• Problem-based learning;
  • multiple choice questions;
  • assessment;
  • scenario-based questions;
  • cognitive skills;
  • medical and health professional education


For over 35 years, multiple choice questions (MCQs) have been used in the assessment of students in medical, dental, nursing, and physiotherapy courses. MCQs enable educators to test a broad range of topics in the curriculum. However, the educational goals of MCQs used currently are to test factual knowledge rather than a deeper understanding or use of information. They do not focus on testing cognitive skills, and many of them test small print in textbooks. With the introduction of problem-based learning in medical and health professional courses and a full shift from a traditional lecture-based curriculum to a student-centered program, many schools are currently reviewing their assessment tools and introducing new strategies that reflect the philosophy of the new curriculum. However, there is limited information in the literature to guide question writers and provide them with guidelines to construct new styles of MCQs that test higher-order thinking skills. This article provides 12 practical tips to help question writers in creating MCQs that test cognitive skills.