Abstract
Background: Many different guidelines have been presented for the construction of multiple choice items. Those guidelines have been based on the observation of errors when constructing items but not on any clear scientific criterion. Our main objective was to draw up guidelines for the development of multiple choice items based on validity criteria. Method: We used the properties of adjustment, precision, and differentiation, applying them to three basic phases of instrument construction: the definition of the objective and its context; their expression in the instrument and item stem; and the elaboration of response options. Results: We have combined these properties and phases to give nine general guidelines with a firm theoretical footing. Conclusions: Finally, we have written a checklist with twenty-four points to check how far the measurement instruments comply with the proposed guidelines.
