Journal of Educational Evaluation for Health Professions

Technical report

Increased accessibility of computer-based testing for residency application to a hospital in Brazil with item characteristics comparable to paper-based testing: a psychometric study: Marcos Carvalho Borges, Luciane Loures Santos, Paulo Henrique Manso, Elaine Christine Dantas Moisés, Pedro Soler Coltro, Priscilla Costa Fonseca, Paulo Roberto Alves Gentil, Rodrigo de Carvalho Santana, Lucas Faria Rodrigues, Benedito Carlos Maciel, Hilton Marcos Alves Ricz; J Educ Eval Health Prof. 2024;21:32. Published online November 11, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.32

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Purpose
With the coronavirus disease 2019 pandemic, online high-stakes exams have become a viable alternative. This study evaluated the feasibility of computer-based testing (CBT) for medical residency applications in Brazil and its impacts on item quality and applicants’ access compared to paper-based testing.
Methods
In 2020, an online CBT was conducted in a Ribeirao Preto Clinical Hospital in Brazil. In total, 120 multiple-choice question items were constructed. Two years later, the exam was performed as paper-based testing. Item construction processes were similar for both exams. Difficulty and discrimination indexes, point-biserial coefficient, difficulty, discrimination, guessing parameters, and Cronbach’s α coefficient were measured based on the item response and classical test theories. Internet stability for applicants was monitored.
Results
In 2020, 4,846 individuals (57.1% female, mean age of 26.64±3.37 years) applied to the residency program, versus 2,196 individuals (55.2% female, mean age of 26.47±3.20 years) in 2022. For CBT, there was an increase of 2,650 applicants (120.7%), albeit with significant differences in demographic characteristics. There was a significant increase in applicants from more distant and lower-income Brazilian regions, such as the North (5.6% vs. 2.7%) and Northeast (16.9% vs. 9.0%). No significant differences were found in difficulty and discrimination indexes, point-biserial coefficients, and Cronbach’s α coefficients between the 2 exams.
Conclusion
Online CBT with multiple-choice questions was a viable format for a residency application exam, improving accessibility without compromising exam integrity and quality.

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Joyce Santana Rizzi, Lorraine Silva Requena, Angelica Maria Bicudo, Pedro Tadao Hamamoto Filho, Renato Ferretti
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Research article

Post-hoc simulation study of computerized adaptive testing for the Korean Medical Licensing Examination: Dong Gi Seo, Jeongwook Choi; J Educ Eval Health Prof. 2018;15:14. Published online May 17, 2018; DOI: https://doi.org/10.3352/jeehp.2018.15.14; Correction in: J Educ Eval Health Prof 2018;15(0):27

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Abstract PDF Supplementary Material

Purpose
Computerized adaptive testing (CAT) has been adopted in licensing examinations because it improves the efficiency and accuracy of the tests, as shown in many studies. This simulation study investigated CAT scoring and item selection methods for the Korean Medical Licensing Examination (KMLE).
Methods
This study used a post-hoc (real data) simulation design. The item bank used in this study included all items from the January 2017 KMLE. All CAT algorithms for this study were implemented using the ‘catR’ package in the R program.
Results
In terms of accuracy, the Rasch and 2-parametric logistic (PL) models performed better than the 3PL model. The ‘modal a posteriori’ and ‘expected a posterior’ methods provided more accurate estimates than maximum likelihood estimation or weighted likelihood estimation. Furthermore, maximum posterior weighted information and minimum expected posterior variance performed better than other item selection methods. In terms of efficiency, the Rasch model is recommended to reduce test length.
Conclusion
Before implementing live CAT, a simulation study should be performed under varied test conditions. Based on a simulation study, and based on the results, specific scoring and item selection methods should be predetermined.

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Funding information of the article entitled “Post-hoc simulation study of computerized adaptive testing for the Korean Medical Licensing Examination”
Dong Gi Seo, Jeongwook Choi
Journal of Educational Evaluation for Health Professions.2018; 15: 27. CrossRef
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Review

Components of the item selection algorithm in computerized adaptive testing: Kyung (Chris) Tyek Han; J Educ Eval Health Prof. 2018;15:7. Published online March 24, 2018; DOI: https://doi.org/10.3352/jeehp.2018.15.7

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Abstract PDF Supplementary Material

