How to write high-quality questions for a high-stakes examination.

Both the MRCP(UK) written examinations and the specialty certificate examinations (SCEs) use single-best-answer questions to assess the knowledge and problem-solving skills of physicians in training. Since 1999, specialists and senior trainees have created large banks of questions for these examinations that cover the relevant curricula. Question-writing workshops provide detailed guidance on the design of questions that discriminate between candidates of differing ability, in a format and a style that aid speed reading and comprehension. Each question drafted is subjected to face-to-face peer review and subsequent stages of academic scrutiny before reaching the question bank, and later during the exacting processes of question selection and standard setting. Feedback to question writers at every level of scrutiny helps to support the development of question-writing competence, and the analysis of individual question performance provides some insight into optimal question design.