EMS Education Tips

5 Quiz Question Writing Tips

I use Articulate e-learning software to create quiz questions for online EMT and paramedic continuing education. The software makes the process easy.  The real difficulty is writing quiz questions that engage the learner and assess their new knowledge based on the lesson objectives. Determining the type and difficulty of quiz questions as well as actually writing usable questions is a challenge for many subject matter experts (SMEs). These are five of the tips I share with SMEs.

1. Determine the format for questions. I generally only use multiple choice questions. True/False or Yes/No questions are essentially guessing and provide little meaningful information about student retention or comprehension of the material presented. Unless I specifically tell SME’s I want multiple choice questions I usually receive 50% or more True/False questions.

2. Question construction. A multiple choice question has three parts – the stem, the answer, and multiple distracters. Write question stems based on the objectives of the lesson. Make sure to review the lesson objectives before writing questions. I usually have the source PowerPoint file on the screen in front of me as I begin writing questions – a great use for a dual monitor set-up. As I build a bank of questions I try to write three to ten questions per objective.

3. Present only the essential information in the question stem. Extraneous material does not likely add any educational value to the assessment. A multiple paragraph stem only assesses the student’s ability and determination to actually find the question you are asking. If there is a long scenario present it first and then ask the actual question.

Don’t teach in the stem. Explaining a process that was part of the lesson and then asking a question is unnecessarily redundant.

All of the following, except, none of the above, and all of the above are universally despised by students because it is confusing to determine what is actually being asked. As an educator you don’t know if the student got the question wrong because they didn’t know the material or they couldn’t determine what the question was actually asking. Help me rid the world of these question types.

4. Consistent formatting of the answer and distractors. I recommend these general guidelines for the one correct and three wrong answers:

  • All answers should be approximately the same length. Since a visibly shorter or obviously longer answer is usually right make sure all answers have about the same number of words or one to three word answers or same number of characters for longer answers.
  • Use plausible answers for the distractors. Obviously wrong answers increase the odds of guessing correctly.
  • Any words or phrases repeated in every answer should be part of the stem. Keep the answers as short as possible.
  • Write with a consistent verb tense for every answer. If only one answer is active tense it is likely the right answer.
  • If the answers are numbers, order the numbers sequentially. For example, if a question is to calculate a medication dose order the answers 2, 5, 10, 15 instead of 5, 15, 2, 10.

5. Ask questions to determine comprehension. Student retention of lesson content is merely interesting. At least half of the questions should assess comprehension – the ability to apply information. Use short scenarios for students to apply what they have learned.

Finally, consider other ways to assess student use of e-learning content. If you are only using a quiz to prove they completed the lesson the only question you might need is “I completed this lesson” with the answers Yes or No.


By Greg Friese

Greg Friese, Stevens Point, Wisconsin, is an author, educator, paramedic, and marathon runner.

Greg was the co-host of the award winning EMSEduCast podcast, the only podcast by and for EMS educators. Greg has written for,, Wilderness Medical Associates, JEMS Magazine, and EMS World Magazine, and the NAEMSE Educator Newsletter.