The printable version of our MCQ checker: ten structural checks with what to look for, how to fix it, and the guideline each one comes from (NBME, Haladyna, Tarrant).
This is the full content of the file — what you see here is exactly what you download.
| MCQ item-writing checklist | ||||||
| Run every question down this list before it enters the bank; tick OK? per check. The interactive version runs these checks automatically: https://studydrome.com/tools/mcq-checker/ | ||||||
| Source: Haladyna, Downing & Rodriguez 2002, Applied Measurement in Education | ||||||
| Source: NBME Item-Writing Guide | ||||||
| Source: Tarrant et al. 2006, Nurse Education Today (item-flaw frequency study) | ||||||
| # | Check | What to look for | How to fix it | Severity | Source | OK? |
| R1 | Absolute terms | An option contains a specific determiner — always, never, all, none, only, must. | Reword without the determiner, or make the option defensibly absolute. | Warning | Haladyna, Downing & Rodriguez 2002, Applied Measurement in Education | |
| R2 | Vague frequency terms | The stem or an option hedges with often, sometimes, usually, rarely, frequently, commonly or “may occur”. | Replace with a specific frequency, proportion or condition. | Warning | NBME Item-Writing Guide | |
| R3 | Negative stem | The stem asks for the wrong answer — not, except, false, least. A second, minor flag fires when the negative word isn't capitalized. | Rephrase positively, or capitalize the negative (NOT) if it must stay. | Warning | Tarrant et al. 2006, Nurse Education Today (item-flaw frequency study) | |
| R4 | All / none of the above | An option is literally “All of the above” or “None of the above”. | Replace with a substantive option. | Warning | NBME Item-Writing Guide | |
| R5 | Longest option is the key | The marked correct answer is more than 1.5× the median option length. Requires the key to be marked. | Trim the key or lengthen the distractors until they're parallel. | Critical | NBME Item-Writing Guide | |
| R6 | Option length imbalance | Any option (key or not) is more than 1.5× the median length — flagged even when no key is marked. | Balance option lengths so none stands out. | Info | Haladyna, Downing & Rodriguez 2002, Applied Measurement in Education | |
| R7 | Grammatical cue (heuristic) | The stem's grammar rules out some options before any knowledge is applied — e.g. a stem ending in “an” when only some options start with a vowel, or a plural verb with singular options. | End the stem so every option fits grammatically (e.g. “…a deficiency of which vitamin?”). | Warning | NBME Item-Writing Guide | |
| R8 | Clang association | Exactly one option repeats a distinctive word (6+ letters) from the stem that no other option contains. | Remove the repeated word from the option, or repeat it across several options. | Warning | NBME Item-Writing Guide | |
| R9 | Non-homogeneous options | Options mix numeric and verbal answers, numeric options aren't sorted, or numeric ranges overlap. | Keep options the same kind, sort numerics, make ranges mutually exclusive. | Info | Haladyna, Downing & Rodriguez 2002, Applied Measurement in Education | |
| R10 | Option-count sanity | Fewer than 3 options (Info), or two options with identical text (Warning). | Add at least one plausible distractor; replace duplicates. | Info | Haladyna, Downing & Rodriguez 2002, Applied Measurement in Education |
The preview above is the whole template — the download is the same content as a ready-to-edit XLSX file. We ask for a work email, nothing else.
Browsing and previews are free with no signup. A download stores your email and which template you took — never anything else (see the privacy policy).
This template has an interactive sibling — MCQ Item-Flaw Checker runs the same content as a live tool, free in your browser.
Open MCQ Item-Flaw Checker →This template is derived from:
This checklist catches structural flaws before the exam. StudyDrome catches the rest after it — item analysis shows which questions actually failed with real candidates.
See StudyDrome's item analytics