Department of Surgery, University of Adelaide, and Royal Adelaide Hospital, Adelaide, Australia.
Med Teach. 2010;32(7):e300-7. doi: 10.3109/0142159X.2010.488705.
Exit examinations in medicine are 'high stakes' examinations and as such must satisfy a number of criteria including psychometric robustness, fairness and reliability in the face of legal or other challenges.
We have undertaken a critical review of the exit examination from the University of Adelaide focussing on the written components. This examination consisted of an objective structure clinical examination (OSCE), a multiple choice question (MCQ) paper and a modified essay question (MEQ) paper.
The two written papers were assessed for item writing flaws and taxonomic level using modified Bloom's criteria. Curriculum experts independently assessed adequacy of the examination for validity and fidelity.
The overall examination had good fidelity and validity. The results of the MEQ and MCQ were strongly and positively correlated and there was a weak negative correlation between these papers and the OSCE. The MEQ had a higher proportion of questions focussed on recall of knowledge and the questions were more structurally flawed compared with the MCQs. The MEQ re-marking process resulted in lower scores than were awarded by the original, discipline-based expert markers. The MEQ paper failed to achieve its primary purpose of assessing higher cognitive skills.
The University of Adelaide's MBBS programme has since dropped the MEQ paper from its exit examination and is evaluating in its place the Script Concordance test.
医学结业考试是“高风险”考试，因此必须满足一些标准，包括心理测量学的稳健性、公平性和在法律或其他挑战面前的可靠性。
我们对阿德莱德大学的结业考试进行了批判性回顾，重点是书面考试部分。该考试由客观结构临床考试（OSCE）、多项选择题（MCQ）试卷和改良简答题（MEQ）试卷组成。
使用改良的布鲁姆分类标准评估了这两份书面试卷的试题编写缺陷和分类水平。课程专家独立评估了考试的有效性和忠实度。
总体考试具有良好的忠实度和有效性。MEQ 和 MCQ 的结果呈强烈正相关，而这些试卷与 OSCE 之间呈弱负相关。MEQ 中更侧重于知识的回忆，与 MCQ 相比，其问题结构上存在更多缺陷。MEQ 的重新评分过程导致的分数低于原始、学科专家评分者给出的分数。MEQ 试卷未能实现其评估更高认知技能的主要目的。
阿德莱德大学的 MBBS 课程已将 MEQ 试卷从结业考试中删除，目前正在评估替代试卷 Script Concordance 测试。
