When we discuss the anatomy of a board style question, we have what's called the stem. The stem is the story. The stem is the part of the question that contains the clinical scenario before the answer choices are given. That's the part that you read before you look at the answers. The stem ends with the question. So dermatology stem writing is really quite an art and there is a distinct philosophy behind that art. In dermatology, this philosophy you're going to find in question writing with the American Board of Dermatology and likely other test writing areas of dermatology too. I would say that for me, the American Board of Dermatology test writing is the gold standard of dermatology question writing in the world. So I would follow their guidance whenever possible. First in stem writing, keep it as short as possible. Three sentences or less is common. This is a little different philosophy than someone taking an internal medicine exam, let's say, where you might have a very lengthy paragraph of information. Well, we're not internal medicine, we're dermatology. So put a picture with it and keep your stem as short as possible. Don't turn a knowledge assessment into a speed reading contest or a reading comprehension test. Also, you wanna avoid superfluous information. You're not looking to give a lot of red herrings or information that takes them down a different rabbit hole of thought. You're trying to test information so don't make it a tricky gotcha kind of, I'm gonna tell you one thing, but I don't really mean that at all. I'm looking for something else and you just have to know what I'm thinking. Don't be the test writer that tries to have the test taker guess what I'm thinking. We don't wanna guess what I'm thinking kind of test. Nobody does. We wanna assess the knowledge that they have or don't have. Be careful about using buzzwords. Buzzwords can be associated with correct answers even though the test taker doesn't really know the actual clinical scenarios answer. You just know what the buzzword is associated with. You also want to end every stem with a clear question. The best written stem should be able to be answered with any test taker covering up the answers and just be able to finish the questions answers. So the most likely thing that would happen next is, and you should be able to cover up the answer and answer it without reading through the choices if you're a competent person in that area of knowledge. And then I can't stress enough the importance of using high quality photographs instead of descriptions of physical skin findings. Your words don't mean anything as useful as showing a high quality photo. When you really look around dermatology and dermatology practice across the United States, there's a lot of non-uniform language used to describe things in dermatology. I would really just stress the importance of using high quality photos every opportunity you can when you're talking about a clinical finding rather than describing that physical finding in words and expecting someone else to diagnose it based off of the words that you use. We don't work that way and we work really by looking at things, that's our job. So now I'd like to take a moment to practice. I want you to read through this and I want you to decide if it's good as is or if there are edits that you think are needed. And if you think there are edits that are needed, what would you want to change? So I think that this is not good as is. First of all, it's way too long. It contains a lot of information that is not necessary to make a diagnosis. Let me go through this paragraph and show you some of the thoughts I would have for edits. First, we have some things that I call red herrings or trap statements. I personally don't think we need to know that his name is John. Why not just say a 57-year-old man? We don't need to get to know John. We just need to know the facts. So some might see his occupation as well and think, well, why would they give us his occupation? That seems unusual. And, oh, yeah, by the way, automotive workers get a lot of contact dermatitis. That must be what we're talking about here. Now I'm, you know, I'm biasing my train of thought based on what it is that I was told is his occupation. Then there's his wife is an avid internet user and is concerned this rash is related to diabetes. Well, again, this is sending us down a red herring pathway of, gosh, what are all the rashes related to diabetes that I should be thinking of? Same thing with what his daughter had to say about internal malignancy. Next, we have superfluous information in here as well. That's one common mistake people make who are new to dermatology question writing, is that they talk about extra information that it is true, but it's an unnecessary element to the question. Do we really need to know in this particular question that is a past medical history significant for insulin-dependent diabetes and hypertension? If it's not relevant to the question, I would say no. Do we really need to know what the fever temperature was? Probably not. Just saying that he has fevers is probably adequate for the purposes of what you're trying to test. We will trust as test takers that if you say that the patient had a fever, that it was genuine fever and that it wasn't a misread of the thermometer. Next, we have answer cues. Things like being from Connecticut, having a bull's-eye rash, those two things, ding, ding, ding, are big answer cues. They read us to a diagnosis, and though there are plenty of other diseases in Connecticut that a person could have, the fact that it specifically says Connecticut on the test, ding, ding, ding, I'm thinking of Lyme, Connecticut. It must be Lyme disease. Next, is to guess what I'm describing. Substituting words to describe visual information, terrible thing for a dermatology test. Try very hard to avoid it. You'd be much better off including a picture instead. So, now think about how would you change it? I can tell you how I changed it. So, here's the before and here's the after. Go ahead and read through it. I would go from this lengthy paragraph that we started with to a much shorter paragraph, which causes less anxiety, where I'm not knowing that it's John. I don't care what his wife and his daughter are thinking. I just want the facts, and this is what I come up with, and you can read it and see how it compares to what you came up with.

board-style question

dermatology

effective stem writing

clear language

high-quality photographs