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Case Based (Factual) Unseen Passages: Practice English Grammar for School Classes

• Post last modified: 17 September 2022
• Post category: Grammar Exercises / School Grammar

What are Case Based (Factual Passages)? Simply put, factual passages are those passages, which let the readers imagine and feel the factual qualities of a topic as mentioned in the passage. The topic can be about a place, person, thing or event. A factual passage tells the reader about the consecutive things related to the topic in detail, occurring in an orderly manner.

Case Based (Factual) Passages

1. read the passage given below: [cbse set 2, 2021-22] .

• Milkha Singh, also known as The Flying Sikh, was an Indian track and field sprinter who was introduced to the sport while serving in the Indian Army. He is the only athlete to win gold in 400 metres at the Asian Games as well as the Commonwealth Games. He also won gold medals in the 1958 and 1962 Asian Games. He represented India in the 1956 Summer Olympics in Melbourne, the 1960 Summer Olympics in Rome and the 1964 Summer Olympics in Tokyo) He was awarded the Padma Shri, India’s fourth-highest civilian honour, in recognition of his sporting achievements 
• The race for which Singh is best remembered is his fourth-place finish in the 400 metres final at the 1960 Olympic Games. He led the race till the 200 m mark before easing off, allowing others to pass him. Singh’s fourth-place time of 45.73 seconds was the Indian national record for almost 40 years. 
• From beginnings that saw him orphaned and displaced during the partition of India, Singh became a sporting icon in the country. In 2008, journalist Rohit Baijnath described Singh as “the finest athlete India has ever produced”. 
• He was disappointed with his debut performance at the 1956 Melbourne Olympics. *1 returned to India, chastened by my poor performance in Melbourne. I had been so excited by the prospects of being part of the Indian Olympics team, but, hadn’t realized how strong and professional the competition would be. My success in India had filled me with a false sense of pride and it was only when I was on the track that I saw how inconsequential my talents were when pitted against superbly fit and seasoned athletes. It was then that I understood what competition actually meant, and that if I wanted to succeed on the international arena, I must be prepared to test my mettle against the best athletes in the world.” 
• Then he decided to make sprinting the sole focus of his life. “Running had thus become my God, my religion and my beloved”. My life during those two years was governed by strict rules and regulations and a self-imposed penance. Every morning I would rise at the crack of dawn, get into my sports kit and dash off to the track, where I would run two or three miles cross-country in the company of my coach.” 
• On how he pushed himself through the tough days of vigorous training. “I practiced so strenuously that often I was drained of all energy, and there were times when I would increase my speed to such an extent that after my rounds, I would vomit blood or drop-down down unconscious through sheer exercise. My doctors and coaches warned me, asked me to slow down to maintain my health and equilibrium but my determination was too strong to give up. My only focus was to become the best athlete in the world. But then images of    a    packed    stadium    filled    with    cheering    spectators, wildly applauding me as I crossed the finishing line, would flash across my mind and I would start again, encouraged by visions of victory.” 

Based on your reading answer any five questions from the six given below: 1×5=5  

(i) What is Milka Singh known as? What realization did Milkha Singh have when he was on the track during the Melbourne Olympics?  

(ii) List any two of Milkha Singh’s achievements.  

(iii)  What strict rules and regulations did Milkha Singh follow?  

(iv)  State two consequences of his hard and strenuous practice.  

(v)  What motivated Milkha Singh to become the best athlete in the world?  

(vi)  Explain the phrase ‘I would start again’ in the last sentence. 

1. Milkha Singh was known as ‘The Flying Sikh’. 

He realised how inconsequential his talents were when pitied against superbly fit seasoned athletes. He also realised that he needed to prepare well to test his mettle against the best athletes in the world. 

2. (i) The only athlete to win 400 meters at the Asian Games as well as Commonwealth Games. 

(ii) Won gold in 1958 and 1962 Asian Games. His national record stood unbroken for 40 years. 

(iii) He was awarded Padam Shiri for his sporting achievements. 

3. Every morning he would rise at the crack of the dawn, get into his sports kit and dash off to the track, where he would run two or three miles cross-country with his coach. 

4. ( i) He was drained of all energy. 

(ii) He would vomit blood or drop-down unconscious through sheer exercise. 

5. He was motivated by his vision of victory at a packed stadium with spectators cheering and applauding him as he crossed the finishing line. 

6. ‘I would start again’ means here that he was encouraged to shun any complacency and start again with the double energy and determination to become the best athlete. 

Q. Read the following excerpt from a Case Study. J.K. Rowling – A Journey. [CBSE SET 2, 2022] 

The story of Joanne Kathleen Rowling’s near magical rise to fame is almost as well known as the characters she creates. 

Rowling was constantly writing and telling stories to her younger sister Dianne. “The first story I ever wrote down was about a rabbit called Rabbit.” Rowling said in an interview. “He got the measles and was visited by his friends including a giant bee called Miss Bee. And ever since Rabbit and Miss Bee, I have always wanted to be a writer, though I rarely told anyone so. 

However, my parents, both of whom come from impoverished backgrounds and neither of whom had been to college, took the view that my overactive imagination was an amusing personal quirk that would never pay a mortgage or secure a pension. 

A writer from the age of six, with two unpublished novels in the * drawer, she was stuck on a train when Harry walked into her mind fully formed. She spent the next five years constructing the plots of seven books, one for every year of his secondary school life. 

Rowling says she started writing the first book, Harry’ Potter and the Sorcerer’s Stone, in Portugal, where she was teaching English. 

At first nobody wanted to publish Harry Potter.  She was told that plot was too complex. Refusing to compromise, she found a publisher. 

n 1997 Rowling received her first royalty cheque. By book three, she had sky rocketed to the top of the publishing world. A row of zeroes appeared on the author’s bank balance and her life was turned upside down. Day and night she had journalists knocking on the unanswered door of her flat. 

Rowling’s quality control has become legendary, as her obsession with accuracy. She’s thrilled with Stephen Fry’s taped version of the books and outraged that an Italian dust jacket showed Harry minus his glasses. “Don’t they understand that the glasses are the clue to his vulnerability.” 

Annual earnings of J.K. Rowling from 2010 to 2019 

On the basis of your understanding of the passage answer any five of the six questions given below. 1×5=5 

(i) Explain J.K. Rowling’s ‘near magical rise to fame’. 

(ii) What reason did the publishers give for rejecting Rowling’s book?  

(iii) What was the drawback of achieving fame? 

(iv) Why was Rowling outraged with the Italian dust jacket? 

(v)  Find a word in the last para that means the same as ‘insecure/helpless. 

(vi) According to the graph, how many years did it take Rowling to become very successful?

(i) Jk Rowling’s near magical rise to fame is well known as the character she creates I.e. her popular characters led her to magical fame. She was on top of the world of publishing house after the book three was published and her bank balance increased tremendously.  

(ii) She was told that her plot of Harry Potter was too complex. 

(iii) The draw back was that she was approached day and night by journalists knocking at the door of her flat. It was becoming a nuisance and she did not respond all of them. 

(iv) She was obsessed with quality and accuracy and therefore was outraged at an Italian just Jacket for showing Harry without glasses. 

(v) vulnerability 

(v) It took around 6 years for Rowlings to become very successful.

Q. Read the passage and answer the questions that follow:

India Covid-19 numbers explained

1. With novel Coronavirus spreading rapidly all over the country, there are only three states right now, Meghalaya, Sikkim and Andaman and Nicobar Islands, that have less than 1,000 people infected with the disease.

2. Lakshadweep, of course, still hasn’t reported even a single case till now, the only region in India entirely free of the epidemic.

3. Otherwise, even the relatively smaller states now have significantly large spread of the disease. Goa, for example, has seen more than 7,000 of its people infected by the virus till now. Tripura has over 5,500 cases, while Manipur has more than 3,000, and Nagaland a little less than 2,500. Puducherry has more than 4,000 cases, while even Daman and Diu has over 1,300 people infected.

4. And in each of these states, the numbers are rising at a fast pace, at a rate higher than the national level. The infections had initially reached these states in the first and second week of May, when the lockdown was relaxed for the first time to enable people stuck in different parts of the country to return to their native places.

5. After a period of very slow growth, the number of cases have begun to rise rapidly in the last one month. In Goa, for example, the total number of infected people has nearly doubled in the last 15 days. Same has happened in Puducherry, as well.

6. Tuesday was one of those rare occasions when the number of active cases in the country, those who are yet to recover from the disease, went down compared to the previous day. That is because the number of recoveries, combined with the number of deaths, exceeded the new cases that were detected on Tuesday.

7. With over 52,500 new cases detected in the country, the total number of infections crossed 19 lakh, out of `which 12.82 lakh people have recovered from the disease. The number of dead is now close to 40,000.

8. The number of recoveries on Tuesday was the highest-ever for a single day. More than 51,700 people were declared to have been recovered. Three days earlier, the number of recoveries had crossed 50,000 for the first time, but in the next two days the number had fallen to much lower levels.

Choose the correct option to answer the questions based on the above passage and graphics. Do any ten.

(a) How are these three states – Meghalaya, Sikkim and Andaman and Nicobar Islands – different from the rest of India? (i) they are the only states to have less than 1,000 people infected with novel coronavirus (ii) they are three of the five states to have less than 1,000 people infected with novel coronavirus (iii) they are the only states to have less than 2,000 people infected with novel coronavirus (iv) none of these

(b) __________ is the only region in India which is entirely free of the epidemic. (i) Andaman and Nicobar Islands (ii) Maharashtra (iii) Lakshadweep (iv) Tripura

(c) What is common among Goa, Tripura, Manipur, Nagaland, Puducherry and Daman and Diu? (i) the numbers are rising at a fast pace at rates lower than the national level (ii) the numbers are falling at a fast pace at rates equal than the national level (iii) the numbers are rising at a fast pace at rates higher than the national level (iv) none of these

(d) Based on your understanding of the passage, choose the option that lists the inherent qualities of climate in the present times. (i) 1 and 4 (ii) 2 and 6 (iii) 1 and 3 (iv) 3 and 5

(e) Which date in the graph shows the highest jump of detected cases in a day? (i) July 30 (ii) July 31 (iii) August 1 (iv) August 2

(f) Of the 19 lakh infected cases, how many have recovered? (i) 11.82 lakh (ii) 13.82 lakh (iii) 12.81 lakh (iv) 12.82 lakh

(g) More than 51,700 people were declared to have been recovered on _______. (i) Wednesday (ii) Sunday (iii) Tuesday (iv) Monday

(h) When had the number of recoveries crossed 50,000 for the first time? (i) two days earlier (ii) Tuesday (iii) three days earlier than Tuesday (iv) none of these

(i) Which word in the passage means the same as “quickly”? (i) rapidly (ii) significantly (iii) native (iv) rare

(j) Which word in the passage is opposite in meaning to “indigenous”? (i) rapidly (ii) significantly (iii) native (iv) rare

Answers: (a) (i) they are the only states to have less than 1,000 people infected with novel coronavirus (b) (iii) Lakshadweep (c) (iii) the numbers are rising at a fast pace at rates higher than the national level (d) (iii) 1 and 3 (e) (ii) July 31 (f) (iv) 12.82 lakh (g) (iii) Tuesday (h) (iii) three days earlier than Tuesday (i) (i) rapidly (j) (iii) native

Australia’s 2019-2020 Bushfire Season was not Normal

• Data from satellite sources assembled by the United Nations Environment Programme’s (UNEP) World Environment Situation Room confirms that the wildfires in Australia in the last two months of 2019 and the first six weeks of 2020 were far from normal. 2019 was the second hottest year on record since 1880, and Australia recorded its warmest temperatures ever in December 2019.
• “Rising temperatures continue to melt records. The past decade was the hottest on record. Scientists tell us that ocean temperatures are now rising at the equivalent of five Hiroshima bombs a second. One million species are in near-term danger of extinction. Our planet is burning,” says United Nations Secretary-General António Guterres.
• “The trend is very clear: 37 of the last 40 years were the warmest recorded since 1880, and the six warmest years recorded were the last six years,” says Pascal Peduzzi, Director of UNEP’s Global Resource Information Database in Geneva. “For those who think Australia is always burning, graphs clearly show that these fires were exceptional.”
• “This service, accessible via the UNEP’s World Environment Situation Room, is provided for all countries at national and provincial levels. It identifies trends in wildfire activity since 2003, when the data first became available and monitoring began. We have sliced and diced the satellite-based data on wildfires worldwide from 2009 to the present day. We analyse the wildfires’ data by month, type of land cover, protected area, province and nation to produce information products,” Peduzzi adds. (Source: UN Environment)

(a) What do the reports confirm about the 2019-20 Australian fires? (i) the fires were not normal (ii) the fires were normal (iii) the fires were natural (iv) data inconclusive

(b) What was the difference in the recorded temperatures in 2019 from the 1880s? (i) 2019 recorded the wettest temperatures since 1880s (ii) 2019 recorded the hottest temperatures ever (iii) 2019 recorded the cooler temperatures than 1880s (iv) 2019 recorded the warmest temperatures since 1880s

(c) What comparison has been made between the rising sea temperatures and Hiroshima? (i) ocean temperatures are rising at the equivalent of three Hiroshima bombs a second (ii) ocean temperatures are rising at the equivalent of five Hiroshima bombs a second (iii) ocean temperatures are rising at the equivalent of five Hiroshima bombs an hour (iv) none of these

(d) Choose the option that lists the CORRECT answers for the following:

“Rising temperatures continue to melt records. The past decade was the hottest on record. Scientists tell us that ocean temperatures are now rising at the equivalent of five Hiroshima bombs a second”. Whose statement is this?

“The trend is very clear: 37 of the last 40 years were the warmest recorded since 1880, and the six warmest years recorded were the last six years.” Whose statement is this?