Computerized adaptive testing (CAT) greatly improves measurement efficiency in high-stakes testing operations through the selection and administration of test items with the difficulty level that is most relevant to each individual test taker. This paper explains the 3 components of a conventional CAT item selection algorithm: test content balancing, the item selection criterion, and item exposure control. Several noteworthy methodologies underlie each component. The test script method and constrained CAT method are used for test content balancing. Item selection criteria include the maximized Fisher information criterion, the b-matching method, the astratification method, the weighted likelihood information criterion, the efficiency balanced information criterion, and the KullbackLeibler information criterion. The randomesque method, the Sympson-Hetter method, the unconditional and conditional multinomial methods, and the fade-away method are used for item exposure control. Several holistic approaches to CAT use automated test assembly methods, such as the shadow test approach and the weighted deviation model. Item usage and exposure count vary depending on the item selection criterion and exposure control method. Finally, other important factors to consider when determining an appropriate CAT design are the computer resources requirement, the size of item pools, and the test length. The logic of CAT is now being adopted in the field of adaptive learning, which integrates the learning aspect and the (formative) assessment aspect of education into a continuous, individualized learning experience. Therefore, the algorithms and technologies described in this review may be able to help medical health educators and high-stakes test developers to adopt CAT more actively and efficiently.

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Review article

Overview and current management of computerized adaptive testing in licensing/certification examinations: Dong Gi Seo; J Educ Eval Health Prof. 2017;14:17. Published online July 26, 2017; DOI: https://doi.org/10.3352/jeehp.2017.14.17

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Abstract PDF

Computerized adaptive testing (CAT) has been implemented in high-stakes examinations such as the National Council Licensure Examination-Registered Nurses in the United States since 1994. Subsequently, the National Registry of Emergency Medical Technicians in the United States adopted CAT for certifying emergency medical technicians in 2007. This was done with the goal of introducing the implementation of CAT for medical health licensing examinations. Most implementations of CAT are based on item response theory, which hypothesizes that both the examinee and items have their own characteristics that do not change. There are 5 steps for implementing CAT: first, determining whether the CAT approach is feasible for a given testing program; second, establishing an item bank; third, pretesting, calibrating, and linking item parameters via statistical analysis; fourth, determining the specification for the final CAT related to the 5 components of the CAT algorithm; and finally, deploying the final CAT after specifying all the necessary components. The 5 components of the CAT algorithm are as follows: item bank, starting item, item selection rule, scoring procedure, and termination criterion. CAT management includes content balancing, item analysis, item scoring, standard setting, practice analysis, and item bank updates. Remaining issues include the cost of constructing CAT platforms and deploying the computer technology required to build an item bank. In conclusion, in order to ensure more accurate estimations of examinees’ ability, CAT may be a good option for national licensing examinations. Measurement theory can support its implementation for high-stakes examinations.

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Brief report

Smart device-based testing for medical students in Korea: satisfaction, convenience, and advantages: Eun Young Lim, Mi Kyoung Yim, Sun Huh; J Educ Eval Health Prof. 2017;14:7. Published online April 24, 2017; DOI: https://doi.org/10.3352/jeehp.2017.14.7

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Abstract PDF

The aim of this study was to investigate respondents’ satisfaction with smart device-based testing (SBT), as well as its convenience and advantages, in order to improve its implementation. The survey was conducted among 108 junior medical students at Kyungpook National University School of Medicine, Korea, who took a practice licensing examination using SBT in September 2015. The survey contained 28 items scored using a 5-point Likert scale. The items were divided into the following three categories: satisfaction with SBT administration, convenience of SBT features, and advantages of SBT compared to paper-and-pencil testing or computer-based testing. The reliability of the survey was 0.95. Of the three categories, the convenience of the SBT features received the highest mean (M) score (M= 3.75, standard deviation [SD]= 0.69), while the category of satisfaction with SBT received the lowest (M= 3.13, SD= 1.07). No statistically significant differences across these categories with respect to sex, age, or experience were observed. These results indicate that SBT was practical and effective to take and to administer.

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Brief Report

Cross-platform digital assessment forms for evaluating surgical skills: Steven Arild Wuyts Andersen; J Educ Eval Health Prof. 2015;12:13. Published online April 17, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.13

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Abstract PDF: A variety of structured assessment tools for use in surgical training have been reported, but extant assessment tools often employ paper-based rating forms. Digital assessment forms for evaluating surgical skills could potentially offer advantages over paper-based forms, especially in complex assessment situations. In this paper, we report on the development of cross-platform digital assessment forms for use with multiple raters in order to facilitate the automatic processing of surgical skills assessments that include structured ratings. The FileMaker 13 platform was used to create a database containing the digital assessment forms, because this software has cross-platform functionality on both desktop computers and handheld devices. The database is hosted online, and the rating forms can therefore also be accessed through most modern web browsers. Cross-platform digital assessment forms were developed for the rating of surgical skills. The database platform used in this study was reasonably priced, intuitive for the user, and flexible. The forms have been provided online as free downloads that may serve as the basis for further development or as inspiration for future efforts. In conclusion, digital assessment forms can be used for the structured rating of surgical skills and have the potential to be especially useful in complex assessment situations with multiple raters, repeated assessments in various times and locations, and situations requiring substantial subsequent data processing or complex score calculations.

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