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Exam Co-Chairs:  Dr. Mark Bosma and Dr. Cheryl Murphy

In the spring of each year, the COPE exam, which represents a national collaborative effort is offered to residents enrolled in psychiatry programs across Canada.  The guideline to writing questions is included below.

COPE Question Writing Guidelines

  • All questions should be referenced when possible
  • Authors should indicate the template topic
  • Re questions:
    • Questions should have a clinical stem if possible, to test application of medical knowledge
    • Questions should have four possible answers, labeled a to d
    • Correct answer should be clearly indicated
    • Questions should not be negatively worded
      • Eg Which of the following is NOT…..
    • Questions should not use the term “except”
      • Eg All of the above are correct EXCEPT….
    • Possible answers should not include “all of the above” or “none of the above”
    • Possible answers should be categorically similar, and be plausible to a less advanced learner
      • Eg If the question asks about “treatments”, all of the answers should be a type of treatment


  • For more detailed question writing guidelines, three good resources are:
    • Medical Council of Canada “Guidelines for the Development of Multiple-choice Questions”
    • “Constructing Written Test Questions for the Basic and Clinical Sciences”, National Board of Examiners, nbme.org
    • The Royal College document “Developing Multiple Choice Questions for the Royal College Certification Exams” (Royal College Guide to Developing MCQs)