(i) (1) is from United Nations Secretary and (2) is from the UN President (ii) (1) is from the UN President and (2) is from the UN General Secretary (iii) (1) is from United Nations Secretary and (2) is from the Director of UNEP (iv) (1) is from the UN General Secretary and (2) is from the UN President

(e) Based on your understanding of the passage, choose the option that lists the inherent qualities of climate in the present times. (i) 1 and 3 (ii) 2 and 6 (iii) 3 and 4 (iv) 5 and 6

(f) Which of the following independent data source is NOT PRESENT in the given graph? (i) NASA (ii) NOAA (iii) ISRO (iv) JMA

(g) Choose the option that lists the CORRECT statement. (i) Pascal Peduzzi is the Director of UNEP’s Global Renaissance Information Database (ii) Pascal Peduzzi is the Director of UNO’s Global Resource Information Database (iii) Pascal Peduzzi is the Manager of UNEP’s Global Resource Information Database (iv) Pascal Peduzzi is the Director of UNEP’s Global Resource Information Database

(h) How can you say that the UN is concerned about the rising numbers of coal plants? (i) UNDP Secretary General António Guterres is calling for curbs on new plants (ii) UN Secretary General António Guterres is calling for curbs on new plants (iii) UN Executive Secretary António Guterres is calling for curbs on new plants (iv) UN Secretary General Antony Guterres is calling for curbs on new plants

(i) UNEP’s World Environment Situation Room has been tracking the world temperatures since. (i) 2003 (ii) 2013 (iii) 2000 (iv) 2001

(j) The graph compiled with data from four different sources shows that the global surface temperatures have been _ . (i) steady (ii) falling (iii) on the rise (iv) none of these

(k) Which word in the passage means the same as “collect”? (i) assembled (ii) extinction (iii) exceptional (iv) provincial

(l) Which word in the passage is opposite to the meaning of ‘vague/murky’? (i) assembled (ii) clear (iii) extinction (iv) provincial

(a) (i) the fires were not normal (b) (iv) 2019 recorded the warmest temperatures since 1880s (c) (ii) ocean temperatures are rising at the equivalent of five Hiroshima bombs a second (d) (iii) (1) is from United Nations Secretary and (2) is from the Director of UNEP (e) (i) 1 and 3 (f) (iii) ISRO (g) (iv) Pascal Peduzzi is the Director of UNEP’s Global Resource Information Database (h) (ii) UN secretary general António Guterres is calling for curbs on new plants (i) (i) 2003 (j) (iii) on the rise (k) (i) assembled (l) (ii) clear

Q. Read the passage given below and answer the questions that follow: [CBSE, 2019]

Hyderabad — The City of Nizams GOLCONDA

1. In the 16th century, when Golconda was the capital of Qutb Shahi Kingdom, it is believed that a shepherd boy came across an idol on the hill. It was then that the Kakatiya dynasty’s ruler built the fort, which is 120 m high. After it was captured by Aurangzeb, the Mughal emperor, the fort fell into ruins.

2. The beautiful ruins of the fort have a story to tell. They make you wonder how the fort may have looked in its days of glory and grandeur. The fort also organises a sound and light show every day and the history of this fort is narrated in such an interesting manner that even a child can understand and enjoy it. The climb to the fort is a difficult one and unless you are physically fit, you should avoid the climb and relax in the gardens below. The view from the top is breath-taking.

3. The next place is Charminar. The literal meaning of the monument is ‘four minarets’. There is a mosque on the second floor. It is said that when the state was hit by severe plague, Sultan Muhammad Quli Qutb Shah, the fifth ruler of the Qutb Shahi dynasty, prayed to end the plague and promised to build a mosque in the very place where he was praying. Thus, Charminar came into being!

4. The walk from the bottom to the top of the monument is a little frightening, owing to the narrowness of the pathway and the steepness of the steps. Once you reach the top, the view of the crowds moving below will surely lift your spirits.

5. Make sure you visit the nearby Laad Bazaar, where there are rows of shops selling the famous Hyderabadi glass bangles and lac bangles.

SALAR JUNG MUSEUM

6. The Salar Jung Museum is the third largest museum in the country and boasts of owning the biggest one-man collection of antiques in the world. A visit to the Salar Jung Museum is a must even if you are not a fan of antique stuff. You can view the Nizam’s collection of textiles, arms, metalware, ivory carvings, Indian bronzes and carpets.

7. The main attraction is definitely the Musical Clock, made by Cook and Kelvy of England. Inside the clock is a timekeeper. Every hour, he comes out and beats a gong as many times as the time indicates. Another attraction of the museum is the Veiled Rebecca, an amazing sculpture made by the Italian sculptor, Giovanni Maria Benzoni.

On the basis of your understanding of the above passage, answer any ten of the following questions: (any eight) (a) What led to the construction of the Golconda Fort? (b) What led to the destruction of the Golconda Fort? (c) How is the interest in the Fort kept alive? (d) What does the word ‘breath-taking’ in para 2 mean? (e) Why did Quli Qutb Shah build a mosque? (f) How does one feel after reaching the top of Charminar? (g) What is unique about the Salar Jung Museum? (h) What else can one find in this museum apart from antiques? (i) Name the two attractions of the Salar Jung Museum.

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The Ultimate Guide to Qualitative Research - Part 1: The Basics

• Introduction and overview
• What is qualitative research?
• What is qualitative data?
• Examples of qualitative data
• Qualitative vs. quantitative research
• Mixed methods
• Qualitative research preparation
• Theoretical perspective
• Theoretical framework
• Literature reviews

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

Applications for case study research, what is a good case study, process of case study design, benefits and limitations of case studies.

• Ethnographical research
• Ethical considerations
• Confidentiality and privacy
• Power dynamics
• Reflexivity

Case studies

Case studies are essential to qualitative research , offering a lens through which researchers can investigate complex phenomena within their real-life contexts. This chapter explores the concept, purpose, applications, examples, and types of case studies and provides guidance on how to conduct case study research effectively.

Whereas quantitative methods look at phenomena at scale, case study research looks at a concept or phenomenon in considerable detail. While analyzing a single case can help understand one perspective regarding the object of research inquiry, analyzing multiple cases can help obtain a more holistic sense of the topic or issue. Let's provide a basic definition of a case study, then explore its characteristics and role in the qualitative research process.

Definition of a case study

A case study in qualitative research is a strategy of inquiry that involves an in-depth investigation of a phenomenon within its real-world context. It provides researchers with the opportunity to acquire an in-depth understanding of intricate details that might not be as apparent or accessible through other methods of research. The specific case or cases being studied can be a single person, group, or organization – demarcating what constitutes a relevant case worth studying depends on the researcher and their research question .

Among qualitative research methods , a case study relies on multiple sources of evidence, such as documents, artifacts, interviews , or observations , to present a complete and nuanced understanding of the phenomenon under investigation. The objective is to illuminate the readers' understanding of the phenomenon beyond its abstract statistical or theoretical explanations.

Characteristics of case studies

Case studies typically possess a number of distinct characteristics that set them apart from other research methods. These characteristics include a focus on holistic description and explanation, flexibility in the design and data collection methods, reliance on multiple sources of evidence, and emphasis on the context in which the phenomenon occurs.

Furthermore, case studies can often involve a longitudinal examination of the case, meaning they study the case over a period of time. These characteristics allow case studies to yield comprehensive, in-depth, and richly contextualized insights about the phenomenon of interest.

The role of case studies in research

Case studies hold a unique position in the broader landscape of research methods aimed at theory development. They are instrumental when the primary research interest is to gain an intensive, detailed understanding of a phenomenon in its real-life context.

In addition, case studies can serve different purposes within research - they can be used for exploratory, descriptive, or explanatory purposes, depending on the research question and objectives. This flexibility and depth make case studies a valuable tool in the toolkit of qualitative researchers.

Remember, a well-conducted case study can offer a rich, insightful contribution to both academic and practical knowledge through theory development or theory verification, thus enhancing our understanding of complex phenomena in their real-world contexts.

What is the purpose of a case study?

Case study research aims for a more comprehensive understanding of phenomena, requiring various research methods to gather information for qualitative analysis . Ultimately, a case study can allow the researcher to gain insight into a particular object of inquiry and develop a theoretical framework relevant to the research inquiry.

Why use case studies in qualitative research?

Using case studies as a research strategy depends mainly on the nature of the research question and the researcher's access to the data.

Conducting case study research provides a level of detail and contextual richness that other research methods might not offer. They are beneficial when there's a need to understand complex social phenomena within their natural contexts.

The explanatory, exploratory, and descriptive roles of case studies

Case studies can take on various roles depending on the research objectives. They can be exploratory when the research aims to discover new phenomena or define new research questions; they are descriptive when the objective is to depict a phenomenon within its context in a detailed manner; and they can be explanatory if the goal is to understand specific relationships within the studied context. Thus, the versatility of case studies allows researchers to approach their topic from different angles, offering multiple ways to uncover and interpret the data .

The impact of case studies on knowledge development

Case studies play a significant role in knowledge development across various disciplines. Analysis of cases provides an avenue for researchers to explore phenomena within their context based on the collected data.

This can result in the production of rich, practical insights that can be instrumental in both theory-building and practice. Case studies allow researchers to delve into the intricacies and complexities of real-life situations, uncovering insights that might otherwise remain hidden.

Types of case studies

In qualitative research , a case study is not a one-size-fits-all approach. Depending on the nature of the research question and the specific objectives of the study, researchers might choose to use different types of case studies. These types differ in their focus, methodology, and the level of detail they provide about the phenomenon under investigation.

Understanding these types is crucial for selecting the most appropriate approach for your research project and effectively achieving your research goals. Let's briefly look at the main types of case studies.

Exploratory case studies

Exploratory case studies are typically conducted to develop a theory or framework around an understudied phenomenon. They can also serve as a precursor to a larger-scale research project. Exploratory case studies are useful when a researcher wants to identify the key issues or questions which can spur more extensive study or be used to develop propositions for further research. These case studies are characterized by flexibility, allowing researchers to explore various aspects of a phenomenon as they emerge, which can also form the foundation for subsequent studies.

Descriptive case studies

Descriptive case studies aim to provide a complete and accurate representation of a phenomenon or event within its context. These case studies are often based on an established theoretical framework, which guides how data is collected and analyzed. The researcher is concerned with describing the phenomenon in detail, as it occurs naturally, without trying to influence or manipulate it.

Explanatory case studies

Explanatory case studies are focused on explanation - they seek to clarify how or why certain phenomena occur. Often used in complex, real-life situations, they can be particularly valuable in clarifying causal relationships among concepts and understanding the interplay between different factors within a specific context.

Intrinsic, instrumental, and collective case studies

These three categories of case studies focus on the nature and purpose of the study. An intrinsic case study is conducted when a researcher has an inherent interest in the case itself. Instrumental case studies are employed when the case is used to provide insight into a particular issue or phenomenon. A collective case study, on the other hand, involves studying multiple cases simultaneously to investigate some general phenomena.

Each type of case study serves a different purpose and has its own strengths and challenges. The selection of the type should be guided by the research question and objectives, as well as the context and constraints of the research.

The flexibility, depth, and contextual richness offered by case studies make this approach an excellent research method for various fields of study. They enable researchers to investigate real-world phenomena within their specific contexts, capturing nuances that other research methods might miss. Across numerous fields, case studies provide valuable insights into complex issues.

Critical information systems research

Case studies provide a detailed understanding of the role and impact of information systems in different contexts. They offer a platform to explore how information systems are designed, implemented, and used and how they interact with various social, economic, and political factors. Case studies in this field often focus on examining the intricate relationship between technology, organizational processes, and user behavior, helping to uncover insights that can inform better system design and implementation.

Health research

Health research is another field where case studies are highly valuable. They offer a way to explore patient experiences, healthcare delivery processes, and the impact of various interventions in a real-world context.

Case studies can provide a deep understanding of a patient's journey, giving insights into the intricacies of disease progression, treatment effects, and the psychosocial aspects of health and illness.

Asthma research studies

Specifically within medical research, studies on asthma often employ case studies to explore the individual and environmental factors that influence asthma development, management, and outcomes. A case study can provide rich, detailed data about individual patients' experiences, from the triggers and symptoms they experience to the effectiveness of various management strategies. This can be crucial for developing patient-centered asthma care approaches.

Other fields

Apart from the fields mentioned, case studies are also extensively used in business and management research, education research, and political sciences, among many others. They provide an opportunity to delve into the intricacies of real-world situations, allowing for a comprehensive understanding of various phenomena.

Case studies, with their depth and contextual focus, offer unique insights across these varied fields. They allow researchers to illuminate the complexities of real-life situations, contributing to both theory and practice.

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Understanding the key elements of case study design is crucial for conducting rigorous and impactful case study research. A well-structured design guides the researcher through the process, ensuring that the study is methodologically sound and its findings are reliable and valid. The main elements of case study design include the research question , propositions, units of analysis, and the logic linking the data to the propositions.

The research question is the foundation of any research study. A good research question guides the direction of the study and informs the selection of the case, the methods of collecting data, and the analysis techniques. A well-formulated research question in case study research is typically clear, focused, and complex enough to merit further detailed examination of the relevant case(s).

Propositions

Propositions, though not necessary in every case study, provide a direction by stating what we might expect to find in the data collected. They guide how data is collected and analyzed by helping researchers focus on specific aspects of the case. They are particularly important in explanatory case studies, which seek to understand the relationships among concepts within the studied phenomenon.

Units of analysis

The unit of analysis refers to the case, or the main entity or entities that are being analyzed in the study. In case study research, the unit of analysis can be an individual, a group, an organization, a decision, an event, or even a time period. It's crucial to clearly define the unit of analysis, as it shapes the qualitative data analysis process by allowing the researcher to analyze a particular case and synthesize analysis across multiple case studies to draw conclusions.

Argumentation

This refers to the inferential model that allows researchers to draw conclusions from the data. The researcher needs to ensure that there is a clear link between the data, the propositions (if any), and the conclusions drawn. This argumentation is what enables the researcher to make valid and credible inferences about the phenomenon under study.

Understanding and carefully considering these elements in the design phase of a case study can significantly enhance the quality of the research. It can help ensure that the study is methodologically sound and its findings contribute meaningful insights about the case.

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Conducting a case study involves several steps, from defining the research question and selecting the case to collecting and analyzing data . This section outlines these key stages, providing a practical guide on how to conduct case study research.

Defining the research question

The first step in case study research is defining a clear, focused research question. This question should guide the entire research process, from case selection to analysis. It's crucial to ensure that the research question is suitable for a case study approach. Typically, such questions are exploratory or descriptive in nature and focus on understanding a phenomenon within its real-life context.

