The mission of the Education and Training Practice and Research Network (EDTR PRN) is to promote dialogue and interaction among members and to develop programs that enhance the knowledge and skills of members involved in education and training within clinical pharmacy.
The EDTR PRN currently has over 800 members, including faculty and preceptors, practicing pharmacists, 200+ students, 60+ residents, 20+ fellows, and retired members from a variety of practice settings and backgrounds!
We encourage you to follow our social media to continue the conversation!
- X/Twitter: @accpedtrprn
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- Contact: [email protected]
Benefits of EDTR PRN membership include:
Networking
- Network with clinicians, academicians, residency/fellowship directors, postgraduate trainees, and pharmacy students through virtual and in-person networking forums and programming
- Receive pharmacy education–related information through Communities posts, newsletters, and publications
- Take advantage of mentorship opportunities for aspiring or early-career educators
Programming
- Attend EDTR PRN live continuing education focus sessions at ACCP meetings
- Participate in or present PRN webinars for advancing educational practices in diverse settings
- Participate in student mock interviews at the ACCP Annual Meeting
Funding
- Travel scholarships are available for students and residents to attend the ACCP Annual Meeting
- Teaching enhancement grant is available to advance pharmacy education and training through support of educational initiatives, scholarship of teaching and learning, and/or professional development of EDTR PRN members
- Support is offered for PRN members to pursue ACCP MeRIT/FIT scholarships
Leadership
- Serve on committees to advance the PRN’s initiatives and goals
- Participate in a poster walk-rounds competition
Upcoming Opportunities for Residents and Fellows:
The following items must be submitted by August 30, 2026:
- A brief (500-word maximum) essay describing the applicant’s interest and experiences in pharmacy education/training, why the applicant is involved with the EDTR PRN, and how attending the Annual Meeting will assist with the applicant’s career goals. The applicant is encouraged to highlight involvement relevant to leadership, research, and ACCP/PRN activities indicating an interest in education
- A current CV highlighting experiences related to education and training (eg, teaching certificate program) and/or ACCP activities at the regional, PRN, and national level
- One letter of recommendation highlighting the applicant’s interest and experiences in pharmacy education/training, interaction with and interest in the EDTR PRN, how the travel award will help the trainee achieve their career goals, and the trainee’s involvement in research and ACCP
- EDTR PRN Newsletter Article: Most recent article below
Awards
- Teaching and Mentoring Award: Recognizes a PRN member who has demonstrated excellence in an area of teaching and/or mentoring pertaining to a yearly rotating theme
- Scholarship of Teaching and Learning (SoTL) Paper of the Year Award: Recognizes an outstanding contribution to the SoTL literature by one of the PRN members
Multiple-Choice Question Best Practices: Piloting 3 Answer Choices to Reduce Nonfunctional Distractors
Written by: Jessica Webber, Pharm.D., PGY1 Pharmacy Resident, UF Health Shands Hospital, Gainesville, FL; and Leslie Phillips, Pharm.D., PGY1 Pharmacotherapy Resident, UT Medical Center, Knoxville, TN
Reviewed by: Bethany Shoulders, Pharm.D., BCCCP; and Kelly Covert, Pharm.D., BCPS
Multiple-choice questions (MCQs) have been a staple of assessments for over 100 years, dating back to the early 1900s. Initially introduced to eliminate grading subjectivity and improve testing efficiency, this format quickly became a widely accepted, standardized method to evaluate knowledge on a large scale.1 Crafting high-quality MCQs involves following best practices with respect to writing the stem and answer options. Each question’s stem should be a clear, focused prompt that includes only relevant information, allowing a knowledgeable reader to anticipate the answer before seeing the choices. In addition, each question should include 1 correct answer and several incorrect but plausible options, known as distractors. Effective distractors should be based on common errors or misconceptions and should closely mirror the correct answer in context and complexity. This strategy ensures the question differentiates between learner levels of understanding.2,3 When written thoughtfully, MCQs can enhance assessments by measuring clinical reasoning and reinforcing key concepts in pharmacy education.
Pharmacy licensure and board certification examinations often use 4- or 5-option items, following the theory that additional distractors reduce guessing probability and address a broader range of misconceptions. However, crafting 4 high-quality distractors is challenging. In practice, many 4- or 5-option MCQs include only 2 or 3 truly plausible options, with the remaining distractors serving as unselected fillers. In addition, studies have shown little to no improvement in examination reliability or validity when using 5-option items compared with using fewer choices. In fact, motivated examinees rarely rely on pure guessing, and poorly constructed extra options can increase unnecessary reading load without increasing discriminatory power.4 Although 5-option MCQs can be effective if all distractors are well crafted and relevant, more answer options do not inherently improve a question’s effectiveness, and unnecessary choices may add complexity without meaningful assessment value.
