True-False Test Items
There are different ways of classifying types of test items. One way is to group items according to how they are scored—objectively or subjectively. Another way is to group them by the type of response required of the test-taker. Selected-response items require the test-taker to select the correct or best answer from options provided by the teacher.
These items include true–false, matching exercises, multiple-choice, and multiple-response. Constructed-response items ask the test-taker to supply an answer rather than choose from options already provided. Constructed-response items include completion and essay (short and extended). There are two , item formats are classified as selected-response (or “choice”) and constructed-response (or “supply”) items.
In addition to these test items, other assessment strategies are written assignments, case methods and case studies, discussions, simulations, presentations, and projects. These strategies and others, including methods for evaluating clinical performance, are discussed.
Selected Response Items
Selected-response items can be used effectively to test a variety of student outcomes, as discussed. The choice of the specific selected-response format should be guided by an understanding of the strengths and weaknesses of each item type.
In general, selected-response items can be scored quickly and with a high degree of reliability, but each item format has specific limitations. In this topic, two types of selected-response items are presented: true–false and matching exercises. Although important principles are described, the lists presented are not intended to be inclusive; Other sources on test construction might include additional helpful suggestions for writing test items.
True–False
A true–false item consists of a statement that the student judges as either true or false. In some items, students also correct the response or supply a rationale as to why the statement is true or false. True–false items are most effective for recall of facts and specific information but also may be used to test the student’s understanding of an important principle or concept.
Each item represents a declarative sentence stating a fact or principle and asking the learner to decide whether it is true or false, right or wrong, correct or incorrect. Some authors refer to this type of test item as alternate response, allowing for these varied response formats. For affective outcomes, agree–disagree might be used, asking the learner to agree or disagree with a value-based statement.
There are different opinions as to the value of true–false items. Although some authors express concern over the low level of testing, focusing on recall of facts, and the opportunity for guessing, others indicate that true–false items provide an efficient means of examining student acquisition of knowledge in a course. With true–false items, students can answer a large number of questions in a short time.
For that reason, true–false items are useful to include on a test, and they also provide a way of testing a wide range of content. These items are easy to write and to score (Brookhart & Nitko , 2008). Although true–false items are relatively easy to construct, the teacher should avoid using them to test meaningless information. Designed to examine student recall and comprehension of important facts and principles, true–false items should not be used to evaluate memorization of irrelevant information.
Prior to constructing these items, the teacher should ask: Is the content assessed by the true–false item important when considering the course objectives? Does the content represent knowledge taught in the class or through other methods of instruction? Do the students need an understanding of the content to progress through the course and for their further learning?
The main limitation to true–false items is guessing. Because one of the two responses has to be correct, the probability that a student will answer the item correctly is 50%. However, the issue with guessing is not as much of a problem as it seems. With no knowledge of the facts being tested, on a 10-point quiz, the student would only be expected to answer 5 of the items or 50% correctly.
Nitko and Brookhart (2007) suggested that few students in a course respond to test items with blind or completely random guessing. Most students have some knowledge of the subject even if they need to guess an answer. It is also difficult to obtain an adequate score on a test by using random guessing only.
Although students have a 50/50 chance of guessing a correct answer on one true–false item, the probability of guessing correctly on a test with many items is small. For example, if a test has 20 true–false items, a student who guesses blindly on all of those items only has 2 chances in 1,000 of having 80% of the items correct ( Nitko & Brookhart, 2007, p. 141).
Writing True–False Items
The following discussion includes some important principles for the teacher to consider when constructing true–false items.
- The true–false item should test recall of important facts and information. Avoid constructing items that test trivia and meaningless information. The content should be worth knowing.
- The statement should be true or false without qualification—unconditionally true or false. The teacher should be able to defend the answer without conditions.
- Avoid words such as “usually,” “sometimes,” “often,” and similar terms. Miller, Linn, and Ground (2009) indicated that these words typically occur in true statements, giving the student clues as to the correct response. Along the same lines, avoid words such as “never,” “always,” “all,” and “none,” which often signal a false response.
- Avoid terms that indicate an infinite degree or amount such as “large.” They can be interpreted differently by students.
- Each item should include one idea to be tested rather than multiple ones. When there are different propositions to be tested, each should be designed as a single true–false item.
- Items should be worded precisely and clearly. The teacher should avoid long statements with different qualifiers and focus the sentence instead on the main idea to be tested. Long statements take time for reading and do not contribute to testing student knowledge of an important fact or principle.
