Situational judgment test validity: an exploratory model of the participant response process using cognitive and think-aloud interviews

Opening the Black Box: Agreement and Reliability of a Situational Judgment Test Across Multiple Institutions

OBJECTIVE

The primary objective of this study was to examine the levels of agreement and reliability of a situational judgment test (SJT) using a diverse pool of pharmacy practice faculty as subject matter experts. Secondary aims included analyses to build support for test validity and fairness.

METHODS

An SJT containing 18 scenarios and 118 responses assessing empathy, integrity, and teamwork was developed and delivered to pharmacy practice faculty at 5 schools of pharmacy across the United States. Reliability was assessed by examining internal consistency, inter-rater reliability, and split-half reliability. Only responses which attained an inter-rater agreement>0.7 were included in the final version of the SJT. All responses were scored using a near-miss system, allowing higher scores for answers more closely aligned with the key, which was determined by the faculty who completed the SJT. Test fairness was reported using descriptive statistics.

RESULTS

Thirty-nine faculty across the 5 participating institutions completed the SJT. The final version of the SJT included 105 responses, achieving an inter-rater agreement of>0.7 (inter-rater reliability of 0.98). Split-half reliability was 0.72. The average score was 85.7%, and no differences in performance were observed based on demographic characteristics.

CONCLUSION

An SJT designed to assess empathy, integrity, and teamwork achieved reasonable levels of reliability among pharmacy practice faculty across the United States, and the results provided initial support for test validity and fairness. These results support a pilot to assess this SJT among students representing multiple institutions.

Parent Perspectives for Type B Ulnar Polydactyly Management

BACKGROUND

Type B ulnar polydactyly is one of the most commonly encountered congenital hand differences and can be treated with ligation or excision. The purpose of this study was to determine what factors families consider in selecting treatment for their child with type B ulnar polydactyly.

METHODS

We reviewed treatment outcomes and administered a survey by telephone to parents of children with type B ulnar polydactyly treated at a pediatric hospital between 2015 and 2020. We assessed satisfaction, reasons for choosing treatment, and post-management complications.

RESULTS

The families of 70 of the 156 consecutive treated patients were successfully contacted and agreed to participate (45% response rate). The mean follow-up was 27 months. Twenty-eight chose in-office suture ligation and 42 chose excision. Rapid treatment was prioritized by those who opted for in-office ligation (P = .044). The complication rate for suture ligation was significantly higher than excision (P < .0001), with the most common complication being a residual remnant (nubbin or neuroma stump) (64%). Respondents with residual remnant reported significantly less satisfaction with the appearance of their child's hand (P < .001) and with treatment outcomes (P = .028) compared to those without residual remnants.

CONCLUSIONS

Factors considered by parents in choosing type of treatment for type B ulnar polydactyly vary and may be significantly influenced by the surgeon. Although the majority of parents remain extremely satisfied with their child's outcome regardless of management type, time to treatment plays a determinative role in parents opting for ligation rather than excision in the operating room.

The Relationship Between a Multiple Mini-interview and Situational Judgment Test for Admissions

Objective. To explore the relationship between a multiple mini-interview (MMI) and situational judgment test (SJT) designed to evaluate nonacademic constructs.Methods. A 30-question ranked-item SJT was developed to test three constructs also measured by MMIs during a pharmacy school's admissions process. First-year pharmacy students were invited to complete the SJT in fall 2020. One hundred four students took the SJT (82.5% response rate), with 97 (77% of possible participants) having MMI scores from the admissions process. Descriptive statistics and other statistical analyses were used to explore the psychometric properties of the SJT and its relationship to MMI scores.Results. Seventy-four percent of students identified as female (n=72), and 11.3% identified with an underrepresented racial identity (n=11). The average age, in mean (SD), was 21.8 (2.1) years. Students' mean (SD) scores were 85.5 (3.1) (out of 100 points) on the SJT and 6.1 (1.0) (out of 10 points) on the MMI. Principal components analysis indicated that the SJT lacked construct validity and internal reliability. However, reliability of the entire SJT instrument provided support for using the total SJT score for analysis (α=.63). Correlations between total SJT and MMI scores were weak (r p<0.29).Conclusion. Results of this study suggest that an SJT may not be a good replacement for the MMI to measure distinct constructs during the admissions process. However, the SJT may provide useful supplemental information during admissions or as part of formative feedback once students are enrolled in a program.

