THE PULSE - Why SSH Certification avoids negatively stated questions > The Society for Simulation in Healthcare

Greetings from the SSH Certification team!


Things are absolutely hopping at SSH, so I’ll dive right in with a few important dates and deadlines:

1. SSH Fellows Academy Nominations are open and will close on June 17.
2. SimOps is fast approaching! This year we will be in Aurora, Colorado, July 17-19. Click here to register!
3. From the Certification side of things, we will be sending out a call for volunteers for item writing within the next few weeks. So, watch for that!

Next, let’s talk item writing … and you!

As y’all may know, all test questions are written by currently certified individuals who volunteer to serve as Subject Matter Experts for this annual activity. All item writers receive training on what makes a “good” test question. The core of this training focuses on how to avoid confusing or tricking candidates. One way we encourage this is to not allow negatively stated test questions. And that is what I want to share with you today — why we do not allow this format and how we hope it benefits our candidates.

To start, what is a negatively stated question? These are questions where the stem, or prompt, asks for the exemption, or “what not to do.” For example:

  1. Which of the following is not one of Rachel’s favorite pinball tables?
  • Iron Maiden
  • Medieval Madness
  • Jaws
  • Teenage Mutant Ninja Turtles


The candidate now has to determine which is NOT the right answer, or the exception. Now, item writers may curse my name when they learn we do not allow this format as these items are way easier to write. However, from a testing perspective, these items can be tricky and unfair. 

Candidates are under an expected amount of stress when sitting for a certification exam. And while we expect candidates to read every test question carefully, sometimes that stress makes that task difficult. It is reasonable to expect a competent candidate might overlook the “not” and therefore miss the question. That is not our goal. Candidates who understand the topic and have the knowledge should answer correctly and move on. They should not be disadvantaged by something that’s easy to misinterpret.

Another reason we do not use the negative item format is because negative reinforces negative. Negatively worded questions shift the focus to what's wrong instead of what's right. Our certification programs aim to assess knowledge and competency, so positive wording reinforces desired skills and positive action.

As always, I hope this peek behind the certification curtain helps y’all better understand our processes and allow for confidence in approaching the test. My virtual door is always open if you have any questions.

Until next time, be excellent to each other!

Rachel Araujo
SSH Director of Certification

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