It’s Time to Write!

I know, it feels like the last one just ended. We are a little more than one month into the allotted time. Whether you have looked at your assignment or not, planning your time and content can make the process more effective and efficient. Here are six steps you can take to approach your work and make the most of your time.

Step 1: Schedule Time

Item writing takes time and energy. You have more than four months to help you balance this time with work commitments, vacation, and other challenges. One of the most valuable things you can do to maintain balance is try to identify blocks of time throughout the summer to work on your assignment.

Longer stretches of time can let you get into a groove, though you probably want to avoid writing your entire assignment in one sitting. Trying to accomplish too much at once may result in items that require more edits later. It is also important to leave time before the deadline for a final review before submission.

Step 2: Prepare Your Workspace

Taking time to gather necessary materials before you begin can increase efficiency. Helpful resources include your item writing assignment, the needed topic list(s), your new task area example lead-in questions card (let Emily know if you have misplaced yours and we’ll send you a new one!), task areas and objectives, adult laboratory values, reference books or websites, instructions for using images, and the beloved form and style guidelines. It also does not hurt to have some coffee, chocolate, or other preferred snacks available. Having a designated item writing folder or binder can help you keep things organized, particularly if you spread out your assignment over time. If you have space — and a patient family — it is even better to keep your workspace set up — it is even better to keep your workspace set up, saving you time the next time you are ready to write. See the image above for one example

Step 3: Map Out Your Assignment

Spending time up front determining the topics for each item can stave off writer’s block later. Developing a map for the assignment allows you to balance the topic distribution across your assigned content area in a strategic way. Identify the content area, task area, and topic of each item you are assigned. Make sure it makes sense for the task area. For End of Curriculum Exam Development Board members, make sure to map out the Bloom’s Taxonomy level, setting, and lifespan for each item as well.

Step 4: Write

Honestly, if time is invested in steps 1–3, writing the items becomes the easy part. When writing items, remember to start with a vignette. Clinical vignettes should include information in the following order:

• Patient age
• Gender
• Site of care
• Presenting symptom
• Duration of symptom
• Personal medical history
• Family medical history
• Current history of smoking, drinking, drug use
• Height/weight/body mass index
• Vital signs (temperature, pulse, respirations, and blood pressure. Pulse oximetry.)
• Physical examination findings
• Laboratory findings
• Urinalysis findings
• Imaging study results

Include the scenario in every question, even if the data are normal, so that students can make that determination just as they would with a patient (see this article for why). Make sure every item ends with a lead-in related to the appropriate task area. Answer options should all fit within a single task area category (i.e. they are all diagnoses, medications, or procedures) and be plausible, of similar length and complexity, and parallel in structure.

It is also helpful to keep items in draft form to allow time to step away and review again prior to submission or get feedback from your colleagues during office hours. The goal should be to submit the absolute best, highest quality item from the beginning. This will make small group, editorial, and eventually the Exam Development Summit review go as smoothly as possible.

Step 5: Item Checklist

It is a good idea to do a final check of the items before you hit submit. The following are some key points to make sure you have considered or accomplished:

• Correct number of items as assigned
• Each item matches the assigned content and task areas
• Items are written across the topic list
• Items are clinical vignettes
• Each item ends in a question that matches the task area
• There is a correct answer marked (and it is the only correct answer)
• The distractors are plausible
• Each item follows the Form and Style Guidelines (i.e. avoids the use of acronyms/abbreviations, included generic (Brand) for all medications, places the vital signs in the proper order, and includes C (F) for temperature)
• Medications mentioned are still on the market and the calculations (unit conversions, for instance) are correct
• The item is coded correctly
• The keyword is a diagnosis, not a description, with the first word capitalized and the rest lowercase unless it is a proper noun

Step 6: Submit…and Hope

Once you have written and reviewed each item, click submit. Then, sit back and hope everyone else thinks each item is as great as you do!

And remember, we’re here throughout the whole process if you have any questions.