Selecting and defining the case

The selection of the case should be based on the research question and the objectives of the study. It involves choosing a unique example or a set of examples that provide rich, in-depth data about the phenomenon under investigation. After selecting the case, it's crucial to define it clearly, setting the boundaries of the case, including the time period and the specific context.

Previous research can help guide the case study design. When considering a case study, an example of a case could be taken from previous case study research and used to define cases in a new research inquiry. Considering recently published examples can help understand how to select and define cases effectively.

Developing a detailed case study protocol

A case study protocol outlines the procedures and general rules to be followed during the case study. This includes the data collection methods to be used, the sources of data, and the procedures for analysis. Having a detailed case study protocol ensures consistency and reliability in the study.

The protocol should also consider how to work with the people involved in the research context to grant the research team access to collecting data. As mentioned in previous sections of this guide, establishing rapport is an essential component of qualitative research as it shapes the overall potential for collecting and analyzing data.

Collecting data

Gathering data in case study research often involves multiple sources of evidence, including documents, archival records, interviews, observations, and physical artifacts. This allows for a comprehensive understanding of the case. The process for gathering data should be systematic and carefully documented to ensure the reliability and validity of the study.

Analyzing and interpreting data

The next step is analyzing the data. This involves organizing the data , categorizing it into themes or patterns , and interpreting these patterns to answer the research question. The analysis might also involve comparing the findings with prior research or theoretical propositions.

Writing the case study report

The final step is writing the case study report . This should provide a detailed description of the case, the data, the analysis process, and the findings. The report should be clear, organized, and carefully written to ensure that the reader can understand the case and the conclusions drawn from it.

Each of these steps is crucial in ensuring that the case study research is rigorous, reliable, and provides valuable insights about the case.

The type, depth, and quality of data in your study can significantly influence the validity and utility of the study. In case study research, data is usually collected from multiple sources to provide a comprehensive and nuanced understanding of the case. This section will outline the various methods of collecting data used in case study research and discuss considerations for ensuring the quality of the data.

Interviews are a common method of gathering data in case study research. They can provide rich, in-depth data about the perspectives, experiences, and interpretations of the individuals involved in the case. Interviews can be structured , semi-structured , or unstructured , depending on the research question and the degree of flexibility needed.

Observations

Observations involve the researcher observing the case in its natural setting, providing first-hand information about the case and its context. Observations can provide data that might not be revealed in interviews or documents, such as non-verbal cues or contextual information.

Documents and artifacts

Documents and archival records provide a valuable source of data in case study research. They can include reports, letters, memos, meeting minutes, email correspondence, and various public and private documents related to the case.

These records can provide historical context, corroborate evidence from other sources, and offer insights into the case that might not be apparent from interviews or observations.

Physical artifacts refer to any physical evidence related to the case, such as tools, products, or physical environments. These artifacts can provide tangible insights into the case, complementing the data gathered from other sources.

Ensuring the quality of data collection

Determining the quality of data in case study research requires careful planning and execution. It's crucial to ensure that the data is reliable, accurate, and relevant to the research question. This involves selecting appropriate methods of collecting data, properly training interviewers or observers, and systematically recording and storing the data. It also includes considering ethical issues related to collecting and handling data, such as obtaining informed consent and ensuring the privacy and confidentiality of the participants.

Data analysis

Analyzing case study research involves making sense of the rich, detailed data to answer the research question. This process can be challenging due to the volume and complexity of case study data. However, a systematic and rigorous approach to analysis can ensure that the findings are credible and meaningful. This section outlines the main steps and considerations in analyzing data in case study research.

Organizing the data

The first step in the analysis is organizing the data. This involves sorting the data into manageable sections, often according to the data source or the theme. This step can also involve transcribing interviews, digitizing physical artifacts, or organizing observational data.

Categorizing and coding the data

Once the data is organized, the next step is to categorize or code the data. This involves identifying common themes, patterns, or concepts in the data and assigning codes to relevant data segments. Coding can be done manually or with the help of software tools, and in either case, qualitative analysis software can greatly facilitate the entire coding process. Coding helps to reduce the data to a set of themes or categories that can be more easily analyzed.

Identifying patterns and themes

After coding the data, the researcher looks for patterns or themes in the coded data. This involves comparing and contrasting the codes and looking for relationships or patterns among them. The identified patterns and themes should help answer the research question.

Interpreting the data

Once patterns and themes have been identified, the next step is to interpret these findings. This involves explaining what the patterns or themes mean in the context of the research question and the case. This interpretation should be grounded in the data, but it can also involve drawing on theoretical concepts or prior research.

Verification of the data

The last step in the analysis is verification. This involves checking the accuracy and consistency of the analysis process and confirming that the findings are supported by the data. This can involve re-checking the original data, checking the consistency of codes, or seeking feedback from research participants or peers.

Like any research method , case study research has its strengths and limitations. Researchers must be aware of these, as they can influence the design, conduct, and interpretation of the study.

Understanding the strengths and limitations of case study research can also guide researchers in deciding whether this approach is suitable for their research question . This section outlines some of the key strengths and limitations of case study research.

Benefits include the following:

• Rich, detailed data: One of the main strengths of case study research is that it can generate rich, detailed data about the case. This can provide a deep understanding of the case and its context, which can be valuable in exploring complex phenomena.
• Flexibility: Case study research is flexible in terms of design , data collection , and analysis . A sufficient degree of flexibility allows the researcher to adapt the study according to the case and the emerging findings.
• Real-world context: Case study research involves studying the case in its real-world context, which can provide valuable insights into the interplay between the case and its context.
• Multiple sources of evidence: Case study research often involves collecting data from multiple sources , which can enhance the robustness and validity of the findings.

On the other hand, researchers should consider the following limitations:

• Generalizability: A common criticism of case study research is that its findings might not be generalizable to other cases due to the specificity and uniqueness of each case.
• Time and resource intensive: Case study research can be time and resource intensive due to the depth of the investigation and the amount of collected data.
• Complexity of analysis: The rich, detailed data generated in case study research can make analyzing the data challenging.
• Subjectivity: Given the nature of case study research, there may be a higher degree of subjectivity in interpreting the data , so researchers need to reflect on this and transparently convey to audiences how the research was conducted.

Being aware of these strengths and limitations can help researchers design and conduct case study research effectively and interpret and report the findings appropriately.

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Center for Teaching

Writing good multiple choice test questions, constructing an effective stem, constructing effective alternatives.

• Additional Guidelines for Multiple Choice Questions

Considerations for Writing Multiple Choice Items that Test Higher-order Thinking

Additional resources.

Multiple choice test questions, also known as items, can be an effective and efficient way to assess learning outcomes. Multiple choice test items have several potential advantages:

Reliability: Reliability is defined as the degree to which a test consistently measures a learning outcome. Multiple choice test items are less susceptible to guessing than true/false questions, making them a more reliable means of assessment. The reliability is enhanced when the number of MC items focused on a single learning objective is increased. In addition, the objective scoring associated with multiple choice test items frees them from problems with scorer inconsistency that can plague scoring of essay questions.

Validity: Validity is the degree to which a test measures the learning outcomes it purports to measure. Because students can typically answer a multiple choice item much more quickly than an essay question, tests based on multiple choice items can typically focus on a relatively broad representation of course material, thus increasing the validity of the assessment.

The key to taking advantage of these strengths, however, is construction of good multiple choice items.

A multiple choice item consists of a problem, known as the stem, and a list of suggested solutions, known as alternatives. The alternatives consist of one correct or best alternative, which is the answer, and incorrect or inferior alternatives, known as distractors.

1. The stem should be meaningful by itself and should present a definite problem. A stem that presents a definite problem allows a focus on the learning outcome. A stem that does not present a clear problem, however, may test students’ ability to draw inferences from vague descriptions rather serving as a more direct test of students’ achievement of the learning outcome.

2. The stem should not contain irrelevant material , which can decrease the reliability and the validity of the test scores (Haldyna and Downing 1989).

3. The stem should be negatively stated only when significant learning outcomes require it. Students often have difficulty understanding items with negative phrasing (Rodriguez 1997). If a significant learning outcome requires negative phrasing, such as identification of dangerous laboratory or clinical practices, the negative element should be emphasized with italics or capitalization.

4. The stem should be a question or a partial sentence. A question stem is preferable because it allows the student to focus on answering the question rather than holding the partial sentence in working memory and sequentially completing it with each alternative (Statman 1988). The cognitive load is increased when the stem is constructed with an initial or interior blank, so this construction should be avoided.

1. All alternatives should be plausible. The function of the incorrect alternatives is to serve as distractors,which should be selected by students who did not achieve the learning outcome but ignored by students who did achieve the learning outcome. Alternatives that are implausible don’t serve as functional distractors and thus should not be used. Common student errors provide the best source of distractors.

2. Alternatives should be stated clearly and concisely. Items that are excessively wordy assess students’ reading ability rather than their attainment of the learning objective

3. Alternatives should be mutually exclusive. Alternatives with overlapping content may be considered “trick” items by test-takers, excessive use of which can erode trust and respect for the testing process.

4. Alternatives should be homogenous in content. Alternatives that are heterogeneous in content can provide cues to student about the correct answer.

5. Alternatives should be free from clues about which response is correct. Sophisticated test-takers are alert to inadvertent clues to the correct answer, such differences in grammar, length, formatting, and language choice in the alternatives. It’s therefore important that alternatives

• have grammar consistent with the stem.
• are parallel in form.
• are similar in length.
• use similar language (e.g., all unlike textbook language or all like textbook language).

6. The alternatives “all of the above” and “none of the above” should not be used. When “all of the above” is used as an answer, test-takers who can identify more than one alternative as correct can select the correct answer even if unsure about other alternative(s). When “none of the above” is used as an alternative, test-takers who can eliminate a single option can thereby eliminate a second option. In either case, students can use partial knowledge to arrive at a correct answer.

7. The alternatives should be presented in a logical order (e.g., alphabetical or numerical) to avoid a bias toward certain positions.

8. The number of alternatives can vary among items as long as all alternatives are plausible. Plausible alternatives serve as functional distractors, which are those chosen by students that have not achieved the objective but ignored by students that have achieved the objective. There is little difference in difficulty, discrimination, and test score reliability among items containing two, three, and four distractors.

Additional Guidelines

1. Avoid complex multiple choice items , in which some or all of the alternatives consist of different combinations of options. As with “all of the above” answers, a sophisticated test-taker can use partial knowledge to achieve a correct answer.

2. Keep the specific content of items independent of one another. Savvy test-takers can use information in one question to answer another question, reducing the validity of the test.

When writing multiple choice items to test higher-order thinking, design questions that focus on higher levels of cognition as defined by Bloom’s taxonomy . A stem that presents a problem that requires application of course principles, analysis of a problem, or evaluation of alternatives is focused on higher-order thinking and thus tests students’ ability to do such thinking. In constructing multiple choice items to test higher order thinking, it can also be helpful to design problems that require multilogical thinking, where multilogical thinking is defined as “thinking that requires knowledge of more than one fact to logically and systematically apply concepts to a …problem” (Morrison and Free, 2001, page 20). Finally, designing alternatives that require a high level of discrimination can also contribute to multiple choice items that test higher-order thinking.

• Burton, Steven J., Sudweeks, Richard R., Merrill, Paul F., and Wood, Bud. How to Prepare Better Multiple Choice Test Items: Guidelines for University Faculty, 1991.
• Cheung, Derek and Bucat, Robert. How can we construct good multiple-choice items? Presented at the Science and Technology Education Conference, Hong Kong, June 20-21, 2002.
• Haladyna, Thomas M. Developing and validating multiple-choice test items, 2 nd edition. Lawrence Erlbaum Associates, 1999.
• Haladyna, Thomas M. and Downing, S. M.. Validity of a taxonomy of multiple-choice item-writing rules. Applied Measurement in Education , 2(1), 51-78, 1989.
• Morrison, Susan and Free, Kathleen. Writing multiple-choice test items that promote and measure critical thinking. Journal of Nursing Education 40: 17-24, 2001.

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• J Family Community Med
• v.13(3); Sep-Dec 2006

GUIDELINES FOR THE CONSTRUCTION OF MULTIPLE CHOICE QUESTIONS TESTS

Mohammed o. al-rukban.

Department of Family & Community Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia

Multiple Choice Questions (MCQs) are generally recognized as the most widely applicable and useful type of objective test items. They could be used to measure the most important educational outcomes - knowledge, understanding, judgment and problem solving. The objective of this paper is to give guidelines for the construction of MCQs tests. This includes the construction of both “single best option” type, and “extended matching item” type. Some templates for use in the “single best option” type of questions are recommended.

INTRODUCTION

In recent years, there has been much discussion about what should be taught to medical students and how they should be assessed. In addition, highly publicized instances of the poor performance of medical doctors have fuelled the drive to find a way for ensuring that qualified doctors achieve and maintain appropriate knowledge, skills and attitudes throughout their working lives. 1

Selecting an assessment method for measuring students’ performance remains a daunting task for many medical institutions. 2 Assessment should be educational and formative if it is going to promote appropriate learning. It is important that individuals learn from any assessment process and receive feedback on which to build their knowledge and skills. It is also important for an assessment to have a summative function to demonstrate competence. 1

Assessment may act as a trigger, informing examinees what instructors really regard as important 3 and the value they attach to different forms of knowledge and ways of thinking. In fact, assessment has been identified as possibly the single most potent influence on student learning; narrowing students’ focus only on topics to be tested on (i.e. what is to be studied) and shaping their learning approaches (i.e. how it is going to be studied). 4 Students have been found to differ in the quality of their learning when instructed to focus either on factual details or on the assessment of evidence. 5 Furthermore, research has reported that changes in assessment methods have been found to influence medical students to alter their study activities. 4 As methods of assessment drive learning in medicine and other disciplines, 1 it is important that the assessment tools test the attributes required of students or professionals undergoing revalidation. Staff subsequently, redesign their methods of assessment to ensure a match between assessment forms and their educational goals. 6

Methods of assessment of medical students and practicing doctors have changed considerably during the last 5 decades. 7 No single method is appropriate, however, for assessing all the skills, knowledge and attitudes needed in medicine, so a combination of assessment techniques will always be required. 8 – 10

When designing assessments of medical competencies, a number of issues need to be addressed; reliability, which refers to the reproducibility or consistency of a test score, validity, which refers to the extent to which a test measures what it purports to measure, 11 , 12 and standard setting which defines the endpoint of the assessment. 1 Sources of the evidence of validity are related to the content, response process, internal structure, relationship to other variables, and consequences of the assessment scores. 13

Validity requires the selection of appropriate test formats for the competencies to be tested. This invariably requires a composite examination. Reliability, however, requires an adequate sample of the necessary knowledge, skills, and attitudes to be tested.

