Using Performance Improvement Methods to Evaluate Processes for Writing Multiple-Choice Test Questions in the Postlicensure Clinical Environment: A Case Study

Background: This article is the last of a four-part series to guide educators on the construction and evaluation of multiple-choice test items in the postlicensure environment. Previous articles in this series described the problem and the mechanics of test item construction and evaluation. Method: A replicable strategy for evaluating the organizational process for constructing multiple-choice test questions is provided. Steps taken to create change are described; work tools are provided. Results: Guidance and training are needed to create multiple-choice test questions. Many educators have not had training in item construction. Educators welcomed training. Personalized mentorship resulted in improvement. Asynchronous learning alone was helpful and well received and improved self-perceived knowledge, yet fell short of achieving competence. Conclusion: Voluntary training may not be adequate to assure enculturation of best practices without accountability standards and monitoring. Future research is indicated to assess the situation and provide national standards for adoption within health care organizations. [J J Contin Educ Nurs. 202x;5x(x):xx-xx.]