Academic psychiatrists are often asked to write multiple-choice questions. Some will serve on questionwriting teams for standardized examinations, while others may be required to submit questions for course examinations or continuing medical education activities. Multiplechoice tests are popular because of their practicality in testing a wide body of knowledge and the ease of scoring responses, but criticisms are many. For example, they encourage guessing, require only recognition rather than recall of details, and evaluate only a fragmentary memorization of information rather than a deep understanding of applied knowledge. However, the well-written multiple choice question differentiates those who know the material from those who do not, and may emphasize analysis of information rather than direct recall. Psychiatrists writing for high-stakes examinations (e.g., the United States Medical Licensing Examinations or the American Board of Psychiatry and Neurology written examinations) undergo training in question construction. Many others have little training beyond their own experience in taking such examinations. Even experienced question writers may be unfamiliar with the literature in this area, because the bulk is found in nonmedical journals. As a result, questions written for medical education and evaluation are frequently flawed (1, 2). This article will summarize the literature on multiplechoice questions, recommend how to write proper questions, and examine the literature that informs these recommendations.