However, measuring students’ performances is not the sole determinant for choosing an assessment method. Other factors such as cost, suitability, and safety have profound influences on the selection of an assessment method and, most probably, constitute the major reason for inter-institutional variations for the selection of assessment methods as well success rates. 14

Examiners need to use a variety of test formats when organizing test papers; each format being selected on account of its strength as regards to validity, reliability, objectivity and feasibility. 15

For as long as there is a need to test knowledge in the assessment of doctors and medical undergraduates, multiple choice questions (MCQs) will always play a role as a component in the assessment of clinical competence. 16

Multiple choice questions were introduced into medical examinations in the 1950s and have been shown to be more reliable in testing knowledge than the traditional essay questions. It represents one of the most important well-established examination tools widely used in assessment at the undergraduate and postgraduate levels of medical examinations. The MCQ is an objective question for which there is prior agreement on what constitutes the correct answer. This widespread use may have led examiners to use the term MCQ as synonym to an objective question. 15 Since their introduction, there have been many modifications to MCQs resulting in formats. 16 Like other methods of assessment, they have their strengths and weaknesses. Scoring of the questions is easy and reliable, and their use permits a wide sampling of student's knowledge in an examination of reasonable duration. 15 – 19 MCQ-based exams are also reliable because they are time-efficient and a short exam still allows a breadth of sampling of any topic. 19 Well-constructed MCQs can also assess taxonomically higher-order cognitive processing such as interpretation, synthesis and application of knowledge rather than the test of recall of isolated facts. 20 They could test a number of skills in addition to the recall of factual knowledge, and are reliable, discriminatory, reproducible and cost-effective. It is generally, agreed that MCQs should not be used as a sole assessment method in summative examinations, but alongside other test forms. They are designed to broaden the range of skills to be tested during all phases of medical education, whether undergraduate, postgraduate or continuing. 21

Though writing the questions requires considerable effort, their high objectivity makes it possible for the results to be released immediately after marking by anyone including a machine. 15 , 18 This facilitates the computerized analysis of the raw data and allows the examining body to compare the performance of either the group or an individual with that of past candidates by the use of discriminator questions. 22 Ease of marking by computer makes MCQs an ideal method for assessing the knowledge of a large number of candidates. 16 , 22

However, a notable concern of many health professionals is that they are frequently faced with the task of constructing tests with little or no experience or training on how to perform this task. Examiners need to spend considerable time and effort to produce satisfactory questions. 15

The objective of this paper is to describe guidelines for the construction of two common MCQs types: the “single best option” type, and “extended matching item” type. Available templates for the “single best option” type will be discussed.

Single Best Option

The first step for writing any exam is to have a blueprint (table of specifications). Blueprinting is the planning of the test against the learning objectives of a course or competencies essential to a specialty. 1 A test blueprint is a guide used for creating a balanced examination and consists of a list of the competencies and topics (with specified weight for each) that should be tested on an examination, as in the example presented in Table 1 .

Example of a table of specifications (Blueprint) based on the context, for Internal Medicine examination

If there is no blueprint, the examination committee should decide on the system to be tested by brainstorming to produce a list of possible topics/themes for question items. For example, abdominal pain, back pain, chest pain, dizziness, fatigue, fever, etc, 23 and then select one theme (topic) from the list. When choosing a topic for a question, the focus should be on one important concept, typically a common or a serious and treatable clinical problem from the specialty. After choosing the topic, an appropriate context for the question is chosen. The context defines the clinical situation that will test the topic. This is important because it determines the type of information that should be included in the stem and the response options. Consider the following example: (Topic= Hypertension; Context= Therapy).

The basic MCQ model comprises a stem and a lead-in question followed by a number of answers (options). 19 The option which matches the key in a MCQ is best called “the correct answer” 15 and the other options are the “distracters”.

For writing a single best option type of MCQs, as shown in Appendix 1 , it is recommended that the options are written first. 23 A list of possible homogeneous options based on the selected topic and context is then generated. The options should be readily understood and as short as possible. 18 It is best to start with a list of more than five options (although only five options are usually used in the final version). This allows a couple of ‘spares’, which often come in handy! It is important that this list be HOMOGENOUS (i.e. all about diagnoses, or therapeutics, lab investigations, complications… etc) 23 and one of the options selected as the key answer to the question.

MCQ Preparation Form

A good distracter should be inferior to the correct answer but should also be plausible to a non-competent candidate. 24 All options should be true and contain facts that are acceptable to varying degrees. The examiner would ask for the most appropriate, most common, least harmful or any other feature which is at the uppermost or lowermost point in a range. It needs to be expressed clearly that only one answer is correct. A candidate's response is considered correct if his/her selection matches the examiner's key. 15

When creating a distracter, it helps to predict how an inexperienced examinee might react to the clinical case described in the stem. 24

A question stem is then written with lead-in statement based on the selected correct option. Well-constructed MCQs should test the application of medical knowledge (context-rich) rather than just the recall of information (context- free). Schuwirth et al, 25 found that context-rich questions lead to thinking processes which represent problem solving ability better than those elicited by context-free questions. The focus should be on problems that would be encountered in clinical practice rather than an assessment of the candidate's knowledge of trivial facts or obscure problems that are seldom encountered. The types of problems that commonly encountered in one's own practice can provide good examples for the development of questions. To make testing both fair and consequentially valid, MCQs should be used strategically to test important content, and clinical competence. 19

The clinical case should begin with the presentation of a problem and followed by relevant signs, symptoms, results of diagnostic studies, initial treatment, subsequent findings, etc. In essence, all the information that is necessary for a competent candidate to answer the question should be provided in the stem. For example:

• Age, sex (e.g., a 45-year-old man).
• Site of care (e.g. comes to the emergency department).
• Presenting complaint (e.g. because of a headache).
• Duration (e.g. that has continued for 2 days).
• Patient history (with family history).
• Physical findings.
• +/− Results of diagnostic studies.
• +/− Initial treatment, subsequent findings, etc.

The lead-in question should give clear directions as to what the candidate should do to answer the question. Ambiguity and the use of imprecise terms should be avoided. 16 , 18 There is no place for trick questions in MCQ examinations. Negative stems should be avoided, as should double negatives. Always, never and only are obviously contentious in an inexact science like medicine and should not be used. 16 , 18

Consider the following examples of lead-in questions:

Example 1: Regarding myocardial infarction.

Example 2: What is the most likely diagnosis?

Note that for Example 1, no task is presented to the candidate. This type of lead-in statement will often lead to an ambiguous or unfocused question. In the second example, the task is clear and will lead to a more focused question. To ensure that the lead-in question is well constructed, the question should be answerable without looking at the response options. As a check, the response options should be covered and an attempt made to answer the question.

Well constructed MCQs should be written at a level of difficulty appropriate to level of the candidates. A reason often given for using difficult questions is that they help the examiner to identify the `cream’ of the students. However, most tests would function with greater test reliability when questions of medium difficulty are used. 26 An exception, however, would be the assessment of achievement in topic areas that all students are expected to master. Questions used here will be correctly answered by nearly all the candidates and consequently, will have high difficulty index values. On the other hand, if a few candidates are to be selected for honours, scholarships, etc., it is preferable to have an examination of the appropriately high level of difficulty specifically for that purpose. It is important to bear in mind that the level of learning is the only factor that should determine the ability of a candidate to answer a question correctly. 15

The next step is to reduce the list of option to the intended number of options which is usually five options (including, of course, the correct answer).

Lastly, the option list is to be arranged into a logical order to reduce guessing and avoid putting the correct answer in habitual location (e.g. using alphabetical order will make it possible to avoid choosing options B or C as key answers more frequently).

The role of guessing in answering MCQs has been debated extensively and a variety of approaches have been suggested to deal with the candidate who responds to questions without possessing the required level of knowledge. 27 – 29 A number of issues need closer analysis when dealing with this problem. Increasing the number of questions in a test paper will reduce the probability of passing the test by chance. 15

Once the MCQs have been written, they should be criticized by as many people as possible and they should be reviewed after their use. 16 , 18 The most common construction error encountered is the use of imprecise terms. Many MCQs used in medical education contain undefined terms. Furthermore, there is a wide range of opinions among the examiners themselves about the meanings of such vague terms. 30 The stem and options should read logically. It is easy to write items that look adequate but do not constitute proper English or do not make sense. 18

When constructing a paper from a bank of MCQs, care should be taken to ensure that there is a balanced spread of questions across the subject matter of the discipline being tested. 16 A fair or defensible MCQ exam should be closely aligned with the syllabus; be combined with practical competence testing; sample taken broadly from important content and be free from construction errors. 19

Extended Matching Items (EMIs)

Several analytic approaches have been used to obtain the optimal number of response options for multiple-choice items. 31 – 35 Focus has shifted from traditional 3–5 branches to larger numbers of branches. This may be 20-30 in the case of extended-matching questions (EMIs), or up to 500 for open-ended or ‘uncued’ formats. 36 However, the use of smaller numbers of options (and more items) results in a more efficient use of testing time. 37

Extended-matching items are multiple choice items organized into sets that use one list of options for all items in the set. There is a theme, an option list, a lead-in statement and at least two item stems. A typical set of EMIs begins with an option list of four to 26 options; more than ten options are usually used. The option list is followed by two or more patient-based items requiring the examinee to indicate a clinical decision for each item. The candidate is asked to match one or more options to each item stem.

Extended matching items have become popular in such specialties as internal and family medicine because they can be used to test diagnostic ability and clinical judgment. 15 Its use likely to increase in postgraduate examinations as well as in undergraduate assessment. 21 Computer-based extended matching items have been used for in-course continuous assessment. 38

EMIs are more difficult, more reliable, more discriminating, and capable of reducing the testing time. In addition, they are quicker and easier to write than other test formats. 39 , 40 Over the past 20 years, multiple studies have found that EMI-based tests are more reproducible (reliable) than other multiple-choice question (MCQ) formats aimed at the assessment of medical decision making. 20 , 41 , 42 There is a wealth of evidence that EMIs are the fairest format. 19

Another more recent development is uncued questions where answers are picked from a list of several hundred choices. These have been advocated for use in assessing clinical judgment, 43 but extended matching questions have surprisingly been shown to be as statistically reliable and valid as uncued queries. 20 , 41 , 44

Extended matching questions overcome the problem of cueing by increasing the number of options and are a compromise between free-response questions and MCQs. This offers an objective assessment that is both reliable and easy to mark. 45 – 47

Nevertheless, MCQs have strengths and weaknesses and those responsible for setting MCQ papers may consider investigating the viability and value of including some questions in the extended matching format. Item writers should be encouraged to use the EMI format with a large number of options because of the efficiencies this approach affords in item preparation. 20 , 39

For the construction of EMIs the following steps are suggested ( Appendix 2 ):

Preparation of Extended Matching Item (EMI)

Step 1: The selection of the system, the context, and the theme should be based on a blueprint. Otherwise, the following sequence should be followed:

Example: Respiratory system .

Example: Laboratory investigations .

Example: Respiratory Tract Infection .

Step 2: Write the lead-in statement.

Example: Which is the best specimen to send to the Microbiology laboratory for confirmation of the diagnosis ?

Step 3: Prepare the options: Make a list of 10-15 homogenous options. For example, they should all be diagnoses, managements, blood gas values, enzymes, prognoses, etc, and each should be short (normally only one or two words).

Example of options :

• – Sputum bacterial culture .
• – Nasal swab .
• – Blood for C-reactive protein .
• – Blood culture .
• – Perinasal swab .
• – Cough swab .
• – Throat swab .
• – Bronchioalveolar lavage .
• – Urine for antigen detection .
• – Single clotted blood specimen .

Step 4: Select two to three of the options as the correct answers (keys).

• – Sputum bacterial culture.
• – Blood culture.
• – Bronchioalveolar lavage.

Step 5: The question stems or scenarios: Write two to three vignettes (case scenarios) that suit the selected options, to form the question stem. The scenarios should not be overly complex and should contain only relevant information. This should normally be between two and five sentences in length. For the questions:

• Use patient scenarios.
• Include key patient information.
• Structure all similar scenarios in one group (do not mix adult and paediatric scenarios).
• Scenarios should be straightforward.

Scenarios for most of the options for possible use in future examinations can be written.

• - A 21-year-old man severely ill with lobar pneumonia .
• - A 68-year-old woman with an exacerbation of COPD .
• - A 60-year-old man with strongly suspected TB infection on whom three previous sputum specimens have been film (smear) negative .

N.B: The response options are first written and then the appropriate scenario built for each one.

Step 6: Ensure validity and discrimination:

Look at other options in the provisional list and delete any that suits the written case scenario or that is clearly wrong or plausible.

Step 7: Reduce the option list to the intended number e.g. (10-15 options for a two case scenarios).

Step 8: Review the questions and ensure that there is only one best answer for each question. Ensure that there are at least four reasonable (plausible) distracters for each scenario and ensure that the reasons for matching are clear. It is advisable to ask a colleague to review the EMIs without the answers. If the colleague has difficulty, modify the option list or scenario as appropriate.

The following is a sample:

Respiratory Tract Infection

For the following patients, which is the best specimen to send to the Microbiology laboratory for confirmation of the diagnosis ?

A 21-year-old man severely ill with lobar pneumonia . (d)

A 6- year-old woman with an exacerbation of COPD . (a)

A 60-year-old man with strongly suspected TB infection on whom three previous sputum specimens have been film (smear) negative . (h)

• Sputum bacterial culture.
• Nasal swab.
• Blood for C-reactive protein.
• Blood culture.
• Perinasal swab.
• Cough swab.
• Throat swab.
• Bronchioalveolar lavage.
• Urine for antigen detection.
• Single clotted blood specimen.

