Test questions are used to assess participants’ familiarity with course content and to check for misconceptions. They can be written to assess a wide range of learning objectives in all content areas. Test questions are either objective or subjective.

• Objective questions have one correct answer. Participants either select the answer from a list of options or complete a sentence by providing a missing word or phrase. Objective tests are appropriate when large groups need to be tested. They are also useful if the test will be reused. Objective tests are used when impartiality and fairness are a high priority and there can be no scoring bias. Well-designed and tested objective questions also can produce highly reliable scores that support statistical analysis.
• On the other hand, subjective questions require participants to provide an original answer. For some subjective questions, responses can be as short as a single word or as long as multiple paragraphs. Subjective test questions are good when testing a small group and the test won’t be reused. They are also good if you want to support written communication and/or analysis, synthesis, and evaluation skills. Because participants’ responses are not always uniform, grader bias is a real concern. Essay questions may require a rubric or assessment checklist to standardize grading. For more information on creating assessment tools to measure mastery of learning outcomes, refer to Rubrics and Assessment Checklists.

Within the objective and subjective categories, there are several different types of test questions, each of which have advantages and disadvantages. Regardless of their type, test questions can be written to test comprehension and application of knowledge, as well as critical thinking and problem-solving abilities. Choosing a type or type(s) of questions to use will be based on the course’s learning outcomes, time available for testing and scoring, and the testing requirements or restrictions. Table 8 describes different types of objective test question. For more information on linking assessments and learning outcomes, refer to Using the Outcome Verb to Make Instructional Decisions.

Table 8: Objective Test Questions

Question Type	Description
Multiple choice	Most often multiple choice questions have a question stem and multiple answer choices. Typically there is one correct answer and the others are distractors. One of the drawbacks to this type of question is that writing several plausible distractors for each multiple-choice test item is time consuming. Multiple-choice questions are popular because participants can answer them quickly. Machine-readable response sheets and templates can make grading a fast and accurate process.
True/False	True/false questions feature a statement and two possible answers: True or False. Like multiple-choice questions, True/False questions are useful for assessing familiarity with content and checking for common misconceptions. They are also easy to grade. However, since participants have a 50% chance of choosing the correct answer, guessing may create a misleading picture of participant learning. To follow International Accreditation for Continuing Education and Training’s (IACET) guidelines, assessments should have no more than 10 percent true/false questions.
Matching	Matching questions feature sets of stems and a list of options (e.g., match key terms to their correct definitions). Matching questions are good when participants are expected to recognize and recall detailed information. They are easy to create but often take participants more time to complete than multiple-choice or True/False questions.

Here are some best practices to follow when writing objective test questions and response options:

• It is best to avoid:
• Long or complex sentences
• Trivial statements (focus on the essence of the learning outcome)
• Negative and double negatives (e.g., no, not, etc.)
• Restrictions (e.g., except, all except, etc.)
• Clues to which items are the wrong answer
• Distractors too close to the correct answer
• Distractors that are shorter than the others
• Completely implausible distractors
• “All of the above” and “none of the above”
• Dependent responses (e.g., “If ‘B’ is true, then ‘A’ is true.”)
• It is best to use:
• One clearly described problem (when appropriate)
• At least three response options
• Plausible distractors
• Statements that address common participant misconceptions
• Options that are true but do not answer the question
• Options that are all about the same length
• Logically or numerically ordered options
• Random distribution of correction options (e.g., evenly distributed across A, B, C, etc.)

Table 9 describes types of subjective test question.

Table 9: Subjective Test Questions

Question Type	Description
Short answer	Short-answer questions provide a brief prompt that requires participants to write a word, short phrase, or a few sentences to answer. Depending on the desired answer, this type of question can also be written as a multiple-choice question. One advantage of short-answer questions is that they can be written to test higher-order thinking skills. Another advantage is that they are easy to develop and take less time than multiple-choice questions. Also, it is much more difficult for participants to guess when responding to short-answer questions.
Extended response essay	Extended response essay questions provide a complex prompt that requires written responses that can be as short as a couple of paragraphs to many pages in length. Extended response essays are not commonly used in NHI courses.

Here are some best practices to follow when writing subjective test questions:

• It is best to avoid:
• Trivia
• Long, complex sentences
• Complex or ambiguous wording
• Questions that are too broad to address in the time allotted
• It is best to use:
• Specific problems
• Direct questions
• Instructions like “compare and contrast” at the beginning of an essay prompt
• A rubric to grade essay responses