MOC Exam Development

All examination questions are written and reviewed by committees of Board–certified academicians and practitioners. This is to ensure that there is adequate and appropriate coverage of all content areas within each examination.

Question Review/Editing Process

New questions are assigned to individual members of a test committee for primary and secondary review. Each question is then discussed at least twice by the committee as a whole. During the revision process, each question is also reviewed multiple times by a medical editor to ensure accuracy and by staff editors who standardize question style, format and terminology; correct grammar; and eliminate ambiguity and technical flaws, such as cues to the answer.

Once the committee approves a question for inclusion in the exam item pool, it is made available for selection in future exams. All approved questions are reviewed periodically for accuracy, currency and relevance. This review also includes any questions that have been previously used on an exam.

Question Format

Exam questions are written in a single-best-answer multiple-choice format. This is the most widely used format in the testing industry as it allows for greatest coverage of content within a specified amount of time. Most exam questions are preceded by a clinical stem that provides information about a patient (including laboratory and diagnostic findings). Each question is typically followed by 5 answer options, 1 of which is the correct answer. Part of the question review process is to ensure that the designated answer is clearly correct, uncontroversial, evidence-based, and a better choice than any of the other options. The other options ("distracters") are designed to reflect plausible responses likely to be selected by less knowledgeable candidates.

Graphical illustrations, such as x-ray studies and photographs, are used in approximately 5 to 10% of questions; some specialty exams use graphics more frequently.

Selection Process

Each exam is based on a specific blueprint, also known as a content outline. The outline defines the percentage of questions from each content category that will appear on the exam. Special attention is also provided to ensure that multiple versions of an exam are balanced with regard to difficulty and content.

View the exam content outlines.