Theoretical and test simulation work reveals that under the knowledge-or-randomguessing assumption, three-option item tests are at least as good as four-option item tests in terms of item discrimination and internal consistency. Of concern, however, is the finding that multiple-choice items may be susceptible to testwiseness, thereby contradicting the random-guessing assumption. Both item-level and test-level characteristics were examined for items included in a high stakes school-leaving mathematics examination. As expected, the influence of testwiseness is lessened when three-option items are used instead of four-option items. Differences and nondifferences between the psychometric characteristics of the three-option and four-option test forms tend to agree with the findings of earlier studies: Tests consisting of three-option items are at least equivalent to tests composed of four options in terms of internal consistency score reliability, difficulty is inversely related to the number of options, and the findings for item discrimination are not conclusive.

These results are consistent with data from the literature on the broader aspects of clinical teaching, and imply that the ideal bedside teaching experience from the perspective of the students is heavily influenced by teacher behaviours than that can be modified.

The construct of research utilization is multi-faceted. Several indicators of research utilization were identified, which can be used to augment existing or develop a new and improved measure that taps both instrumental and conceptual use.

Objective-To compare pre-hospital parental administration of pain relief for children with that of the accident and emergency (A&E) department staff and to ascertain the reason why pre-hospital analgesia is not being given. Designlmethods-An anonymous prospective questionnaire was given to parents/guardians of children < 17 years. The children were all self referred with head injuries or limb problems including burns. The first part asked for details of pain relief before attendance in the A&E department. The second part of the questionnaire contained a section for the examining doctor and triage nurse to fill in. The duration ofthe survey was 28 days. MethodsThe questionnaire (fig 1) was devised after discussion with staff from the hospital and the local university (Magee). Further modifications were made over a 48 hour period, to the satisfaction of both medical and nursing staff. The questionnaire was then piloted for a full week (without further modification) to encourage staff participation. The questionnaire was administered over a 28 day period in spring 1998. One questionnaire was distributed per child.The questionnaire was in two parts. The first was filled in by a parents or guardians of the child attending the A&E department. All children were <17 years old. Children entered in the study were self referred with head injuries and limb problems including lacerations and burns. Children attending by ambulance or directly from school or with abdominal, chest, or dermatology conditions were excluded from the study.The first part of the survey ascertained the age of the child, the occupation of the parents/ guardians, the delay in presentation, and if there were painkillers suitable for children at home. When pain relief was given before A&E department attendance, the type and the dose of analgesic were documented. The reason for analgesia not being given was recorded. The second part of the questionnaire was completed by A&E department staff. This included the type, dose, and timing of administration of analgesia. The problem, whether a limb injury, burn, laceration, or head injury and the result of radiography (if required) was recorded. The diagnosis and whether the child required a general anaesthetic were documented. The authors checked each proforma every day against the A&E department ledger and completed any unfinished second part of the proformas. SETTINGThe A&E department serves an urban/rural catchment of more than 250 000. In the year, the busiest periods with children are summer and autumn; 40% of the 43 500 new patient attendances are children. The

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