It is advisable for the writer of MCQ to use templates for the construction of a single best option MCQ in both basic sciences and physician (clinical) tasks. 48

Although the topics in basic sciences could be tested by recall type MCQs, as was discussed earlier, case scenario questions are preferable. Therefore, the focus here will be on this type of questions. The components of patient vignettes for possible inclusion were also described earlier.

Patient Vignettes

• - A (patient description) has a (type of injury and location). Which of the following structures is most likely to be affected?
• - A (patient description) has (history findings) and is taking (medications). Which of the following medications is the most likely cause of his (one history, physical examination or lab finding)?
• - A (patient description) has (abnormal findings). Which [additional] finding would suggest/suggests a diagnosis of (disease 1) rather than (disease 2)?
• - A (patient description) has (symptoms and signs). These observations suggest that the disease is a result of the (absence or presence) of which of the following (enzymes, mechanisms)?
• - A (patient description) follows a (specific dietary regime); which of the following conditions is most likely to occur?
• - A (patient description) has (symptoms, signs, or specific disease) and is being treated with (drug or drug class). The drug acts by inhibiting which of the following (functions, processes)?
• - (Time period) after a (event such as trip or meal with certain foods), a (patient or group description) became ill with (symptoms and signs). Which of the following (organisms, agents) is most likely to be found on analysis of (food)?
• - Following (procedure), a (patient description) develops (symptoms and signs). Laboratory findings show (findings). Which of the following is the most likely cause?

Sample Lead-ins and Option Lists

Option sets could include sites of lesions; list of nerves; list of muscles; list of enzymes; list of hormones; types of cells; list of neurotransmitters; list of toxins, molecules, vessels, and spinal segments.

Option sets could include a list of laboratory results; list of additional physical signs; autopsy results; results of microscopic examination of fluids, muscle or joint tissue; DNA analysis results, and serum levels.

Option sets could include a list of underlying mechanisms of the disease; drugs or drug classes that might cause side effects; toxic agents; hemodynamic mechanisms, viruses, and metabolic defects.

Items Related to Physician Tasks 48

The classic diagnosis item begins with a patient description (including age, sex, symptoms and signs and their duration, history, physical findings on exam, findings on diagnostic and lab studies) and ends with a question:

• - Which of the following is the most likely diagnosis?
• - Which of the following is the most appropriate next step in diagnosis?
• - Which of the following is most likely to confirm the diagnosis?

Management:

Questions to ask include:

• - Which of the following is the most appropriate initial or next step in patient care?
• - Which of the following is the most effective management?
• - Which of the following is the most appropriate pharmacotherapy?
• - Which of the following is the first priority in caring for this patient? (eg, in the emergency department).

Health and Health Maintenance:

The following lead-ins are examples of those used in this category:

• - Which of the following immunizations should be administered at this time?
• - Which of the following is the most appropriate screening test?
• - Which of the following tests would have predicted these findings?
• - Which of the following is the most appropriate intervention?
• - For which of the following conditions is the patient at greatest risk?
• - Which of the following is most likely to have prevented this condition?
• - Which of the following is the most appropriate next step in the management to prevent [morbidity/mortality/disability]?
• - Which of the following should be recommended to prevent disability from this injury/condition?
• - Early treatment with which of the following is most likely to have prevented this patient's condition?
• - Supplementation with which of the following is most likely to have prevented this condition?

Mechanisms of Disease:

Begin your mechanism items with a clinical vignette of a patient and his/her symptoms, signs, history, laboratory results, etc., then ask a question such as one of these:

• - Which of the following is the most likely explanation for these findings?
• - Which of the following is the most likely location of the patient's lesion?
• - Which of the following is the most likely pathogen?
• - Which of the following findings is most likely to be increased/decreased?
• - A biopsy is most likely to show which of the following?

ACKNOWLEDGMENT

The author wishes to gratefully acknowledge and express his gratitude to all professors who have provided him with comments, with special gratitude to Professor Eiad A. Al Faris, Professor Ahmed A. Abdel Hameed and Dr. Ibrahim A Alorainy (College of Medicine, King Saud University) for their support.

• Research article
• Open access
• Published: 02 February 2016

Case-based learning and multiple choice questioning methods favored by students

• Magalie Chéron 1 ,
• Mirlinda Ademi 2 ,
• Felix Kraft 3 &
• Henriette Löffler-Stastka 1  

BMC Medical Education volume  16 , Article number:  41 ( 2016 ) Cite this article

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Investigating and understanding how students learn on their own is essential to effective teaching, but studies are rarely conducted in this context. A major aim within medical education is to foster procedural knowledge. It is known that case-based questioning exercises drive the learning process, but the way students deal with these exercises is explored little.

This study examined how medical students deal with case-based questioning by evaluating 426 case-related questions created by 79 fourth-year medical students. The subjects covered by the questions, the level of the questions (equivalent to United States Medical Licensing Examination Steps 1 and 2), and the proportion of positively and negatively formulated questions were examined, as well as the number of right and wrong answer choices, in correlation to the formulation of the question.

The evaluated case-based questions’ level matched the United States Medical Licensing Examination Step 1 level. The students were more confident with items aiming on diagnosis, did not reject negatively formulated questions and tended to prefer handling with right content, while keeping wrong content to a minimum.

These results should be taken into consideration for the formulation of case-based questioning exercises in the future and encourage the development of bedside teaching in order to foster the acquisition of associative and procedural knowledge, especially clinical reasoning and therapy-oriented thinking.

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Trying to understand how students learn on their own, aside from lectures, is essential to effective teaching. It is known that assessment and case-based questioning drive the learning process. Studies have shown that the way assessment is being conducted influences students’ approach to learning critically [ 1 ]. Several written methods are used for the assessment of medical competence: Multiple Choice Questions (MCQs), Key Feature Questions, Short Answer Questions, Essay Questions and Modified Essay Questions [ 2 ]. Based upon their structure and quality, examination questions can be subdivided into (1) open-ended or multiple choice and (2) context rich or context poor ones [ 3 , 4 ].

Well-formulated MCQs assess cognitive, affective and psychomotoric domains and are preferred over other methods because they ensure objective assessment, minimal effect of the examiner’s bias, comparability and cover a wide range of subjects [ 5 ]. Context rich MCQs encourage complex cognitive clinical thinking, while context poor or context free questions mainly test declarative knowledge (facts, “what” information), which involves pure recall of isolated pieces of information such as definitions or terminologies. In contrast, procedural knowledge (“why” and “how” information) requires different skills: Students are encouraged to understand concepts and to gather information from various disciplines in order to apply their knowledge in a clinically-oriented context. Remarkably, prior clinical experience has been suggested to be a strong factor influencing students’ performance in procedural knowledge tasks [ 6 , 7 ]. With the focus of teaching students to think critically, test items must require students to use a high level of cognitive processing [ 3 ]. A successful approach is using Extended Matching Items (EMIs), consisting of clinical vignettes [ 2 ]. This format is characteristic for examination questions in Step 2 of the United States Medical Licensing Examination (USMLE) [ 8 ]. Step 2 items, test the application of clinical knowledge required by a general physician and encourage examinees to make clinical decision rather than to simply recall isolated facts [ 6 ]. As a well-established examination format introduced by the National Board of Medical Examiners (NBME) USMLE question criteria served for the comparison in our study.

Case-based learning (CBL) has gained in importance within past years. This well-established pedagogical method has been used by the Harvard Business School since 1920 [ 9 ]. Nevertheless, there is no international consensus on its definition. CBL as introduced to students of the Medical University of Vienna (MUV, Austria) in Block 20 is inquiry-based learning demanding students to develop clinical reasoning by solving authentic clinical cases presented as context rich MCQs. Generally, exposing students to complex clinical cases promotes (1) self-directed learning, (2) clinical reasoning, (3) clinical problem-solving and (4) decision making [ 9 ]. In contrast to other testing formats CBL facilitates deeper conceptual understanding. As students see the direct relevance of the information to be learnt, their motivation increases and they are more likely to remember facts. Studies showed that CBL fosters more active and collaborative learners and that students enjoy CBL as a teaching method [ 9 ]. This is in line with the improving results from the students’ evaluation of the course Psychic Functions in Health and Illness and Medical Communication Skills-C ( Block 20/ÄGF-C ) performed in 2013 [ 10 ] and 2014 [ 11 ] at the MUV. A Likert scale ranging from 1 (very bad) to 4 (very good) was used to evaluate the quality of the lectures: The mean grade improved from 1.6 in 2013 to 3 one year later, after the introduction of online case-based exercises related to the lectures. Therefore, based upon the assumption that students tend to prefer practical learning, the development of case-based question driven blended-learning will be further encouraged at the MUV, in order to aim for an effective training for the fostering of procedural knowledge, necessary for clinical reasoning processes and clinical authentic care.

There are no published studies analyzing the way medical students construct MCQs regarding their level of clinical reasoning. To learn more about how students deal with case-based questioning we analyzed student-generated MCQs. The study gives important insights by examining students’ way of reasoning, from formal reasoning using only declarative knowledge to clinical and procedural reasoning based on patients’ cases. Moreover, this study allows to observe to what extent negatively formulated questions, a rarely used format in exams, may not be a problem for students.

This analysis is based on the evaluation of a compensatory exercise for missed seminars completed by students in their fourth year of medical studies at the MUV, after attending their first course on psychic functioning ( Block 20/ÄGF-C ). The 5-week-long Block 20 [ 12 ] focused on the fundamentals of psychic functions, the presentation of the most important psychological schools and on the significance of genetic, biological, gender-related and social factors, as well as on the presentation of psychotherapeutic options and prevention of psychic burden [ 13 ]. Basis of the doctor-patient communication and of psychological exploration techniques were offered [ 12 ]. To pass Block 20 , all students had to take part to the related online CBL [ 14 ] exercise. This exercise presented patients cases including detailed information on diagnosis and therapy, subdivided in psychotherapy and pharmacology. The students had to answer MCQ concerning each diagnostic and therapeutic step.

The current study was approved by the ethics committee of the Medical University of Vienna, students gave informed consent to take part and data is deposited in publicly available repositories (online CBL exercise) after finishing the study. The students were instructed to create MCQs with 4–5 answer possibilities per question, related to cases of patients with psychopathological disorders presented in the online CBL exercise and in the lectures’ textbook of the Block 20 [ 15 ]. The “One-Best Answer” format was recommended. Additionally, the students were required to explain why the answers were right or wrong. MCQ examples were offered to the students in the online CBL exercise.

The authors performed the assessment and classification of the students’ MCQs after group briefings. A final review was done by MC to ensure inter-rater reliability, it was stable at k  = .73 between MC and HLS.

Subjects covered by the questions

The proportions of epidemiology, etiology/pathogenesis, diagnosis and therapy oriented items were examined. In order to simplify the classification, etiology and pathogenesis items were gathered into one group. Items asking for symptoms, classifications (e.g. ICD 10 criteria) as well as necessary questions in the anamnesis were gathered as diagnosis items. Among the therapy items, the frequency of items concerning psychotherapy methods and pharmacology was also compared. The proportion of exercises including at least one diagnosis item and one therapy item was observed. These subjects were chosen according to the patient cases of the CBL exercises and the lectures’ textbook.

Level of the questions

The level of the questions was evaluated in comparison to USMLE equivalent Steps 1 and 2, as described by the NBME. While Step 1 questions (called recall items ) test basic science knowledge, “every item on Step 2 provides a patient vignette” and tests higher skills. Step 2 questions are necessarily application of knowledge items and require interpretation from the student [ 6 ].

To assess the level of the items, 2 further groups were created, distinguishing items from the others. Examples of Step 1 and Step 2 Items’ stems offered by the students:

Step 1: “What is the pharmacological first line therapy of borderline patients?” (Item 31) Step 2: “M. Schlüssel presents himself with several medical reports from 5 specialists for neurology, orthopedics, trauma surgery, neuroradiology and anesthesia, as well as from 4 different general practitioners. Diagnostic findings showed no evidence for any pathology. Which therapy options could help the patient?” (Item 86)

Further, “Elaborate Items” were defined by the authors as well thought-out questions with detailed answer possibilities and/or extensive explanations of the answers.

Finally, “One-Step questions” and “n-steps questions” were differentiated. This categorization reflects the number of cognitive processes needed to answer a question and estimates the complexity of association of a MCQ. Recall items are necessarily one-step questions, whereas application of knowledge items may be one-step questions or multiple (n) steps questions. Because the evaluation of the cognitive processes is dependent on the knowledge of the examinee, the NBME does not give priority to this categorization anymore, although it gives information on the level and quality of the questions [ 6 ]. The previous example of a Step 2 question (Item 86) is an application of knowledge (Step 2) item categorized as n-Step item, because answering the question necessitates an association to the diagnosis, which is not explicitly given by the question. An example for a Step 2 question necessitating only one cognitive process would be: “A patient complains about tremor and excessive sweating. Which anamnestic questions are necessary to ask to diagnose an alcohol withdrawal syndrome?” (Item 232)

Formulation of the questions

The proportion of positively and negatively formulated questions created by the students was examined, as well as the number of right and wrong answer choices, in correlation to the formulation of the question.

Descriptive statistics were performed using SPSS 22.0 to analyze the subjects covered by the questions, their level and formulation, and the number of answer possibilities offered. The significance of the differences was performed using the Chi-square Test or Mann–Whitney U Test, depending on the examined variable, after testing for normal distribution. A given p -value < .05 was considered statistically significant in all calculations.

The study included 105 compensation exercises, performed by 79 students, representing 428 MCQs. After reviewing by the examiner (HLS), who is responsible for pass/fail decisions on the completion and graduation concerning the curriculum element Block 20/ÄGF-C, followed by corrections from the students, two questions were excluded, because the answers offered were not corresponding to the MCQ’s stem. Finally, 426 questions remained and were analyzed.

The subjects covered by the 426 questions concerned the diagnosis of psychiatric diseases (49.1 %), their therapies (29.6 %) and their etiology and pathogenesis (21.4 %). 18 questions covered two subjects (Table  1 ).

