Although multiple choice test items are well-suited for assessing fact recall and comprehension, with some extra effort, they can also be used to assess higher-order thinking such as application, analysis and evaluation. The category of intellectual ability assessed by your multiple choice questions is driven by your learning objectives, which can be used to construct a test blueprint to help in planning your test.
If your objective is to have students achieve higher-order thinking, it is necessary that the test items reflect this intention. A multiple choice item developed to assess higher-order thinking usually provides a situation/scenario or graphic/chart followed by several questions that require students to use what they have learned to provide the correct answer. For example, an item may provide a scenario that describes the symptoms of a patient and asks learners to judge which stage of a disease that particular patient exemplifies. Compare this item to one that asks learners to recall the symptoms of a particular stage of a disease. The former provides an opportunity for learners to apply what they have learned; the latter merely requires students to remember the facts.
Developing test items to assess higher-order thinking is not an easy task. A useful technique is to start from your existing items and transform them into items assessing more than recalling facts. The “Assessing more than facts” resource provides examples of how you can transform your items. The additional resources provide a range of examples of multiple choice items developed to assess different levels of thinking.