Do item-writing flaws reduce examinations psychometric quality?

The impact of the IWF was heterogeneous, the Writing the Stem and Writing the Choices categories had a negative impact (higher difficulty and lower discrimination) while the other categories did not have any impact. The anatomical site effect was higher than IWF effect in the psychometric characteristics of the examination. When constructing MCQ, the focus should be in the topic/area of the items and only after in the presence of IWF.