Significantly more items concerned the diagnosis of psychiatric diseases than their therapies ( p  < .001, Chi-Square Test); 63.3 % of the students offered at least one item regarding diagnosis and one item regarding therapy in their exercise.

Among the therapy items, significantly more pharmacology items were offered than psychotherapy items (59 % versus 41 %; p  = .043, Chi-Square Test).

395 (92.7 %) of the questions were classified as Step 1-questions. Nevertheless, 199 (46.7 %) of the questions were elaborate. 421 (98.8 %) out of the 426 questions were One-Step questions, according to USMLE criteria (Table  1 ). From the 18 questions covering two subjects, 16 were Step 1-questions.

72.5 % of the questions were positively formulated, 27.5 % negatively. A significant difference was observed between the positively and negatively formulated questions regarding the number of right answers: Table  2 shows the distribution of the number of right answers, depending on the questions’ formulation. The students offered significantly more right answer possibilities per positive-formulated question than per negative-formulated questions ( p  < .001, Mann–Whitney U Test).

The positive-formulated questions had more often two or more right answers than the negative-formulated questions ( p  < .001, Chi-square value = 44.2).

The students also offered less answer possibilities per positive-formulated question than per negative-formulated question ( p  < .001, Mann–Whitney U Test). Further, Table  2 presents the distribution of the number of answers offered depending on the questions’ formulation. The proportion of questions with 4 answer possibilities instead of 5 is higher within the group of positive-formulated questions ( p  < .001, Chi-square value = 16.56). Regarding the proportion of elaborate questions depending on their formulation, there was no significant difference.

Twenty-nine (36.7 %) students offered only positively formulated questions. The students who formulated at least one question negatively (63.3 %) formulated 41.1 ± 22.4 % of their questions negatively.

Many more questions aiming on diagnosis

At the end of year 4, students of the MUV had had various lectures but hardly any actual experiences with therapies. This may explain why significantly more items concerned the diagnosis of psychiatric diseases than their therapies.

Among questions aiming on therapy, significantly more concerned pharmacotherapy than psychotherapy

Before Block 20 , the seminars concerning therapies in the MUV Curriculum were almost exclusively pharmacological. After successful attendance of Block 20 most students who did not have any personal experience of psychotherapy only had little insight into how psychotherapy is developing on the long-term and what psychotherapy can really provide to the patient. Psychotherapy associations were still loaded with old stereotypes [ 13 , 16 ]. This could explain why significantly more therapy questions addressed pharmacology than psychotherapy.

A huge majority of Step 1 questions

The students mainly offered Step 1 questions. It can be questioned, whether the lack of case-oriented questions was an indication for insufficient clinical thinking by the students. An essential explanation could be that students lacked adequate patient contact until the end of year four. Indeed, MUV students were allowed to begin their practical experience after year two and eight compulsory clerkship weeks were scheduled before the beginning of year five [ 17 ]. Thus, Austrian medical students gained consistent clinical experience only after year four, with rotations in year five and the newly introduced Clinical Practical Year in year six. A European comparison of medical universities’ curricula showed that students of other countries spent earlier more time with patients: Dutch, French and German medical students began with a nursing training in year one and had 40, 10 and 4 months, respectively, more clerkship experience than Austrian students before entering year five [ 18 – 21 ]. French and Dutch universities are extremely centered on clinical thinking, with a total of 36 clerkship months in France and the weekly presence of patients from the first lectures on in Groningen [ 22 ]. Thus, it would be interesting to repeat a similar case-based exercise in these countries to explore if medical students at the same educational stage but with more practical experience are more likely to offer patient vignette items.

Students preferred to work with right facts and did not reject negatively worded questions

As negatively worded questions were usually banished from MCQ exams, it was interesting to observe that medical students did not reject them. In fact, negatively formulated questions are more likely to be misunderstood. Their understanding correlates to reading ability [ 23 ] and concentration. Although many guidelines [ 6 , 24 ] clearly advised to avoid negative items, the students generated 27.5 % of negatively formulated questions. Also Pick N format -questions with several right answers were offered by the students, despite the recommendations for this exercise: They offered significantly less total answer possibilities but significantly more right answers to positively worded questions than to negatively worded questions. Those results supported the hypothesis that the students preferred handling right content while keeping wrong content to a minimum.

Several possible reasons can be contemplated. When students lack confidence with a theme and try to avoid unsuitable answer possibilities, it can be more difficult to find four wrong answers to a positively worded question instead of several right answers, which may be listed in a book. Furthermore, some students may fear to think up wrong facts to avoid learning wrong content. Indeed, among positively worded items, 26.6 % were offered with 3 or more right answers, which never happened for negatively worded items (Table  2 ).

Notably, “right answer possibilities” of negatively worded items’ stems as well as “wrong answer possibilities” of positively worded items’ stems are actually “wrong facts”. For example, the right answer of the item “Which of the following symptoms does NOT belong to ICD-10 criteria of depression?” (Item 177) is the only “wrong fact” of the 5 answer possibilities. Writing the 4 “wrong answers” of this question, which are actually the ICD-10 criteria for depression, can help the students learn these diagnostic criteria. On the contrary, the “right answers” to a positively worded item such as “Which vegetative symptoms are related to panic attacks?” (Item 121) are the true facts.

Finally, the students’ interest for right facts supports the theory that a positive approach, positive emotions and curiosity are favorable to learning processes. Indeed, asking for right content is a natural way of learning, already used by children from the very early age. The inborn curiosity — urge to explain the unexpected [ 25 ], need to resolve uncertainty [ 26 ] or urge to know more [ 27 ]— is shown by the amount of questions asked by children [ 28 , 29 ]. The students’ way to ask for right contents appears very close to this original learning process.

The inputs of developmental psychology, cognitive psychology as well as of neurosciences underline this hypothesis. Bower presented influences of affect on cognitive processes: He showed a powerful effect of people’s mood on their free associations to neutral words and better learning abilities regarding incidents congruent with their mood [ 30 ]. Growing neurophysiological knowledge confirmed the close relation between concentration, learning and emotions — basic psychic functions necessitating the same brain structures. The amygdala, connected to major limbic structures (e.g. pre-frontal cortex, hippocampus, ventral striatum), plays a major role in affect regulation as well as in learning processes [ 15 ], and the hippocampus, essential to explicit learning, is highly influenced by stress, presenting one of the highest concentrations of glucocorticoid receptors in the brain [ 31 ]. Stress diminishes the synaptic plasticity within the hippocampus [ 32 ], plasticity which is necessary to long-term memory.

Neuroscientific research also underlined the interdependence of cognitive ability and affect regulation. Salas showed on a patient after an ischemic stroke event with prefrontal cortex damage that, due to executive impairment and increased emotional reactivity, cognitive resources could not allow self-modulation and reappraising of negative affects anymore [ 33 ].

Considering this interdependence, right contents might be related to a positive attitude and positive affects among the students. It could be interesting to further research on this relation as well as on the students’ motivations concerning the formulation of the questions.

The combination of those reasons probably explains why the students offered significantly more wrong answers to negatively worded items and more right answers to positively worded items, both resulting in the use of more right facts. All the students’ assessment questions and associated feedback were used to create a new database at the MUV trying to integrate more right facts in case-based learning exercises in the future.

The main limitation concerns the small sample size and the focus on only one curriculum element. Further studies with convenient sampling should include other medical fields and bridge the gap to learning outcome research.

The evaluation of the questions offered by medical students in their fourth year at the MUV showed that the students were much more confident with items aiming on diagnosis. Among items aiming on therapy, they proved to be more confident with pharmacotherapy than with psychotherapy. These results, together with the improving evaluation of the Block 20 after introducing CBL exercises and the international awareness that case-based questioning have a positive steering effect on the learning process and foster the acquisition of associative and procedural knowledge, should encourage the further development of affective positively involving case-based exercises, especially with a focus on clinical reasoning and therapy-oriented thinking.

The development of bedside teaching and the implementation of clerkships from the first year of studies (e.g. a 4-week practical nursing training) could also be considered in order to stimulate earlier patient-centered thinking of the students of the MUV. A comparison with the level of clinical reasoning of medical students from countries where more practical experience is scheduled during the first year of study would be interesting.

Concerning assessment methods and particularly the formulation of case-based questions, the students did not reject negatively formulated questions, but showed a tendency to prefer working with right contents, while keeping wrong content to a minimum. This preference could be further explored and considered in the future for the formulation of MCQs in case-based exercises.

Availability of supporting data

Data of the patients’ cases, on which the MCQs created by the students were based on, can be found in the textbook of the curriculum element and lectures [ 15 ] and via the Moodle website of the Medical University of Vienna [ 34 ]. The Moodle website is available for students and teachers of the Medical University of Vienna with their username and password. The analyzed and anonymous datasets including the MCQs [ 34 ] are accessible on request directly from the authors.

Abbreviations

Case-based learning

Extended Matching Items

• Multiple Choice Question

Medical University of Vienna

National Board of Medical Examiners

United States Medical Licensing Examination

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Acknowledgment

Prof. Dr. Michel Slama.

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Department for Psychoanalysis and Psychotherapy, Advanced Postgraduate Program for Psychotherapy Research, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

Magalie Chéron & Henriette Löffler-Stastka

Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria

Mirlinda Ademi

Department of Anaesthesia, General Intensive Care and Pain Therapy, Medical University Vienna, Vienna, Austria

Felix Kraft

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Correspondence to Henriette Löffler-Stastka .

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MC carried out the study, performed the statistical analysis and drafted the manuscript. MA performed the statistical analysis and helped to draft the manuscript. FK participated in the design of the study and statistical analysis. HLS conceived of the study, participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

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Chéron, M., Ademi, M., Kraft, F. et al. Case-based learning and multiple choice questioning methods favored by students. BMC Med Educ 16 , 41 (2016). https://doi.org/10.1186/s12909-016-0564-x

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Multiple Choice Questions: Top Strategies, Types, & Examples

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Sameer Bhatia is the Founder and Chief Executive Officer of ProProfs.com. He believes that software should make you happy and is driven to create a 100-year company that delivers delightfully ... Read more

Sameer Bhatia is the Founder and Chief Executive Officer of ProProfs.com. He believes that software should make you happy and is driven to create a 100-year company that delivers delightfully smart software with awesome support. His favorite word is 'delight,' and he dislikes the term 'customer satisfaction,' as he believes that 'satisfaction' is a low bar and users must get nothing less than a delightful experience at ProProfs. Sameer holds a Masters in Computer Science from the University of Southern California (USC). He lives in Santa Monica with his wife & two daughters. Read less

Market Research Specialist

Emma David, a seasoned market research professional, specializes in employee engagement, survey administration, and data management. Her expertise in leveraging data for informed decisions has positively impacted several brands, enhancing their market position.

From picking a vacation spot to deciding on your favorite ice cream flavor, making choices can be tough. But there’s one thing that can simplify even the most complex decisions: a clear list of options! Well, that’s what multiple-choice questions are all about – they present you with a range of possibilities, making it easier to identify the best fit for you.

Multiple-choice questions (MCQs) simplify decision-making by offering a set of clear options. A well-framed multiple-choice question survey follows a structured format, presenting respondents with clear and concise answer choices.

This format ensures consistency in the response collection process, making it easier to analyze and interpret the data.

In this blog, we will explore various MCQ types and examples in detail to help you create engaging questions for your audiences.

Let’s go!

What are Multiple Choice Questions?

Multiple choice questions (MCQs) are a type of assessment item or survey question that presents respondents with several answer options, out of which they must select the one correct answer or, in some formats, multiple correct answers.

MCQs are widely used in educational testing, surveys, and quizzes because they are straightforward to administer and score, making them efficient for both large and small groups. 

They can assess a wide range of knowledge, from basic recall of facts to application, analysis, and evaluation of information.

An example of a popular MCQ question is:

Which of the following aspects of our product/service did you find most impressive?

• A) Speed and Efficiency
• B) User-Friendly Interface
• C) Quality and Reliability
• D) Customer Support
• E) Pricing and Value for Money

A multiple-choice question and answer consists of several important parts:

• Stem : The stem refers to the main question or statement. The stem should be clear, straightforward, and written in simple language.
• Distractors : Distractors are incorrect options that are used to distract and challenge the respondent. You must carefully pick the distractors so as not to seem too obvious.
• Answer : This is the correct answer to the stem or question. There may be more than one correct answer in some cases, and the respondent is allowed to make multiple selections.

How to Write a Multiple-Choice Question?

Creating an effective multiple-choice question (MCQ) involves careful planning and construction to ensure it accurately assesses knowledge, comprehension, or application skills. Here’s a detailed guide on how to craft a multiple-choice question:

1. Define the Objective

Start by determining what the question is intended to assess. Is it factual knowledge, conceptual understanding, application of skills, or analysis and evaluation? Clearly defining the objective will guide the development of both the stem and the distractors.

2. Write the Stem

The stem is the part of the MCQ that poses the question or problem. It should be clearly written, focused, and free of unnecessary information. Ensure the stem presents a single, clear problem or question that can be understood without reading the options first.

• Direct Question : Pose a direct question that requires an answer.
• Incomplete Statement : Present a statement that the respondent must complete with the correct option.
• Scenario-based : Provide a scenario or case study that leads to a question, testing application, and analysis skills.

3. Develop the Options

• Key : This is the correct answer to the question. It should be indisputably correct and fully supported by the content being tested.
• Distractors : These are the incorrect answers. Good distractors are plausible, based on common misconceptions, errors, or closely related concepts, making the question challenging but fair.

4. Maintain Option Consistency

• Length and Form : All options should be similar in length and complexity. An outlier can often be mistakenly identified as the correct answer.
• Content : Options should be homogeneous in content type (all dates, all theories, etc.) to avoid clues to the correct answer.
• Grammar : Ensure that grammatically, all options fit seamlessly with the stem.

5. Avoid Common Pitfalls

• Avoid Absolutes : Words like “always” or “never” can make distractors obviously wrong.
• Randomize Option Order : The position of the correct answer should vary from question to question.
• Use “All of the Above” and “None of the Above” Sparingly : These can sometimes give away the answer or invalidate the question if not used carefully.

