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Item Writing


Osteopathic Continuous Certification (OCC)

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142 East Ontario Street
Floor 4
Chicago, Illinois 60611

Phone 800-621-1773,
Extension 8267
Fax 312-202-8441

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Item Writing

Each candidate for the General Pediatric Certification and Osteopathic Continuous Certification examination is required to submit THREE (3) exam questions with their application. 

  • Assignments in specific areas will accompany the applicant packet. 
  • Each item must be typed on a single page and each page must include the candidates name, address, phone number and AOA number. 
  • Each item must be referenced in a current and widely available textbook or journal and the edition and page number noted.
    • Acceptable references for items are recognized textbooks of Pediatrics. Acceptable references should be from recognized textbooks and journals of Pediatrics such as:
      • Nelson’s Textbook of Pediatrics
      • AAP Redbook
      • Care of the High Risk Neonate (Klaus & Fanaroff)
      • Zitelli’s Atlas of Pediatric Physical Diagnosis
      • The Journal of Pediatrics
      • Foundations for Osteopathic Medicine
      • and others similar to these.
    • References such as Pediatrics in Review and online references will not be accepted.
  • Each item must involve a specific clinical scenario and include four (4) to five (5) distracters (answers).

Acceptable items may be of two types:

  • Stand alone:  One question related to a clinical scenario.
  • Cases:  Includes 2-3 questions related to the same clinical scenario.

The clinical scenario should follow a general pattern that is used to construct items.

  • A (patient description) presents with (symptoms).  History reveals (historical findings).  Examination reveals (examination findings).  Diagnostic studies reveal (diagnostic findings).

The clinical scenario should be brief and concise, with little to no superfluous information.  Patients should not be personalized unless the information presented is crucial to the case. The question that is asked should relate to one of the following areas:

  • Health Promotion/Disease Prevention:  Focus on areas related to public health issues, wellness, health maintenance and the prevention of disease or complications.
  • History & Physical:  Focus on areas regarding either the diagnosis of disease based on the clinical scenario or the physical findings that would be related to the disease.
  • Diagnostic Technologies:  Focus on appropriate diagnostic modalities for the clinical scenario.
  • Management:  Focus on appropriate treatments for the presenting condition.
  • Scientific Understanding:  Focus on the pathophysiology of disease or the mechanism of the prescribed treatment.
  • Health Care Delivery:  Focus on issues involving socioeconomic and ethical aspects of primary pediatrics.

All items must include the following:

  • A specific clinical scenario
  • Positive wording in the question.  No phrases such as except, inappropriate, least of, not a, least likely will be accepted.
  • A specific objective should be evident in the question.
  • Four or five answer choices of similar length, placed in alphabetical or numerical order.
  • Focused answer choices.  All options should be in the same category, management choices, treatment choices, diagnostic choices, etc.
  • Plausible answer choices.
  • An answer key for each question noted on the page.
  • A reference, including edition and page.

Each item must also follow these guidelines:

  • Each answer choice should grammatically follow from the question.
  • Use only non-proprietary (generic) names of drugs.
  • Limit the use of abbreviations.  It is preferable to spell it out.
  • The question should be worded so as not to provide a clue to the answer.
  • Distracters should be worded such that there is only one possible correct answer.  Do not attempt to trick the examinee.
  • If ranges are used, be sure that they are separated from each other so that no overlap is present.
  • Do not teach in the stem.
  • Do not use interrelated answer choices, such as “all of the above”, “none of the above”, “A & C”, etc.

Each candidate will be assigned three specific topics and these are described separately on the three accompanying item submission forms.  Your application will not be considered complete until you have submitted THREE (3) acceptable questions.  Each question must be typed and submitted on the enclosed forms.

If you need further assistance with this project, you may review the NBOME item writing guide, Metricks item writer’s guidebook or the AOBP examples.

AOBP Examples of Inappropriate Items

NBOME Online Item-Writer Training Course - Item Writing 101

  • The NBOME course is free to AOA members. To access the course, AOBP diplomates may log-in using their AOA number.

For item topics please email:



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Operating under the authority of the American Osteopathic Association