of AM in this community should alert decision makers to look at the difficult accessibility to the health system

Management of hypertensive patients in primary health care setting, auditing the practice

To audit the medical care provided to hypertensive patients in a health care center in Riyadh, Kingdom of Saudi Arabia [KSA] and determine the efficient control of hypertension. We carried out this cross-sectional study on all patients who visited the Health Care Specialty Center of King Abdul-Aziz Medical City, Riyadh, KSA for hypertension follow-up during the study period from October to December 2004. A representative sample of patients was allocated randomly using simple randomization method. All patient's records were reviewed for proper recording in a designed form. Out of the 242 records we reviewed, 201 were included in the study. The patients' mean age was 58.3 +/- 12.5 years. All were Saudis and 78.6% were females. Most of them [84.3%] received their management at primary care level only. Age, gender, presence of diabetes, level of medical care, blood glucose, lipid levels and drugs used for management of hypertension were sufficiently recorded. Smoking history, body mass index and family history of ischemic heart disease were poorly recorded. Quarter of the hypertensive patients was sufficiently controlled. The factors associated with poor blood pressure [BP] control were advanced age [p=0.008] and presence of diabetes, [odds ratio [95% CI]=2.98 [1.47-6.08]]. The study reflects the deficiencies in BP control and physicians practice. Introducing a checklist or electronic medical records may help the improvement of care. Frequent auditing is recommended to ensure the required development

Guidelines for the construction of multiple choice questions tests

Multiple Choice Questions [MCQs] are generally recognized as the most widely applicable and useful type of objective test items. They could be used to measure the most important educational outcomes - knowledge, understanding, judgment and problem solving. The objective of this paper is to give guidelines for the construction of MCQs tests. This includes the construction of both [single best option] type, and [extended matching item] type. Some templates for use in the [single best option] type of questions are recommended

Characteristics of immunization providers in Riyadh and their self-perception of competency

To study the demographic characteristics of immunization providers in Riyadh City and their self-perception of competency. A cross-sectional study was conducted among immunization providers in Riyadh City from August 2003 to March 2004. This study covered 71 institutions: [25 primary health care centers, 30 private clinics and dispensaries, 8 government hospitals and 8 private hospitals]. Immunization providers were selected by stratified random process. One hundred and one physicians participated in the study and the data were obtained by self-administered questionnaires, tabulated and analyzed using appropriate statistics. The participating physicians were mostly pediatricians [50.5%] and general practitioners [38.6%]. About 47% of them had had no training in immunization during the preceding 10 years. Self-evaluation revealed that 30.7% of them ranked themselves as excellent, 67.3% as average and 2.0% as poor immunization providers. Self-confidence was associated with specialty, qualification, place of work, years of experience and training on immunization [p<0.05]. Most of participating doctors [83.7%] used books as their references. The doctors were least confident in vaccinating pregnant and lactating women and the vaccination of travelers to endemic areas. To improve immunization services, doctors should be trained before being involved in this practice. There should be frequent distribution of national and international protocols with the auditing of the practice to improve and sustain a highly effective service

criteria and analysis of good multiple choice questions in a health professional setting

Assessment of health workers as students and professionals has a profound impact on their learning and is an essential safety valve before certification. It is used for their training, their placement, their certification, and their promotion. The multiple choice question MCQ type of tests represents one of the most important examination tools that is commonly used in this assessment. The MCQs can be reliable, valid, and cost-effective in assessing medical knowledge. This paper portrays the different purposes of assessment in the medical field. The paper discusses in detail the criteria of a good assessment tool. Interpretation of MCQ test results is the final section of the paper

Obesity among Saudi male asolescents in Riyadh, Saudi Arabia

The purpose of the study was to determine the prevalence of overweight and obesity and its correlates among Saudi male adolescents in Riyadh. As well as evaluating their knowledge, attitude and practice towards obesity. A cross-sectional study conducted in intermediate and secondary schools in Riyadh, Saudi Arabia was carried out during a 5-month period, September 2001 - January 2002. A sample of 894 Saudi male adolescents [age 12-20 years] was selected through the multi-stage sampling technique. Socio-demographic characteristics; dietary and activity history; obesity-related knowledge and behavior; and family and past medical history data were obtained by a self-administered questionnaire. Anthropometric measurements of weight and height were performed. Body mass index [BMI] was calculated, and adolescents with a BMI age-specific percentile of >/= 85th - <95th were considered overweight and >/= 95th were considered obese. The prevalence of overweight was 13.8% and obesity was 20.5%. Family history [odds ratio, 2.49; 95% confidence interval, 1.72-3.61] and lack of physical activity [odds ratio, 1.63; 95% confidence interval, 1.01-2.62] were associated with adolescent obesity. Twenty% of overweight participants did not think they were overweight. Obesity constitutes an important public health problem among male adolescents in Riyadh. A national prevention program with involvement of schools is recommended to avoid obesity-related morbidity in adulthood