Validation of response processes in medical assessment using an explanatory item response model

BACKGROUND

Response process validation is a crucial source of test validity. The expected cognitive load scale was created based on the reflection of the mental effort by which borderline students solve an item defined by experts. The stem length affects the students' extraneous cognitive load. The purposes of this study were to develop an exam for medical students and corroborate the response process validity by analyzing the correlation between the expected cognitive load, stem length, and the difficulty.

METHODS

This was a correlational study. Five medical teachers as the experts and 183 third-year medical students were enrolled from the Faculty of Medicine, Prince of Songkla University, Thailand. The instruments used were a medical physiology exam and a three-level expected cognitive load evaluation form judged by medical teachers. Data were analyzed using an explanatory item response model.

RESULTS

The test consists of 20 items and 21 possible scores. The median score was 8, with a quartile deviation of 1.5. Nine items had long stems (more than two lines). Sixteen items were judged as high (level 2 or 3) expected cognitive load. When adding the expected cognitive load in a Rasch model, the expected cognitive load significantly correlated with item difficulty. In the Rasch model that included both the expected cognitive load and stem length, a long stem had a greater effect on item difficulty than low expected cognitive load. However, the Rasch model showed the best fit.

CONCLUSIONS

The long stem had a stronger correlation with test difficulty than expected cognitive load, which indirectly implied response process validity. We suggest incorporating stem length and expected cognitive load to create an appropriate distribution of the difficulty of the entire test.

Use of Situational Judgment Tests to Teach Empathy, Assertiveness, Communication, and Ethics

Objective. The objectives of this study were to develop situational judgment test (SJT) scenarios for use in teaching empathy, assertiveness, and interprofessional communication in second-year pharmacy (P2) students and ethics in third-year pharmacy (P3) students, determine whether the SJTs developed were effective at measuring students' communication skills and ethical judgment, compare the performance of individual third-year students to the performance of teams of third-year students on the ethics SJT, and evaluate student feedback about SJTs as a teaching tool.Methods. Pharmacy faculty developed five SJT scenarios related to communications and five SJT scenarios related to ethics and piloted the scenarios with P2 and P3 students, respectively. Second-year students completed SJTs individually, while P3 students completed SJTs individually and in teams. Scenarios and responses were discussed with faculty after completion of the SJTs, and students completed a questionnaire to provide feedback on the SJTs.Results. The communications SJT was completed by 59 P2 students with a mean score of 67.5%. The ethics SJT was completed by 57 P3 students with a mean score of 80.1%. The ethics SJT was also completed by 10 teams of P3 students resulting in a mean score of 93.2%. Students indicated the SJT content was realistic and the tests provided the opportunity to reflect on how to approach challenging situations.Conclusion. Situational judgment tests were useful for teaching empathy, assertiveness, interprofessional communication, and ethics in pharmacy students. Future research should focus on predictive validity of SJTs for these content areas.

Interested in situational judgment tests? Preparing pharmacy educators for potential challenges

PURPOSE

There is a growing interest in situational judgment tests (SJTs) for assessments and the authors offer their insights to help others develop and utilize these instruments while navigating common challenges.

DESCRIPTION

This manuscript provides important considerations to those interested in SJTs using the "What? So What? Now What?" reflection framework. The authors offer their experience developing, implementing, and evaluating SJTs designed to measure empathy, adaptability, and integrity.

ANALYSIS/INTERPRETATION

Effective SJT design can be organized around five key steps: attribute definition, item design, key development and scoring, test administration, and data analysis and interpretation. There are general recommendations to optimize SJT design to enhance reliability and validity of the results; however, there are often other challenges that have not been previously described.

CONCLUSIONS

SJTs offer an exciting tool for measuring social and behavioral attributes; however, their infancy in health professions education warrants caution. Like any assessment, there are several challenges to consider when designing, implementing, and evaluating SJTs in pharmacy education.

IMPLICATIONS

Individuals interested in SJTs are encouraged to ensure the construct measured is well-defined, there are clear and supported decisions around item and key design, and the appropriate psychometric analyses are conducted.

