Assessment Questions Submission Form

Use this form to submit your MOC or CME assessment questions. NOTE: MOC question MUST include feedback.

Name *

First

Last

Presentation Title: *

Presentation Date

Credit Type: Is this question for CME, MOC or both? Check all that apply.

CME
MOC

Question Type:

Multiple Choice Single Answer
Multiple Choice, Multiple Answer

Question Stem

Correct Answer *

Correct Answer 2

Correct Answer 3

Select to add more correct answers

OPTIONAL: Select to add more correct answers

Correct Answer 4

Correct Answer 5

Correct Answer 6

Distractor 1 *

Distractor 2 *

Distractor 3 *

Select to add more distractors

OPTIONAL: Select to add more distractors

Distractor 4

Distractor 5

Distractor 6

Feedback for MOC: why is the correct or preferred choice correct/preferred? Why are the incorrect or less preferable choices incorrect/less preferable? *

OPTIONAL: Feedback for CME. Why is the correct or preferred choice correct/preferred? Why are the incorrect or less preferable choices incorrect/less preferable?

Select to add another question

Select to add another question