National Board of Examiners, 3750 Market Street, Philadelphia, PA 19104, USA.
Acad Med. 2009 Oct;84(10 Suppl):S90-3. doi: 10.1097/ACM.0b013e3181b37b0b.
During 2007, multimedia-based presentations of selected clinical findings were introduced into the United States Medical Licensing Examination. This study investigated the impact of presenting cardiac auscultation findings in multimedia versus text format on item characteristics.
Content-matched versions of 43 Step 1 and 51 Step 2 Clinical Knowledge (CK) multiple-choice questions describing common pediatric and adult clinical presentations were administered in unscored sections of Step 1 and Step 2 CK. For multimedia versions, examinees used headphones to listen to the heart on a simulated chest while watching video showing associated chest and neck vein movements. Text versions described auscultation findings using standard medical terminology.
Analyses of item responses for first-time examinees from U.S./Canadian and international medical schools indicated that multimedia items were significantly more difficult than matched text versions, were less discriminating, and required more testing time.
Examinees can more readily interpret auscultation findings described in text using standard terminology than those same findings presented in a more authentic multimedia format. The impact on examinee performance and item characteristics is substantial.
2007 年期间，多媒体形式的特定临床发现展示被引入美国医师执照考试。本研究调查了以多媒体与文本格式呈现心脏听诊发现对试题特征的影响。
以内容匹配的形式，在 Step 1 和 Step 2 CK 的不记分部分，呈现了 43 道描述常见儿科和成人临床表现的 Step 1 和 51 道 Step 2 Clinical Knowledge（CK）选择题。对于多媒体版本，考生使用耳机在模拟胸部上听心脏，同时观看显示相关胸部和颈静脉运动的视频。文本版本使用标准医学术语描述听诊发现。
对来自美国/加拿大和国际医学院的首次考生的试题作答分析表明，多媒体试题明显比匹配的文本版本更难，区分度更低，且需要更多的测试时间。
考生可以更轻松地使用标准术语解释以文本形式描述的听诊发现，而不是以更真实的多媒体格式呈现的相同发现。这对考生表现和试题特征的影响是显著的。
