Technical flaws in multiple-choice questions in the access exam to medical specialties ("examen MIR") in Spain (2009-2013)

Utility of RAND/UCLA appropriateness method in validating multiple-choice questions on ECG

OBJECTIVES

This study aimed to investigate the utility of the RAND/UCLA appropriateness method (RAM) in validating expert consensus-based multiple-choice questions (MCQs) on electrocardiogram (ECG).

METHODS

According to the RAM user's manual, nine panelists comprising various experts who routinely handle ECGs were asked to reach a consensus in three phases: a preparatory phase (round 0), an online test phase (round 1), and a face-to-face expert panel meeting (round 2). In round 0, the objectives and future timeline of the study were elucidated to the nine expert panelists with a summary of relevant literature. In round 1, 100 ECG questions prepared by two skilled cardiologists were answered, and the success rate was calculated by dividing the number of correct answers by 9. Furthermore, the questions were stratified into "Appropriate," "Discussion," or "Inappropriate" according to the median score and interquartile range (IQR) of appropriateness rating by nine panelists. In round 2, the validity of the 100 ECG questions was discussed in an expert panel meeting according to the results of round 1 and finally reassessed as "Appropriate," "Candidate," "Revision," and "Defer."

RESULTS

In round 1 results, the average success rate of the nine experts was 0.89. Using the median score and IQR, 54 questions were classified as " Discussion." In the expert panel meeting in round 2, 23% of the original 100 questions was ultimately deemed inappropriate, although they had been prepared by two skilled cardiologists. Most of the 46 questions categorized as "Appropriate" using the median score and IQR in round 1 were considered "Appropriate" even after round 2 (44/46, 95.7%).

CONCLUSIONS

The use of the median score and IQR allowed for a more objective determination of question validity. The RAM may help select appropriate questions, contributing to the preparation of higher-quality tests.

Questioning the questions: Methods used by medical schools to review internal assessment items

This article was migrated. The article was marked as recommended. Objective: Review of assessment questions to ensure quality is critical to properly assess student performance. The purpose of this study was to identify processes used by medical schools to review questions used in internal assessments. Methods: The authors recruited professionals involved with the writing and/or review of questions for their medical school's internal assessments to participate in this study. The survey was administered electronically via an anonymous link, and participation was solicited through the DR-ED listserv, an electronic discussion group for medical educators. Responses were collected over a two-week period, and one reminder was sent to increase the response rate. The instrument was comprised of one demographic question, two closed-ended questions, and two open-ended questions. Results: Thirty-nine respondents completed the survey in which 22 provided the name of their institution/medical school. Of those who self-identified, no two respondents appeared to be from the same institution, and participants represented institutions from across the United States with two from other countries. The majority (n=32, 82%) of respondents indicated they had a process to review student assessment questions. Most participants reported that faculty and course/block directors had responsibility for review of assessment questions, while some indicated they had a committee or group of faculty who was responsible for review. Most focused equally on content/accuracy, formatting, and grammar as reported. Over 81% (n=22) of respondents indicated they used NBME resources to guide review, and less than 19% (n=5) utilized internally developed writing guides. Conclusions: Results of this study identified that medical schools are using a wide range of item review strategies and use a variety of tools to guide their review. These results will give insight to other medical schools who do not have processes in place to review assessment questions or who are looking to expand upon current procedures.

Impact of panelists' experience on script concordance test scores of medical students

BACKGROUND

The evaluation process of French medical students will evolve in the next few years in order to improve assessment validity. Script concordance testing (SCT) offers the possibility to assess medical knowledge alongside clinical reasoning under conditions of uncertainty. In this study, we aimed at comparing the SCT scores of a large cohort of undergraduate medical students, according to the experience level of the reference panel.

METHODS

In 2019, the authors developed a 30-item SCT and sent it to experts with varying levels of experience. Data analysis included score comparisons with paired Wilcoxon rank sum tests and concordance analysis with Bland & Altman plots.