Research into the optimal number of distractors began in 1989 with an item-writing guideline, which suggested that as many functional distractors as possible should be included for each item on a test. The authors subsequently updated the guideline in 2002 to suggest that 3 options per item were adequate according to multiple studies.3 This suggestion was supported by a meta-analysis, which concluded that items with 3 options are optimal compared with 4- or 5-option items because of the reduction in time and effort required to develop plausible distractors and time required for test taking.5 The most effective strategy for developing the 3-option items described was to remove nonfunctional distractors, defined as those selected by less than 5% of examinees.6 Research demonstrated that the possibility of examinees guessing correctly because of having fewer options was unlikely; in fact, the reduction in plausible options led examinees to make more educated guesses.5 Rather than focusing on the number of distractors, these studies suggest ensuring an adequate number of questions are included on each examination to reduce the risk of students passing examinations solely by random guessing.7 Suggestions on how to convert 4- or 5-option questions to 3 options are provided in Table 1.
However, although there is strong evidence for 3-option MCQs, this practice has not been widely accepted in professional health education. One recent study compared 3-option with 5-option MCQs for students in their final year of medical school. Students were randomly assigned to take a 3-option (experimental) or 5-option (control) MCQ test. The 3-option experimental test was formulated by removing the 2 least attractive options from the control test. There was no significant difference in the reliability, difficulty index, or discrimination index between the 2 test versions, but the 3-option item test required much less time for students to complete. The study concluded that 3-option items are optimal, even in professional health education.8 Until recently, minimal research on using 3-option items had been conducted in the professional health education space. Given this lack of data and the fact that most high-stakes examinations, such as the NAPLEX, continue to use the 4- or 5-option format, there has been hesitation to adopt the 3-option format in this field.6
Ultimately, implementing 3-option items in the pharmacy education curriculum may decrease the time and effort required by educators to develop high-quality MCQs without affecting the reliability of the assessment. As evidence for 3-option items increases in professional health education, it will be interesting to see if this practice is implemented in high-stakes examinations for licensing and certifications.
Table 1. Suggested Approaches to Converting 4- or 5-Option Exams to 3-Option Exams
Scenario: Evaluating results of 4- or 5-option items from previous examinations | Suggested action: Create 3-option items |
Correct answer selected by 100% of students | Remove least plausible answer choice(s) using clinical judgment |
Answer choice(s) selected by 0% of studentsa | Remove answer choice(s) |
Answer choice(s) selected by < 5% of students (nonfunctional distractors)a | Remove answer choice(s) |
All answer choices selected by > 5% of students | Remove answer choice(s) with the lowest selection percentage(s) |
aIf removing all options selected by 0 or < 5% of students would leave < 3 options, could remove least plausible answer choice(s) using clinical judgment and consider strengthening the remaining third option.
References
1. Veritas Journal. The history of the multiple-choice question. 2019. https://veritasjournal.org/2019/04/30/the-history-of-the-multiple-choice-question/
2. Forsythe G. Designing multiple choice assessments. In: Digital Teaching and Learning at the UofL. Pressbooks; 2004. https://pressbooks.openeducationalberta.ca/digitalteachingandlearning/chapter/designing-multiple-choice-questions/
3. Haladyna TM, Downing SM, Rodriguez MC. A review of multiple-choice item-writing guidelines for classroom assessment. Appl Meas Educ. 2002;15(3):309-333. https://doi.org/10.1207/S15324818AME1503_5
4. Vegada B, Shukla A, Khilnani A, Charan J, Desai C. Comparison between three option, four option and five option multiple choice question tests for quality parameters: a randomized study. Indian J Pharmacol. 2016;48(5):571-575. https://doi.org/10.4103/0253-7613.190757
5. Rodriguez MC. Three options are optimal for multiple-choice items: a meta-analysis of 80 years of research. Educ Meas Issues Pract. 2005;24(2):3-13. https://doi.org/10.1111/j.1745-3992.2005.00006.x
6. Raymond MR, Stevens C, Bucak SD. The optimal number of options for multiple-choice questions on high-stakes tests: application of a revised index for detecting nonfunctional distractors. Adv Health Sci Educ Theory Pract. 2019;24(1):141-150. https://doi.org/10.1007/s10459-018-9855-9
7. Royal KD, Stockdale MR. The impact of 3-option responses to multiple-choice questions on guessing strategies and cut score determinations. J Adv Med Educ Prof. 2017;5(2):84-89.
8. Al-Lawama M, Kumwenda B. Decreasing the options’ number in multiple choice questions in the assessment of senior medical students and its effect on exam psychometrics and distractors’ function. BMC Med Educ. 2023;23(1):212. https://doi.org/10.1186/s12909-023-04206-3