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Tips For Answering Single Best Answer Exam Questions

Published on: 7 Nov 2023
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Tips for answering SBA questions

 

Authors: Faris Hussain, junior doctor, Cardiff University School of Medicine, Wales and Phil Smith, consultant neurologist (and lead for written examinations), University Hospital of Wales, Cardiff.

 

Every day, doctors encounter multiple clinical scenarios – situations where they must use their knowledge and understanding of science and evidence-based best practice to weigh up probabilities and make appropriate decisions for the patient in front of them. 

Most UK medical examinations – both undergraduate and postgraduate – use realistic example clinical scenarios written in a “single best answer” (SBA) format to test not only a candidate’s clinical knowledge, but most importantly application of that knowledge.

The SBA format has several clear advantages for examiners over other tests of knowledge in exams, including high reliability, efficient marking for large candidate groups, (1,2) and extensive evidence to support its use across a wide breadth of specialties. 

Good SBA questions should be challenging to answer, so candidates understandably find preparing for SBA examinations difficult.  

Here are some tips to help prepare for SBA examinations:

  • Practise answering SBA questions. It may sound obvious, but effective preparation for an SBA assessment relies largely on deliberate practice of these types of questions using past papers and example questions offered by revision tools such as BMJ OnExamination.

  • Learn from many different platforms and experiences. Use placement opportunities and explore reading lists to cover common presentations and conditions. Review up-to-date guidelines, such as NICE guidelines, and read BMJ Best Practice articles to get a good grounding on relevant topics. 

  • Cover the entire breadth of the curriculum. Some candidates think they can miss out on some subjects (eg, ophthalmology in an undergraduate medical exam) because there will be only a couple of questions on it. But they should think instead that all questions will be on common and important topics within each speciality (eg, glaucoma, macular degeneration) and so by focusing on those key areas there may be an easy mark or two. 

  • Understand how SBA questions are structured. An SBA question comprises three components: the question stem (scenario), the lead-in question, and the answer options. It is important to read each of these components thoroughly and in that order. The question stem contains all the key information relevant to the scenario, and should bring to mind a likely answer. All the answer options may be plausible and the candidate needs to pick the “best” option/course of action for that clinical situation.  

  • Use “the cover test” to select the best option. Often when choosing an answer from five possibilities, candidates narrow the options down to two or three. Instead, it may be better to select an answer by applying the cover test – cover the five options and attempt to answer the SBA question using only the stem and lead-in question.

  • Make use of all the question stem information. If a question stem is written appropriately, all the information it contains should be useful for answering the SBA question. Candidates sometimes jump straight from the first part of the stem all the way to the lead-in question, but a better strategy is to apply the cover test (see above).

  • Answer the question at face value. Candidates often think that they are being deliberately tricked with a question stem, but this is almost never the case. Rather than suspecting some Machiavellian subterfuge, read the whole question and then answer as it is written. If there is something you don’t understand when trying to answer an SBA question in an exam, or you find a possible mistake or misspelling, there is no point asking for clarification from the invigilator. Answer the question as best you can – it’s the same for everybody and it will be sorted out later.

  • Go with your gut. Your first initial answer is often the correct one.

  • Don’t spend too much time on a single question. Though most SBA examinations allow adequate time to spend more than one minute per question, many candidates struggle to use their allocated time efficiently and risk having less time at the end than they anticipated. To prevent this, if stuck on a question and deliberating between two options, it is best to select an option and then move on to ensure adequate time to cover the remaining questions. If there is a long and complicated question, it is worth leaving it and coming back (it’s only worth one mark, same as the easy short questions).

  • Never leave a question unanswered. Almost no exams have negative marking. Even if you have no idea, a guessed answer can still turn out right. 

  • Understand how a question is written and constructed. Understanding how an SBA question is written can help candidates to answer them better. To learn more about this see Tips for clinicians on writing single best answer questions. It explains how SBA questions are structured and styled. Acquiring some practice and experience in writing SBA questions may be helpful in improving your SBA examination technique.

 

References

  1. Case SM, Swanson DB. Constructing written test questions for the basic and clinical sciences. 3rd edn. Philadelphia: National Board of Medical Examiners, 2001.
  2. Walsh JL, Harris BH, Smith PE. Single best answer question-writing tips for clinicians. Postgraduate Medical Journal 2017; 93(1096): 76-81.