Spelling, Typos, and Grammar Errors in Multiple-Choice Questions

By Sean P. Kane, PharmD, BCPS

Published June 29, 2025

Typographical Errors Comprormise Assessment Validity

Spelling errors, typographical mistakes, and grammatical problems in exam questions can undermine the validity of the exam by creating barriers for students to demonstrate their mastery of the course content, distract students from demonstrating their knowledge, and damage the credibility of assessments and the exam writer.

From a psychometric perspective, language errors create systematic error that interferes with measuring the intended learning outcomes. When students perform poorly due to confusion caused by spelling or grammatical problems, their scores no longer accurately reflect their knowledge of the subject matter.

This is particularly problematic for students who are non-native speakers of the assessment language, students with learning differences that affect language processing, or students from diverse linguistic backgrounds. These populations may be disproportionately affected by language errors, creating fairness issues in the assessment.

The Distraction Factor

When students encounter spelling or grammatical errors in exam questions, their attention shifts from the content being assessed to the error itself. This cognitive interruption breaks their focus and forces them to expend mental energy deciphering what the question writer intended to communicate, rather than demonstrating their mastery of the subject matter.

Research in cognitive psychology demonstrates that such interruptions can have lasting effects on performance. Students may continue to feel uncertain about their interpretation of the flawed question even after moving on to subsequent items, creating ongoing anxiety and distraction that affects their performance throughout the remainder of the assessment.

Credibility and Professional Standards

Spelling and grammatical errors damage the perceived credibility of the assessment, the faculty exam writer, and potentially the institution. Students, colleagues, and external stakeholders may question the overall quality and rigor of an educational program when they encounter basic language errors in formal assessments.

Additionally, these errors negatively impact students' perceptions of faculty professionalism and course quality. When students see spelling mistakes and grammatical problems in their exams, they may lose confidence in their instructor's attention to detail and overall competence. This can undermine the learning environment and reduce student engagement with course material.

In health sciences programs where students invest hundreds of thousands of dollars in tuition, language errors can be particularly damaging to program credibility. Students expect quality and professionalism matching their investment.

Examples of Spelling and Grammar Flaws in Health Sciences Education

Common Types of Language Errors

• Homophone Mistakes: Confusing words that sound alike but have different meanings (there/their/they're, its/it's, affect/effect) can completely change the meaning of a question, making it difficult for students to determine what is being asked.
• Typographical Errors: Missing letters, extra letters, or letter substitutions can create confusion about technical terms, proper names, or key concepts. In health sciences, such errors might alter medication names or disease states, leading students to interpret the question as referring to a completely different condition or treatment.
• Subject-Verb Disagreements: Grammatical errors that create confusion about who or what is performing an action can obscure the intended meaning of the question.
• Punctuation Problems: Missing or misplaced punctuation can change sentence meaning, create ambiguity, or make questions difficult to parse correctly.

Prevention and Quality Assurance Strategies

Multiple Review Cycles: Implement systematic proofreading processes that include multiple reviewers examining questions at different stages of development. Fresh eyes often catch errors that the original author misses due to familiarity with the content.

Technology-Assisted Review: Use spell-check and grammar-check tools as initial screening mechanisms, but don't rely on them exclusively as they may miss context-dependent errors or flag technical terminology common in health sciences education.

Professional Standards: In healthcare and other professional fields, attention to detail is critical for patient safety and professional competence. Educational assessments should model the precision and accuracy expected in professional practice.

Best Practices for Quality Control

To minimize language errors, it is essential to have a robust quality control process. This should include:

• Proofreading: Carefully proofread all questions and answer choices before administering an exam.
• Peer Review: Have a colleague review the exam for clarity, accuracy, and grammatical correctness.
• Automated Tools: Use spelling and grammar checkers to catch common errors.

Spelling, typographical, and grammatical errors in exam questions create barriers to student success and compromise the validity of health sciences assessments. ExamEval provides AI-powered analysis that automatically detects and corrects language errors, helping educators create professional, clear, and equitable assessments that accurately measure student learning outcomes.

References

1. National Board of Medical Examiners (NBME). Item-Writing Guide. Philadelphia, PA: National Board of Medical Examiners; February 2021.
2. 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
3. Rudolph MJ, Daugherty KK, Ray ME, Shuford VP, Lebovitz L, DiVall MV. Best Practices Related to Examination Item Construction and Post-hoc Review. Am J Pharm Educ. 2019;83(7):7204. doi:10.5688/ajpe7204