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  HOW THE PT EXAM IS WRITTEN...  By: Editors of PTSponsor.com Date Posted: 12 Jul 2010
  Each question on the exam has 3 parts.
1. The stem: background information
2. The lead-in: question being asked
3. The options

Every item is made up of three parts. First, there is the stem, which provides background information, such as a clinical vignette. Next, there is the lead-in, or the actual question being asked. And finally, there are the options or answer choices. Three to five options are acceptable, but four are preferred. The correct response is referred to as the key and incorrect answers are referred to as distractors.  Note the example shown here; this is called an A-type item. Later, we’ll introduce you to another category you’ll use, called a G-type item.  You are probably familiar with other question types, such as true/false, multiple-multiple choice— or select all that apply — and matching. However, to maintain consistency of specialist certification items contained in the test bank, we’ll restrict our discussion to A- and G-type questions. If you’d like more information about why these other item types are not used, refer to the ABPTS or NMBE item writing guide, both of which can be found in the Resources area.  Next, we’ll take a closer look at the three item elements: the stem, lead-in, and options.                            
In addition to providing background information, the stem provides information relevant to the material being assessed and to the question being asked. Typically, it takes the form of a clinical vignette, which is important to test application of knowledge and not simply rote memory.  The stem can contain any tests and measures that would be useful in answering the question, such as charts, range of motion information, or photos. When possible, provide opportunities for practitioners to analyze related evidence to test their ability to synthesize data to arrive at the correct answer.  The stem and lead-in should be in the form of a complete sentence, never a fill in the blank. Fill-in-the-blank type questions are more likely to test simple recall. Also, the language used must be positive, meaning we do not ask what is least likely to happen or whether a patient may exhibit all symptoms except one, and so on. We ask what is likely to happen or what symptoms will be exhibited. We’ll talk more about the use of positive language shortly.           
The question is presented in this order.
1. Age and gender
2. Site of care
3. Presenting complaint
4. Duration of symptoms
5. Detailed family and medical history (with tables/photos)

Written vignette will allow you to keep all answer options short and succinct. For instance, examiner might write, “A 53-year-old female visits a physical therapist, complaining of shoulder pain” instead of “A 53-year-old female visits your office, complaining of shoulder pain.”  Use the active voice. For example, you should write, “A physical therapist examined a 35-year-old male,” instead of presenting the information in the passive voice, such as: “A 35-year-old male was examined by a physical therapist.”  Also, avoid using abbreviations in stems. It is difficult — if not impossible — to be sure that they would be recognized nationally by test takers.        

A 63-year-old male with Parkinson’s disease was recently transferred from a hospital to a skilled nursing facility. During the first consultation, the physical therapist notes that the patient’s usual medications were discontinued during hospitalization and he is having profound difficulty with his movement and mobility. What should the therapist do first?

Options are the answer choices provided. We’ll discuss the characteristics of good options shortly, but for now just keep in mind that the correct answer is referred to as the key and the incorrect answers are referred to as distractors.  And there can be only one correct answer.  Note that although three to five options are acceptable, the National Board of Medical Examiners recommends a total of four options, unless it makes logical sense to have fewer. For example, options for increased, decreased, or no change.   The majority of the current item bank items employ one key and three distractors; new items must be consistent with this presentation.  See the References section for citations to articles that discuss testing options further.       

Now let’s take a look at the some of the general characteristics of an item. Many of these are common sense while others may be less obvious:  The item must reflect information that is important for the specialist to know. Don’t spend your time writing questions against minutiae. The item content must be realistic and relevant. In other words, it should address a situation typically encountered by the specialist. Item content should be noncontroversial. For example, don’t link a question to current, major legal actions. Issues addressed by the item should be universal rather than regional. You would not expect a national certification exam to include protocols particular to one area of the country. The basis for items should not be too new. In other words, it would not be realistic to expect test takers to know about a paper published the day you wrote the item. Conversely, items cannot be based on obsolete information. When possible, incorporate data that is no more than five or six years old. And most importantly, items must be evidence-based and supported by references. Every item you include requires two references so that, if a correct answer is disputed, it can be supported with relevant evidence. Items can never be based on information you think that “everyone simply knows.”                                                                                                                                                                                                                                                                                                                                                                                    Ref: APTA website