Does the ability to identify the construct on an empathy situational judgment test relate to performance? Exploring a new concept in assessment

INTRODUCTION

The ability to identify criteria (ATIC) refers to an examinee's capacity to distinguish the construct being evaluated. Previous research indicates ATIC can be predictive of performance on some assessments. This exploratory study investigated the relationship between a participant's ability to identify criteria and their performance on an empathy situational judgment test (SJT), an assessment format used to measure social and behavioral attributes.

METHODS

A 12-item empathy SJT was completed by 15 students and 15 pharmacists. During a cognitive interview, participants were asked what they believed each exam question measured. Responses were coded to determine whether participants stated "empathy" (indication of ATIC). The point-biserial correlation coefficient was calculated to explore the relationship of ATIC (correctly or not correctly identifying the item measured empathy) and performance on the SJT (total score).

RESULTS

Participants identified empathy 33.3% of the time, and it was the construct most often identified. Pharmacists (27.5%) identified empathy less often than students (39.2%). When empathy was identified as the construct, it was most often reported for items in a non-healthcare setting (56.3%) rather than a healthcare setting (43.7%) and for questions targeting affective empathy (71.3%) rather than cognitive empathy (28.7%). There were no statistically significant relationships with correctly identifying the construct and performance on individual items and the overall test.

CONCLUSIONS

There is inconclusive evidence that ATIC relates to performance on an empathy SJT. Additional research is needed to evaluate the role of ATIC and assessment performance to corroborate study results.

Exploring the Role of Item Scenario Features on Situational Judgment Test Response Selections

Objective. To explore pharmacists' and pharmacy students' perceptions regarding the significance of changing the features of test item scenario (eg, switching from a health care to a non-health care context) on their situational judgment test (SJT) responses.Methods. Fifteen Doctor of Pharmacy students and 15 pharmacists completed a 12-item SJT intended to measure empathy. The test included six scenarios in a health care context and six scenarios in a non-health care context; participants had to rank potential response options in order of appropriateness and no two items could be of equal rank. Qualitative data were collected individually from participants using think-aloud and cognitive interview techniques. During the cognitive interview, participants were asked how they selected their final responses for each item and whether they would have changed their answer if features of the scenario were switched (eg, changed to a non-health care context if the original item was in a health care context). Interviews were transcribed and a thematic analysis was conducted to identify the features of the scenario for each item that were perceived to impact response selections.Results. Participants stated that they would have changed their responses on average 51.3% of the time (range 20%-100%) if the features of the scenario for an item were changed. Qualitative analysis identified four pertinent scenario features that may influence response selections, which included information about the examinee, the actors in the scenario, the relationship between examinee and actors, and details about the situation. There was no discernible pattern linking scenario features to the component of empathy being measured or participant type.Conclusion. Results from this study suggest that the features of the scenario described in an SJT item could influence response selections. These features should be considered in the SJT design process and require further research to determine the extent of their impact on SJT performance.

Role of Knowledge and Experience in Situational Judgment Test Responses of Pharmacists and Pharmacy Students

Objective. To describe the role of examinee knowledge and experience in situational judgment test (SJT) response processes.Methods. Thirty participants (15 students and 15 pharmacists) completed a 12-item SJT on empathy. Each participant completed a think-aloud interview followed by a cognitive interview to elicit their understanding of the items and factors that influenced their response selections. Interviews were coded to identify references to general and job-specific knowledge and experiences. Utterances were quantified to explore differences in the occurrence based on the individual item, item setting (ie, health care or non-health care setting), participant type (ie, student or pharmacists), and empathy component being assessed (ie, affective or cognitive empathy).Results. Participants made 480 references to knowledge and experiences: 45.2% were job-specific knowledge or experiences, 27.5% were general knowledge or experiences, 17.9% related to a lack of experience, and 9.4% were nondescript and could not be distinguished. There were significant differences in the reference to general and job-specific knowledge or experiences based on whether the item scenario occurred in a health care or non-health care setting and the component of empathy being assessed. Experience references often included comments about location, actors, task, similarity, specificity, and recency; knowledge references were classified by information, strategies, and skills.Conclusion. Findings from this study suggest general and job-specific knowledge and experiences influence response processes in SJTs.