- Avoid the use of negatives, particularly double negatives. They are confusing to read and may interfere with student ability to understand the statement. For instance, the item “It is not normal for a 2-year-old to demonstrate hand-preference” (true) would be stated more clearly as, “It is normal for a 2-year-old to demonstrate hand-preference” (false).
- With a series of true–false items, statements should be similar in length. The teacher may be inclined to write longer true sentences than false ones in an attempt to state the concept clearly and precisely.
- Use an equal number, or close to it, of true and false items on a test (Miller et al., 2009). Some experts recommend including slightly more false than true statements because false statements tend to differentiate better between most and least knowledgeable students. Higher discrimination power improves the reliability of test scores (Nitko & Brookhart, 2007).
- Check that the true–false items are not ordered in a noticeable pattern on the test. For example, the teacher should avoid arranging the items in a pattern such as TFTF or FTTFTT (Nitko & Brookhart, 2007).
- Decide how to score true–false items prior to administering them to students. In some variations of true–false items, students’ correct false statements; For this type, the teacher should award 2 points, 1 for identifying the statement as false and 1 for correcting it. In another variation of true–false items, students supply a rationale for their answers, either true or false. A similar scoring principle might be used in which students receive 1 point for correctly identifying the answer as true or false and another point for providing an acceptable rationale.
Sample items follow: For each of the following statements, select T if the statement is true and F if the statement is false: TF Type I diabetes was formerly called insulin-dependent diabetes. (T) TF Hypothyroidism is manifested by lethargy and fatigue. (T) TF The most common congenital heart defect in children is Tetralogy of Fallot. (F)
Variations of True–False Items There are many variations of true–false items that may be used for testing. One variation is to ask the students to correct false statements. Students may identify the words that make a statement false and insert words to make it true. In changing the false statement to a true one, students may write in their own corrections or choose words from a list supplied by the teacher.
One other modification of true–false items is to have students include a rationale for their responses, regardless of the statement being true or false. This provides a means of testing their understanding of the content. For all of these variations, the directions should be clear and specific. Some examples follow: If the statement is true, select T and do no more. If the statement is false, select F and underline the word or phrase that makes it false.
TF Tetany occurs with increased secretion of parathyroid hormones. Because this statement is false, the student should select F and underline the word “increased”: TF Tetany occurs with increased secretion of parathyroid hormones. (F) If the statement is true, select T and do no more. If the statement is false, select F, underline the word or phrase that makes it false, and write in the blank the word or phrase that would make it true. TF Canned soups are high in potassium. TF Fresh fruits and vegetables are low in sodium.
In the first example, because the statement is false, the student should select F, underline “potassium,” and write “sodium” in the blank to make the statement true. In the second example, because the statement is true, the student should only select T: TF Canned soups are high in potassium. (F) Sodium TF Fresh fruits and vegetables are low in sodium. (T) If the statement is true, select T and do no more.
If the statement is false, select F and select the correct answer from the list that follows the item. TF Bradycardia is a heart rate less than 80 beats per minute. 40, 50, 60, 100 Because the statement is false, the student should select both F and 60: TF Bradycardia is a heart rate less than 80 beats per minute. (F) 40, 50, 60, 100 If the statement is true, select T and explain why it is true.
If the statement is false, select F and explain why it is false. TF Patients with emphysema should have low-flow oxygen. (T) One other variation of true–false items is called multiple true–false. This is a cross between a multiple-choice and a true–false item. Multiple true–false items have an incomplete statement followed by several phrases that complete it; Learners indicate which of the phrases form true or false statements. This type of item clusters true–false statements under one stem.
However, rather than selecting one answer as in a multiple-choice item, students decide whether each alternative is true or false (Nitko & Brookhart, 2007). Directions for answering these items should be clear, and the phrases should be numbered consecutively because they represent individual true–false items. As with any true–false item, the phrases that complete the statement should be unequivocally true or false. Sample items follow:
The incomplete statements below are followed by several phrases. Each of the phrases completes the statement and makes it true or false. If the completed statement is true, select T. If the completed statement is false, select F. A patient with a below-the-knee amputation should: TF
1. Avoid walking until fitted with a prosthesis. (F) TF
2. Keep the stump elevated at all times. (F) TF
3. Lift weights to build up arm strength. (T) TF
4. Wrap the stump in a figure-8 style. (T) Bloom’s taxonomy of the cognitive domain includes the: TF
5. Application level. (T) TF
6. Knowledge level. (T) TF
7. Calculation level. (F) TF
8. Recommended actions level. (F) TF
9. Analysis level. (T) TF
10. Manipulation level. (F) TF
11. Synthesis level. (T)