RESULTS

A panel of 75 experts was divided into three groups: 31 residents, 21 non-experienced physicians (NEP) and 23 experienced physicians (EP). Among each group, random samples of N = 20, 15 and 10 were selected. A total of 985 students from nine different medical schools participated in the SCT examination. No matter the size of the panel (N = 20, 15 or 10), students' SCT scores were lower with the NEP group when compared to the resident panel (median score 67.1 vs 69.1, p < 0.0001 if N = 20; 67.2 vs 70.1, p < 0.0001 if N = 15 and 67.7 vs 68.4, p < 0.0001 if N = 10) and with EP compared to NEP (65.4 vs 67.1, p < 0.0001 if N = 20; 66.0 vs 67.2, p < 0.0001 if N = 15 and 62.5 vs 67.7, p < 0.0001 if N = 10). Bland & Altman plots showed good concordances between students' SCT scores, whatever the experience level of the expert panel.

CONCLUSIONS

Even though student SCT scores differed statistically according to the expert panels, these differences were rather weak. These results open the possibility of including less-experienced experts in panels for the evaluation of medical students.

Development of a New Scoring System To Accurately Estimate Learning Outcome Achievements via Single, Best-Answer, Multiple-Choice Questions for Preclinical Students in a Medical Microbiology Course

During the preclinical years, single-best-answer multiple-choice questions (SBA-MCQs) are often used to test the higher-order cognitive processes of medical students (such as application and analysis) while simultaneously assessing lower-order processes (like knowledge and comprehension). Consequently, it can be difficult to pinpoint which learning outcome has been achieved or needs improvement. We developed a new scoring system for SBA-MCQs using a step-by-step methodology to evaluate each learning outcome independently. Enrolled in this study were third-year medical students (n = 316) who had registered in the basic microbiology course at the Faculty of Medicine, Siriraj Hospital, Mahidol University during the academic year 2017. A step-by-step SBA-MCQ with a new scoring system was created and used as a tool to evaluate the validity of the traditional SBA-MCQs that assess two separate outcomes simultaneously. The scores for the two methods, in percentages, were compared using two different questions (SBA-MCQ1 and SBA-MCQ2). SBA-MCQ1 tested the students' knowledge of the causative agent of a specific infectious disease and the basic characteristics of the microorganism, while SBA-MCQ2 tested their knowledge of the causative agent of a specific infectious disease and the pathogenic mechanism of the microorganism. The mean score obtained with the traditional SBA-MCQs was significantly lower than that obtained with the step-by-step SBA-MCQs (85.9% for the traditional approach versus 90.9% for step-by-step SBA-MCQ1; p < 0.001; and 81.5% for the traditional system versus 87.4% for step-by-step SBA-MCQ2; p < 0.001). Moreover, 65.8% and 87.8% of the students scored lower with the traditional SBA-MCQ1 and the traditional SBA-MCQ2, respectively, than with the corresponding sets of step-by-step SBA-MCQ questions. These results suggest that traditional SBA-MCQ scores need to be interpreted with caution because they have the potential to underestimate the learning achievement of students. Therefore, the step-by-step SBA-MCQ is preferable to the traditional SBA-MCQs and is recommended for use in examinations during the preclinical years.

The MIR 2018 Exam: Psychometric Study and Comparison with the Previous Nine Years

Background and Objectives: The aim of the present research is to study the questions used in the 2018 MIR exam (a test that allows access to specialized medical training in Spain), describe their psychometric properties, and evaluate their quality. Materials and Methods: This analysis is performed with the help of classical test theory (CTT) and item response theory (IRT). The answers given to the test questions by a total of 3868 physicians are analyzed. Results: According to CTT, the average difficulty index for all of the test questions was 0.629, which falls into the acceptable category. The average difficulty index with correction for random effects was 0.515, which corresponds to a value within the optimal range. The mean discrimination index was 0.277, which is in the good category, while the mean point biserial correlation coefficient, with a value of 0.275 fits in the regular category. The values of difficulty and discrimination calculated according to the model of two parameters of the IRT seem adequate with average values of -0.389 and 0.677. The Cronbach alpha score obtained for the overall test was 0.944. This value is considered as very good. Conclusions: A decrease was observed in the average values of discrimination in the last three calls, which may be related to the greater proportion of Spanish graduates that take the exam in the same year of finalization of their studies in Medicine.