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EXAM: STEP2 540
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COMPUTER-BASED TESTING AND THE INTERNET
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GROUP 480 Testing Time (minutes) NBME-esl Rsq = 00203 420 NBME-eng Rsq = 00266 360 IMG-esl Rsq = 00275 300 IMG-eng 240 14 0 160 180 200 22 0 240 Rsq = 00350
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Figure 94 Testing time as a function of test performance, native English speaking status (eng and esl), and location of medical education (NBME US/Canadian, IMG international medical graduate)
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pro ciency Lower-pro ciency examinees are more adversely affected than high-pro ciency examinees Note that NBME s pre-CBT eld tests using an adaptive sequential testing model indicated that this difference might not be the case in an adaptive testing context, where more able examinees may be time challenged because of their interaction with more dif cult test material These data have supported analyses that would have been impossible in paper and pencil testing They have resulted in changes in item pacing for the Step 2 examination These timing data provide just one example of new data available from CBT that affect test form construction (to assure equivalency) and test administration standards If this information is judiciously collected, analyzed, and acted upon, a higher-quality, fairer test will result The use of new formats, such as Primum CCS, force important considerations, such as their relationship to overall performance, the evidence that they provide unique information, judgments about how this information should be integrated into the overall test decision, etc Furthermore, newer testing formats all seem to be less time ef cient than MCQs, and careful consideration needs to be given to supplanting time allocated to MCQs in favor of new, more authentic assessment tools The complex scoring approaches described for Primum CCS demand new approaches to test validation All in all, these challenges provide full employment for future generations of measurement specialists At this point in the history of CBT, it would be erroneous to conclude that an operational CBT program can be implemented without a signi cant investment on an ongoing basis in continued research and development
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HEALTH PROFESSIONAL LICENSING AND CERTIFICATION
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FUTURE POTENTIAL FROM CBT
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In licensing and certifying examination programs for medicine, testing the range of competencies necessary for safe and effective practice is essential However, for four decades tools have not been available that allowed defensible assessment of some of these competencies The emergence of technologybased testing, allowing innovative testing formats such as simulations, has contributed to renewed interest in developing licensing and certifying examination instruments that assess a more complete range of relevant competencies than is now the case What are the competencies needed to practice safely and effectively Figure 95 shows a taxonomy for the competencies of doctors, proposed by
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Observation, audit, ratings
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Practice (does) Performance (can do) Competence (knows how)
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SPs, bedside/ lab exam, CCS
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MCQ, Case Simulations, Essay, Oral
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Knowledge (knows) MCQ, Short answer
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Figure 95 The Miller pyramid: sequential stages of competency and tools for their assessment
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Miller more than a decade ago (Miller, 1990) In this model, the foundation of physician effectiveness is knowledge An effective physician knows Built upon knowledge must be competence The physician must not only know, he or she must know how to be able to apply knowledge appropriately However, this is not enough The effective practitioner must be able to perform based on knowledge and competence The can do is at least as important as the knows how Finally, all of this must be put into daily practice Even the physician who can perform effectively may not do so consistently MCQ examinations do a superb job of testing knowledge, and with careful attention to test design and question writing they may test knowing how The addition of computer-based case simulations to USMLE enhanced the examination s ability to test competence, and it begins to test performance in certain aspects of the doctor s tasks However, other tools will be necessary to allow full
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