6. Review and Revise

After drafting, review the question to ensure it meets the objective, is clear and unambiguous, and that the distractors are plausible but not too similar to the correct answer. Pilot testing with a small group can help identify issues before the MCQ is used more widely.

7. Consider Higher-Order Thinking

Whenever possible, design MCQs that test higher-order thinking skills rather than mere recall of facts. Questions that require analysis, synthesis, and evaluation to arrive at the answer are more challenging and provide a better assessment of the respondent’s understanding and ability to apply knowledge.

12 Types of Multiple-Choice Questions

If you thought that a multiple-choice question only includes a typical question with four options, you might be wrong. You will be surprised to know that at least 12 different types of MCQs can be used for different purposes. Let’s explore them right away.

1. Yes or No

This is a widely used multiple-choice question that offers two obvious options – “Yes” or “No”. It can be used to ask a direct question such as ‘Would you recommend our business to your friends or family members?’ or ‘Does our product serve your purpose?’.

One demerit of this question is that although you can capture feedback, you will not know the reason behind why someone gave a “no” or a “yes” as an answer. Therefore, to make sense of your data, you also need to add an open-ended question.

2. True or False

The “True” or “False” questions are some of the most commonly used multiple-choice questions. It includes the stem (question or statement) and two answer options – True and False. These questions are used to test critical thinking and evaluate the respondent’s knowledge by challenging them to choose the correct option.

If you wish to engage your audience in a challenging game or teach them something new, this is the way to go.

3. Odd One Out

The “odd one out” question provides several options to respondents and asks them to choose an option that does not match the others or seems the most “odd.”

Such questions are used to test people’s ability to form relationships between ideas. The odd one out question is quite popular among school students. Let’s look at the example below to gain more clarity.

4. Image-Based Multiple Choice Question

As the name suggests, this type of MCQ presents two or more images as response options. To answer this question, the respondent can select a single image or multiple images if it is specified. Image-based questionnaires are visually appealing, highly interactive, and can be used to engage your target audience.

These questions are used where visual representation is needed. For example, Google offers a service called ReCAPTCHA that uses smart image-based questions to identify humans and prevent bots from causing security threats.

5. Best Answer

This type of question can be quite challenging for people to answer. But why? Well, in most cases, the options include more than one answer that might seem correct at first glance. However, the correct answer is the one that is the truest.

The “best answer” question can be used to understand what people think or perceive about different situations. Let’s understand this better with this multiple-choice question example:

6. Single-Select Multiple-Choice Questions

This is a common type of multiple-choice question where the respondent is allowed to select a single option from a list of options. The dropdown menu is a great example of a single select question.

Single-select questions work best when presenting a long list of options. Whether someone is on their smartphone or laptop, the respondents can easily scroll through the options and select the right answer.

7. Multiple Select Questions

Unlike single-select questions, the respondent can select more than one option in multiple select questions. While taking orders, such questionnaires are often used by restaurants as the customers can easily customize their meals.

In some cases, these questions also offer the “Select All” or “All of the Above” option so that respondents can easily select this option without having to pick and choose specific options. Multiple select questions offer more freedom and flexibility to respondents compared to other types of MCQ questions.

8. Star Rating Multiple Choice Question

Star rating is another popular multiple-choice question type that allows respondents to answer on a rating scale . Respondents are usually offered a 1-5 or 1-7 rating scale, where 5 or 7 stars denote the highest satisfaction. Such questions are quite interactive, easy to answer and work great on mobile devices.

These types of questions are usually used by businesses to get customer reviews on their products or services. For example, you must have received a survey asking you to rate your cab ride experience once you reached your destination. Instead of stars, you can even use other types of rating scales such as “Thumbs up” or “Smileys”.

9. Matrix Table Multiple Choice Question

A matrix table question allows you to ask multiple questions or multiple parts of a single question. For example, you can take feedback about the various elements of your website – design, user interface, image quality, browsing experience , product descriptions, payment options, etc.

The multiple questions or elements are accompanied by a three-point or five-point Likert scale . However, if not executed correctly, matrix table questions can confuse your respondents. Here is a sample multiple-choice question with answer options:

10. Slider Multiple Choice Question

This is another type of multiple-choice question in which the respondent can use a slider to answer the given question. The slider can be adjusted to a numeric value that best describes their answer.

For example, you can share the classic NPS question : “How likely are you to recommend our brand to your friends or colleagues?” The customers can adjust the slider and rate their answers on a scale of 1-10. For a better understanding, you can look at this multiple-choice example below:

11. Ranking Multiple Choice Question

A ranking multiple choice question allows respondents to rank the answer options based on their importance or priority. The respondent can first compare all the options against each other and then rank them accordingly.

To make this question work, you will have to present a numerical drop-down box for each answer option. This will help the respondent allocate the correct numerical value to each option. Such questions can be helpful when you wish to know a person’s opinion or perception about particular topics.

12. Drag & Drop Question

In these types of multiple-choice questions, the respondent can drag and drop the answer options to arrange them in the most suitable order. This is quite similar to a ranking question; however, the respondent can simply drag and drop options to achieve the best order instead of assigning a numerical value.

The drag-and-drop questions are quite interactive in nature and can lead to a fun survey experience for your customers. Educators can also use them to teach young kids. Let’s take a look at this example below:

Watch: How to Collect Customer Feedback

Advantages of Using Multiple-Choice Questions

Well, it will not be wrong to say that a multiple-choice questionnaire means multiple benefits. Let’s explore some of the top advantages of MCQs.

1. Convenient

Imagine you ordered food online and received it well on time. Now, the app asks you to rate the delivery partner on a scale of 1-5. By spending just a couple of seconds, you can rate the delivery partner and appreciate them for a job well done. Yes, MCQs are really that convenient!

Whether you are taking an application form or sharing feedback with your favorite brand, you can fill MCQs anytime and from anywhere. As long as there are fewer questions to answer, it will not take a toll on your brain or body.

2. Gathers Objective Data

There are situations when you don’t need the subjective opinions of your respondents. For example, if you wish to know the most popular election candidate, you can simply present the names of the people who are contesting. Taking subjective opinions about the importance of elections or democracy will not serve any purpose here.

With multiple-choice questions, you can get objective data that is both observable as well as measurable. This helps you achieve your research goals faster.

3. Takes Less Time to Complete

Multiple-choice questionnaires take less time to complete in comparison to open-ended questions. For instance, if students are asked to write an essay for a test instead of answering MCQs, they will take more time.

Similarly, a business can share short MCQ surveys with customers and allow them to complete them at their convenience. When customers know that such questions will take less time to complete, the business can enjoy higher survey response rates.

4. Makes Data Analysis Simpler

With multiple-choice questions, you can easily automate your data analysis process. For example, in the case of student tests, automated grading can help teachers evaluate tests and grade students on a larger scale. Even if a thousand students are given the same test, grading can be easily done.

Moreover, when people are made to type their answers, there can be grammatical or typographical errors. However, you can reduce human errors and make data analysis easier when you provide selected response options.

How to Use Multiple Choice Questions in Your Survey

Multiple choice questions (MCQs) are a versatile and effective tool for gathering data in surveys. They provide structured response options that make it easy for respondents to provide feedback, opinions, or information. Here’s a detailed guide on how to use multiple choice questions effectively in your survey:

• Define Your Objectives : Before designing your survey, clearly define the objectives and what information you aim to collect. Determine the specific topics or areas you want to cover with multiple choice questions.
• Choose the Right Type of MCQs : Consider the nature of your survey and the type of data you want to collect when selecting the appropriate types of multiple choice questions. Decide whether single-select, multi-select, rating scales or other formats best suit your needs.
• Keep It Clear and Concise : Ensure that each multiple choice question is clear, concise, and easy to understand. Use simple language and avoid ambiguity to prevent confusion among respondents.
• Limit the Number of Options : Provide a reasonable number of response options to prevent respondent fatigue and ensure accurate data collection. Too many options can overwhelm respondents and lead to lower response rates or incorrect selections.
• Include an “Other” Option : If applicable, include an “Other” option to allow respondents to provide additional answers or specify options not listed. This ensures inclusivity and captures diverse responses.
• Randomize Response Options : To minimize order bias, consider randomizing the order of response options for each multiple choice question. This prevents the first or last option from receiving disproportionate selections.
• Use Logical Ordering : Arrange response options in a logical order, such as alphabetical or chronological, to facilitate easy navigation for respondents. This enhances the survey experience and reduces cognitive load.
• Provide Clear Instructions : Include clear instructions at the beginning of the survey and before each multiple choice question to guide respondents on how to answer. Clarify whether they should select one or multiple options and any specific criteria for response selection.
• Pilot Test Your Survey : Before distributing your survey, pilot test it with a small group of participants to identify any ambiguities, errors, or issues with the multiple choice questions. Revise and refine as needed based on feedback.
• Balance Closed and Open-ended Questions : While multiple choice questions offer structured response options, balance them with open-ended questions to capture nuanced responses and qualitative insights. This combination provides a comprehensive understanding of the topic.
• Add Visual Enhancements : Incorporate visual elements such as images, icons, or color-coded scales in your surveys to enhance the visual appeal and engagement of multiple choice questions. Visual stimuli can improve comprehension and response accuracy.
• Segment Questions Appropriately : Group multiple choice questions logically and segment them into sections or categories based on themes or topics. This organization helps respondents navigate the survey more efficiently and maintains their interest.
• Monitor Response Quality : Regularly monitor response quality and data integrity throughout the survey administration process. Implement quality checks and validation measures to identify and address any anomalies or inconsistencies.
• Respect Respondent Privacy and Anonymity : Ensure confidentiality and anonymity in survey responses whenever possible to encourage honest and candid feedback. Clearly communicate how respondent data will be used and protected to build trust and confidence.
• Analyze and Interpret Results : After collecting survey responses, analyze the data from multiple choice questions systematically. Use statistical methods, charts, and graphs to interpret the results and draw meaningful conclusions.

How to Create a Survey With Multiple Choice Questions Using ProProfs Survey Maker

It is really easy to create a multiple choice question survey using ProProfs Survey Maker. Depending on your requirements, you can create the survey from scratch or select one from our wide range of templates categorized under Customer , Employee , Education , Market Research , Event , and Course Feedback .

Step 1: On your ProProfs Survey Maker Dashboard, click + Create a Survey .

Step 2: Click Create Survey .

Step 3: Click on the + Create from Scratch button to get started. You can also choose to click on the Create button, as shown in the bottom left corner of the screenshot.

Step 4 : You’ll arrive in the editor, where you can add several elements to your survey, like questions, themes, branding, logo, and so on. Start by giving a name to your survey by clicking Untitled Survey .

Step 5 : Give a title to your survey in the sa text box. You can add a description and image as well. Once you’re done, click Save to go back to the editor.

Step 6: Back in the editor, click More >> Popular Settings, where you can choose the number of questions per page in a survey. You can also select the order of questions and answers that you want to display to each respondent.

Step 6.1: Apply a theme to your survey by clicking the Popular Themes dropdown setting. Customize the theme further by applying your company logo, background image, colors , and more by clicking the Customize your theme option.

Step 7: Go to “ Add Question” and select “ Multiple Choice” as your question type. Edit the questions and options to place your questions and options. You can also click “ Generate with ProProfs AI” to get a readymade questionnaire in seconds!

Step 7: Click “ Preview” to see how the survey will appear to the viewer. Once you’ve created the survey and are happy with the way it looks, click “ Done .” Congratulations, your survey is ready to use!

Create the Best Multiple-Choice Questions for Your Surveys

Due to their versatile nature, multiple-choice questions have gained popularity in education, market research, customer feedback, product development, and many others.

To create the best multiple-choice questionnaire, you need to provide accurate and relevant answer options, keep the language simple, and add the “others” option whenever possible. With well-framed MCQs, you can collect comprehensive data and research your target audience faster.

With ProProfs Survey Maker , you can go for multiple-choice or 20 other question types such as rating scale, NPS scale, text box, etc. You can also choose from our library of 1000,000+ ready-to-use questions or simply create one from scratch. Customize the various elements of your question, add branching to answers, and share your questionnaire via email, social media, or by embedding it on your website.

Yes, collecting the right information is really that simple now!

Frequently Asked Questions

What are the parts of a multiple-choice question.

Multiple-choice questions typically consist of a stem, which is the main question or statement, along with options, one of which is the correct answer, and distractors, which are incorrect options meant to confuse respondents.

When should I use multiple choice questions in my survey?

Multiple-choice questions are best used when there are clear, distinct answer options and can be effective for assessing knowledge, opinions, preferences, or demographics. They are particularly suitable for large-scale surveys to streamline analysis.

What are some of the tips for writing multiple-choice questions?

When writing multiple-choice questions, keep them clear, concise, and free from ambiguity. Ensure that all options provided are plausible and mutually exclusive, avoiding double negatives or overly complex language. Consistent formatting and grammar throughout the questions are crucial, and randomizing answer orders can help mitigate order bias among respondents.

About the author

Emma David is a seasoned market research professional with 8+ years of experience. Having kick-started her journey in research, she has developed rich expertise in employee engagement, survey creation and administration, and data management. Emma believes in the power of data to shape business performance positively. She continues to help brands and businesses make strategic decisions and improve their market standing through her understanding of research methodologies.

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Case study means

A. organising social data

B. verifying hypothesis

C. overlooking

Answer & Explanation

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Sociology is the study of

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Appearance of Ibn-e-Khaldum was in

A. 1332-1406 AD

B. 1336-1409 AD

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In common parlance, a person is said to be cultured if he is

A. polished in manners

B. Polite in speech

C. refined in tastes

D. all three

The classic definition of culture is given by anthropologist

A. Tylor Reads

B. Adam Smith

C. Thomas Malthus

One of the following is not the characterietics of the culture?

A. It preserves features of the past.

B. It discards what is socially condemned.

C. It is found both in the animal and the human society.

D. It is found only in human society.

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In the tech world and beyond, new 5G applications are being discovered every day. From driverless cars to smarter cities, farms, and even shopping experiences, the latest standard in wireless networks is poised to transform the way we interact with information, devices and each other. What better time to take a closer look at how humans are putting 5G to use to transform their world.

What is 5G?

