NBE CME programme for DNB consultants - National Board Of ...

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NBE CME programme for DNB consultantsSample question-21. Name of the specialty-General Surgery2. Paper-I/II/III/IV3. Short question- Discuss physiological changes that occur following massive bowelresection (Short Bowel Syndrome)4. Key contents of the short structured question which must be written by the candidates in15-20 minutesThere are three clinical phases following massive small bowel resection:Acute phase -Lasts 4 weeks- Profuse watery diarrheas – 5-10 liters per day;Fluid and electrolytedepletion due to loss of absorptive surface and rapid transit; Gastric hyper secretion due tohypergastreinemia; Acute peptic ulceration-3 marksAdaptive Phase-Complex and takes up to 2 yrs ;Changes more effective in ileum-less in jejunum;Attempt to increase absorptive surface. There is increase in bowel circumference and slight increasein length; Epithelial hyper-plasia leading to increase in number of absorptive cells; Gastric hypersecretion – acid in jejunum precipitates bile salts-inactivates lipase-pancreatic fibrosissteatorrhoes-3marksChronic Phase-Unstable state – adaptive changes are upset by intercurent illness and bowelupsets; Problem maintaining nutrition (Calories, nitrogen and fluid and electrolytes, vitamins,minerals etc.); Ensure good enteral nutrition- May require intermittent parenteral nutrition; Specificproblems-Gall Stone due to chronic bile salt depletion and Urinary Calculi (oxalate) -4 marks5. Reference text book- Oxford Test Book of Surgery Vol. I 1994 ed.6. Page number- 9947. Difficulty Grade (Please encircle the difficulty grade): High/ Moderate/ Low8. Knowledge Zone of question (Please encircle the zone of question): Must know area orVital / Important to know/Good to know170
NBE CME programme for DNB consultantsGeneral Principles for Construction of MCQ’sAn objective test is one in which all the questions are so devised that they can be marked withoutany subjective judgment on the part of the examiner; students select the correct answer given froma list. The correct answer is predetermined ; so that all markers give the same mark and eachstudent receives exactly the same score no matter who marks the script.The main criteria of a good item (questions) are-‣ Validity-i.e. it measures a appropriate knowledge and abilities‣ Reliability- i.e. it applies a consistent standard of measurement to all students in all year‣ Objectivity- i.e. there is concordance between the judgment of independent examiners.Some important points to be borne in mind, while constructing a question are -‣ Break down the topic in number of key issues, which may be arranged in order of theirimportance and try and cover one key issue at a time.‣ Importance- The topic should be important enough for the area of knowledge beingevaluated.‣ Agreed Knowledge- there should be a complete, unanimous agreement on the correctresponses. Questionable interpretations therefore must be excluded.‣ Difficulty level – the questions should be neither too difficult be to comprehended by thegroup of students being examined nor easy as to be answered by each candidate.‣ Central theme and language- The central problem should be clearly stated. In other wordsthe base the stem should be framed in clear, simple, unambiguous language.‣ Internal consistency- The multiple responses should not include two opposites, one ofwhich is obviously wrong, for example among the following two alternatives, obviously oneis correct:-None of the above; All of the above‣ If there is doubt on correctness of scientific aspects check with a standard reference text.It is better not to initiate writing by copying a statement as given in the text and then fillingremaining components by negative statements, etc.‣ A medical dictionary is useful asset in checking correct meaning, definition or spelling.‣ When submitting questions, indicate the key also.Multiple choice questions (Single Response)-This type of question has base or a stem. This maybe in the form of a complete or incomplete statement, question or clinical history, and for eachquestion there is one and only one predetermined correct answer and this is the ‘Key’ option. Thethree other option are distractors and they should be plausible.Some points to remember‣ Make certain that the stem consists of a statement or an idea, not just a single word.‣ Place all common elements in the stem of the item. This adds simplicity and compactnessto the item.‣ Avoid negative statements but if the word “NOT” does appear in the stem of the question,underline it to draw the student’s attending to it.‣ Use plausible distractors, each distractor should, by its content or nature, be such that itappears to have something to do with the statement (question). Unrelated distractrosappear silly to a thoughtful examinee. As the number of possible answers is cut down, theitem loses some of its value.‣ Be sure that the distractors and the correct response possess homogeneity, that is, theyshould be fairly similar in content or in the total number of words.‣ Be careful in the sue of “none of the above” as a distractor. Don not use it as dummy optionalways, but keep it as correct response sometimes.‣ When dealing with items that have numerical answers, arrange the answers in order fromlarge to small or vice-versa.171
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