ExamEval
Item Writing Flaws
Grammatical Mismatches

Grammatical Mismatches Cue Test Takers to the Correct Answer

By Sean P. Kane, PharmD, BCPS

Published June 16, 2025

How Grammar Compromises Assessment Validity

Grammatical inconsistencies between question stems and answer choices create unintended clues that allow students to identify correct answers without demonstrating knowledge of the content being assessed. These mismatches occur when the grammatical structure of the stem does not align properly with one or more answer choices, making some options obviously incorrect due to language rules rather than content accuracy.

Understanding Grammatical Cues

Grammatical mismatch cues typically involve issues like singular/plural disagreements, verb tense inconsistencies, article mismatches (a/an), or pronoun disagreements. These cues provide shortcuts to correct answers that bypass the cognitive processes the assessment is designed to measure. Students may select grammatically consistent options without actually understanding the content assessed by the question.

Critical Issue

Grammatical cues compromise assessment validity by allowing students to answer correctly based on language skills rather than content knowledge. This introduces construct-irrelevant variance, as the question inadvertently measures grammatical proficiency instead of the intended learning objective.

Consider the following fictitious example. Even without having any knowledge of baseball statistics, a test-wise student can make an educated guess on the correct answer:

Baseball Statistics

An _____ is a statistic that measures a player's ability to get on base and hit for power by adding on-base percentage and slugging percentage.

A. ERA and WHIP

B. OPS ✓

C. WHIP

D. BB

The question stem ends with the article 'An,' which cues the test-wise student to look for an answer choice beginning with a vowel sound. Only 'OPS' (on-base plus slugging) begins with a vowel sound and fits grammatically. The other options either do not begin with a vowel sound or are plural, making them inconsistent with the stem ('is' vs. 'are'). This allows a student to select the correct answer based on grammar rather than content knowledge.

Common Types of Mismatches

Grammatical mismatches can take several forms, all of which can lead students to the correct answer through unintended clues:

Singular/Plural Disagreement: The stem may be singular while some options are plural, or vice versa. For example, "The primary cause of the disease is..." followed by options that are plural nouns.
Verb Tense Inconsistency: The stem may be in one tense (e.g., past tense) while the options are in another (e.g., present tense).
Article Mismatch (a/an): The stem may end with the article "a," which would grammatically eliminate any answer choices that begin with a vowel.
Pronoun Disagreement: The stem may use a pronoun that does not agree with the noun in the answer choices.

By carefully crafting stems and options to be grammatically consistent, instructors can ensure that questions accurately assess content knowledge rather than test-taking skills.

Examples of Grammatical Mismatches in Health Sciences Education

Flawed Question

When counseling a patient about warfarin therapy, the pharmacist should emphasize that an important dietary consideration is:

A. Avoiding alcohol consumption and reducing intake of dietary saturated fats

B. Maintaining consistent vitamin K intake

C. Limiting sodium in the diet

D. Increases protein consumption

Because the stem ends in the singular 'is', option A will be ruled out by a test-wise student as the stem would need to be 'are' to fit the plural answer choice text. Additionally, answer D uses 'increases' instead of 'increasing', which also makes it more likely to not be a correct answer choice. Both grammatical cues help test-wise students select the correct answer based on grammatical issues and not knowledge of the concept being tested.

Corrected Question

When counseling a patient about warfarin therapy, which dietary recommendation is most important for the pharmacist to emphasize?

A. Avoiding all alcohol consumption

B. Maintaining consistent vitamin K intake

C. Limiting sodium in the diet

D. Increasing protein consumption

The corrected version fixes the grammatical error in option D and restructures the stem to create consistent grammatical flow with all answer choices. In this version, students must use content knowledge about warfarin counseling rather than grammar rules to identify the correct answer.

Impact on Assessment Validity

Grammatical cues introduce construct-irrelevant variance by allowing students to demonstrate success through language skills rather than content mastery. Students with strong language backgrounds may have advantages unrelated to the subject matter being assessed, while those with different linguistic backgrounds may face unnecessary barriers that don't reflect their understanding of the content.

Closed-Ended Question Formats Tend to Avoid Grammatical Cues

Assessment experts recommend closed-ended questions (i.e., ending in a question with a question mark) instead of open-ended questions (i.e., fill-in-the-blank or sentence completion where the question ends with an open statement). Closed-ended questions are the recommended format primarily because the cognitive load for students is less, but an additional benefit of the closed-ended format is that it tends to be less prone to grammatical cue flaws compared to open-ended questions.

Grammatical cues are most effectively identified during a peer review of exam questions. When faculty peer review is not possible due to limited time or resources, an AI-powered exam review tool such as ExamEval can automatically flag questions with grammatical cueing issues. ExamEval assists educators in identifying and correcting item-writing flaws, enhancing assessment reliability, and supporting better student learning outcomes.

References

National Board of Medical Examiners (NBME). Item-Writing Guide. Philadelphia, PA: National Board of Medical Examiners; February 2021.
Haladyna TM, Downing SM, Rodriguez MC. A review of multiple-choice item-writing guidelines for classroom assessment. Appl Meas Educ. 2002;15(3):309-334. doi:10.1207/S15324818AME1503_5