5G (fifth-generation mobile technology  is the newest standard for cellular networks. Like its predecessors, 3G, 4G and 4G LTE, 5G technology uses radio waves for data transmission. However, due to significant improvements in latency, throughput and bandwidth, 5G is capable of faster download and upload speeds than previous networks.

Since its release in 2019, 5G broadband technology has been hailed as a breakthrough technology with significant implications for both consumers and businesses. Primarily, this is due to its ability to handle large volumes of data that is generated by complex devices that use its networks.

As mobile technology has expanded over the years, the number of data users generate every day has increased exponentially. Currently, other transformational technologies like  artificial intelligence (AI),  the  Internet of Things (IoT ) and  machine learning (ML)  require faster speeds to function than 3G and 4G networks offer. Enter 5G, with its lightning-fast data transfer capabilities that allow newer technologies to function in the way they were designed to.

Here are some of the biggest differences between 5G and previous wireless networks.

• Physical footprint : The transmitters that are used in 5G technology are smaller than in predecessors’ networks, allowing for discrete placement in out-of-the-way places. Furthermore, “cells”—geographical areas that all wireless networks require for connectivity—in 5G networks are smaller and require less power to run than in previous generations.
• Error rates : 5G’s adaptive Modulation and Coding Scheme (MCS), a schematic that wifi devices use to transmit data, is more powerful than ones in 3G and 4G networks. This makes 5G’s Block Error Rate (BER)—a metric of error frequency—much lower. 
• Bandwidth : By using a broader spectrum of radio frequencies than previous wireless networks, 5G networks can transmit on a wider range of bandwidths. This increases the number of devices that they can support at any given time.
• Lower latency : 5G’s low  latency , a measurement of the time it takes data to travel from one location to another, is a significant upgrade over previous generations. This means that routine activities like downloading a file or working in the cloud is going to be faster with a 5G connection than a connection on a different network.

Like all wireless networks, 5G networks are separated into geographical areas that are known as cells. Within each cell, wireless devices—such as smartphones, PCs, and IoT devices—connect to the internet via radio waves that are transmitted between an antenna and a base station. The technology that underpins 5G is essentially the same as in 3G and 4G networks. But due to its lower latency, 5G networks are capable of delivering faster download speeds—in some cases as high as 10 gigabits per second (Gbps).

As more and more devices are built for 5G speeds, demand for 5G connectivity is growing. Today, many popular Internet Service Providers (ISPs), such as Verizon, Google and AT&T, offer 5G networks to homes and businesses. According to Statista,  more than 200 million homes  and businesses have already purchased it with that number expected to at least double by 2028 (link resides outside ibm.com).

Let’s take a look at three areas of technological improvement that have made 5G so unique.

New telecom specifications

The 5G NR (New Radio) standard for cellular networks defines a new radio access technology (RAT) specification for all 5G mobile networks. The 5G rollout began in 2018 with a global initiative known as the 3rd Generation Partnership Project (3FPP). The initiative defined a new set of standards to steer the design of devices and applications for use on 5G networks.

The initiative was a success, and 5G networks grew swiftly in the ensuing years. Today, 45% of networks worldwide are 5G compatible, with that number forecasted to rise to 85% by the end of the decade according to  a recent report by Ericsson  (link resides outside ibm.com).

Independent virtual networks (network slicing)

On 5G networks, network operators can offer multiple independent virtual networks (in addition to public ones) on the same infrastructure. Unlike previous wireless networks, this new capability allows users to do more things remotely with greater security than ever before. For example, on a 5G network, enterprises can create use cases or business models and assign them their own independent virtual network. This dramatically improves the user experience for their employees by adding greater customizability and security.

Private networks

In addition to network slicing, creating a 5G private network can also enhance personalization and security features over those available on previous generations of wireless networks. Global businesses seeking more control and mobility for their employees increasingly turn to private 5G network architectures rather than public networks they’ve used in the past.

Now that we better understand how 5G technology works, let’s take a closer look at some of the exciting applications it’s enabling.

Autonomous vehicles

From taxi cabs to drones and beyond, 5G technology underpins most of the next-generation capabilities in autonomous vehicles. Until the 5G cellular standard came along, fully autonomous vehicles were a bit of a pipe dream due to the data transmission limitations of 3G and 4G technology. Now, 5G’s lightning-fast connection speeds have made transport systems for cars, trains and more, faster than previous generations, transforming the way systems and devices connect, communicate and collaborate.

Smart factories

5G, along with AI and ML, is poised to help factories become not only smarter but more automated, efficient, and resilient. Today, many mundane but necessary tasks that are associated with equipment repair and optimization are being turned over to machines thanks to 5G connectivity paired with AI and ML capabilities. This is one area where 5G is expected to be highly disruptive, impacting everything from fuel economy to the design of equipment lifecycles and how goods arrive at our homes.

For example, on a busy factory floor, drones and cameras that are connected to smart devices that use the IoT can help locate and transport something more efficiently than in the past and prevent theft. Not only is this better for the environment and consumers, but it also frees up employees to dedicate their time and energy to tasks that are more suited to their skill sets.

Smart cities

The idea of a hyper-connected urban environment that uses 5G network speeds to spur innovation in areas like law enforcement, waste disposal and disaster mitigation is fast becoming a reality. Some cities already use 5G-enabled sensors to track traffic patterns in real time and adjust signals, helping guide the flow of traffic, minimize congestion, and improve air quality.

In another example, 5G power grids monitor supply and demand across heavily populated areas and deploy AI and ML applications to “learn” what times energy is in high or low demand. This process has been shown to significantly impact energy conservation and waste, potentially reducing carbon emissions and helping cities reach sustainability goals.

Smart healthcare

Hospitals, doctors, and the healthcare industry as a whole already benefit from the speed and reliability of 5G networks every day. One example is the area of remote surgery that uses robotics and a high-definition live stream that is connected to the internet via a 5G network. Another is the field of mobile health, where 5G gives medical workers in the field quick access to patient data and medical history. This enables them to make smarter decisions, faster, and potentially save lives.

Lastly, as we saw during the pandemic, contact tracing and the mapping of outbreaks are critical to keeping populations safe. 5G’s ability to deliver of volumes of data swiftly and securely allows experts to make more informed decisions that have ramifications for everyone.

5G paired with new technological capabilities won’t just result in the automation of employee tasks, it will dramatically improve them and the overall  employee experience . Take virtual reality (VR) and augmented reality (AR), for example. VR (digital environments that shut out the real world) and AR (digital content that augments the real world) are already used by stockroom employees, transportation drivers and many others. These employees rely on wearables that are connected to a 5G network capable of high-speed data transfer rates that improve several key capabilities, including the following:

• Live views : 5G connectivity provides live, real-time views of equipment, events, and even people. One way in which this feature is being used in professional sports is to allow broadcasters to remotely call a sporting event from outside the stadium where the event is taking place.
• Digital overlays : IoT applications in a warehouse or industrial setting allow workers that are equipped with smart glasses (or even just a smartphone) to obtain real-time insights from an application. This includes repair instructions or the name and location of a spare part.
• Drone inspections : Right now, one of the leading causes of employee injury is inspection of equipment or project sites in remote and potentially dangerous areas. Drones, which are connected via 5G networks, can safely monitor equipment and project sites and even take readings from hard-to-reach gauges.

Edge computing , a computing framework that allows computations to be done closer to data sources, is fast becoming the standard for enterprises. According to  this Gartner white paper  (link resides outside ibm.com), by 2025, 75% of enterprise data will be processed at the edge (compared to only 10% today). This shift saves businesses time and money and enables better control over large volumes of data. It would be impossible without the new speed standards that are generated by 5G technology. 

Ultra-reliable edge computing and 5G enable the enterprise to achieve faster transmission speeds, increased control and greater security over massive volumes of data. Together, these twin technologies will help reduce latency while increasing speed, reliability and bandwidth, resulting in faster, more comprehensive data analysis and insights for businesses everywhere.

5G solutions with IBM Cloud Satellite  

5G presents significant opportunities for the enterprise, but first, you need a platform that can handle its speed. IBM Cloud Satellite® lets you deploy and run apps consistently across on-premises, edge computing and public cloud environments on a 5G network. And it’s all enabled by secure and auditable communications within the IBM Cloud®.

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Summer of 2023 was hottest in 2,000 years, study finds

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An extreme summer marked by deadly heat waves, explosive wildfires and record warm ocean temperatures will go down as among the hottest in the last 2,000 years, new research has found.

The summer of 2023 saw the temperature in the Northern Hemisphere soar 3.72 degrees above the average from 1850 to 1900, when modern instrumental recordkeeping began, according to a study published Tuesday in the journal Nature. The study focused on surface air temperatures across the extra-tropical region, which sits at 30 to 90 degrees north latitude and includes most of Europe and North America.

June, July and August last year were also 3.96 degrees warmer than the average from the years 1 through 1890, which the researchers calculated by combining observed records with tree ring records from nine global regions.

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Jan Esper, the study’s lead author and a professor of climate geography at Johannes Gutenberg University in Germany, said that he was not expecting summer last year to be quite so anomalous, but that he was ultimately not surprised by the findings. The high temperatures built on an overall warming trend driven by greenhouse gas emissions and were further amplified by the onset of El Niño in the tropical Pacific.

“It’s no surprise — this really, really outstanding 2023 — but it was also, step-wise, a continuation of a trend that will continue,” Esper told reporters Monday. “Personally I’m not surprised, but I am worried.”

He said it was important to place 2023’s temperature extreme in a long-term context. The difference between the region’s previous warmest summer, in the year 246, and the summer of 2023 is 2.14 degrees, the study found.

The heat is even more extreme when compared with the region’s coldest summers — the majority of which were influenced by volcanic eruptions that spewed heat-blocking sulfur into the stratosphere. According to the study, 2023’s summer was 7.07 degrees warmer than the coldest reconstructed summer from this period, in the year 536.

“Although 2023 is consistent with a greenhouse gases-induced warming trend that is amplified by an unfolding El Niño event, this extreme emphasizes the urgency to implement international agreements for carbon emission reduction,” the study says.

The sweltering summer temperatures contributed to scores of heat illnesses and deaths, including at least 645 heat-associated deaths in Maricopa County, Ariz., where Phoenix saw temperatures of 110 degrees or hotter for a record 31 consecutive days.

Wildfires exacerbated by high temperatures raged across Canada and sent hazardous smoke down the East Coast of the United States and across the Atlantic. Meanwhile, ocean temperatures off Florida soared above 101 degrees , the temperature of a hot tub.

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Warmest April on record extends planet’s hot streak to 11 months

With an average surface temperature of 59.05 degrees, the month was about 0.25 of a degree warmer than the previous hottest April, in 2016.

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Multiple climate agencies, including the National Oceanic and Atmospheric Administration and the European Union’s Copernicus Climate Change Service, have declared 2023 the hottest year on record globally.

Notably, Copernicus found that the summer months of June, July and August last year measured 1.18 degrees warmer than average — still hot, but not nearly as warm as the study’s findings for the Northern Hemisphere’s extra-tropical region.

That region was especially hot in part because it is home to so much land, which warms faster than oceans, said Karen McKinnon, an assistant professor of statistics and the environment at UCLA who did not work on the study. (June, July and August are also winter months in the Southern Hemisphere.)

McKinnon said the study’s findings are not unexpected, as there was already good evidence that the summer of 2023 was record-breaking when compared with measurable data going back to the mid-1800s. But by going back 2,000 years, the researchers also helped illuminate “the full range of natural variability that could have occurred in the past,” she said.

She noted that tree rings can serve as a helpful proxy for climate conditions in the past, as trees tend to grow more in a given year if they receive the right amount of warmth, water and sunshine. But although last year’s heat was undeniable, the study also underscores that the summer temperature in this region was notably higher than the global target of 2.7 degrees — or 1.5 degrees Celsius — of warming over the preindustrial period, which was established by the Intergovernmental Panel on Climate Change in 2015.

It also notes that some recent research has found the data used to calculate that baseline may be off by several tenths of a degree, meaning it could need to be recalibrated, with the target landing closer to an even more challenging 1.6 or 1.7 degrees.

“I don’t think we should use the proxy instead of the instrumental data, but there’s a good indication that there’s a warm bias,” Esper said. “Further research is needed.”

World & Nation

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McKinnon said there is always going to be some degree of uncertainty when comparing present-day temperatures to past temperatures, but that the 1.5-degree limit is as symbolic as it is literal. Many effects of climate change, including worsening heat waves, have already begun.

“There are definitely tipping points in the climate system, but we don’t understand the climate system well enough to say 1.5 C is the temperature for certain tipping points,” she said. “This is just a policy goal that gives you a temperature change that maybe would be consistent with averting some damages.”

In fact, the study’s publication comes days after a survey of 380 leading scientists from the IPCC revealed deep concerns about the world’s ability to limit global warming to 1.5 degrees. That report, published last week in the Guardian , found that only 6% of surveyed scientists think the 1.5-degree limit will be met. Nearly 80% said they foresee at least 2.5 degrees Celsius of warming.

The report caused a stir among the scientific community, with some saying it focused too heavily on pessimism and despair. But Daniel Swain, a climate scientist with UCLA who participated in the survey, said its findings are worthy of consideration.

“There are many kinds of scientists, myself included, who are very worried and concerned and increasingly alarmed by what is going on and what the data is showing,” Swain said during a briefing Friday . “But if anything, I think that really results in a stronger sense of resolve and urgency to do even more, and to do better.”

Indeed, while scientists continue to weigh in on whether — or how quickly — humanity can alter the planet’s worsening warming trajectory, Esper said he hopes the latest study will serve as motivation for changing outdated modes of energy consumption that contribute to planet-warming greenhouse gases.

“I am concerned about global warming — I think it’s one of the biggest threats out there,” he said.

He added that he is particularly worried for his children and for younger generations who will bear the brunt of adverse climate outcomes. There is a strong likelihood that the summer of 2024 will be even hotter, the study says.

“The longer we wait, the more extensive it will be, and the more difficult it will be to mitigate or even stop that process and reverse it,” Esper said. “It’s just so obvious: We should do as much as possible, as soon as possible.”

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Hayley Smith is an environment reporter for the Los Angeles Times, where she covers the many ways climate change is reshaping life in California, including drought, floods, wildfires and deadly heat.

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