National Board of Medical Examiners, Philadelphia, Pennsylvania 19104, USA.
Acad Med. 2013 May;88(5):688-92. doi: 10.1097/ACM.0b013e31828af039.
Previous studies on standardized patient (SP) exams reported score gains both across attempts when examinees failed and retook the exam and over multiple SP encounters within a single exam session. The authors analyzed the within-session score gains of examinees who repeated the United States Medical Licensing Examination Step 2 Clinical Skills to answer two questions: How much do scores increase within a session? Can the pattern of increasing first-attempt scores account for across-session score gains?
Data included encounter-level scores for 2,165 U.S. and Canadian medical students and graduates who took Step 2 Clinical Skills twice between April 1, 2005 and December 31, 2010. The authors modeled examinees' score patterns using smoothing and regression techniques and applied statistical tests to determine whether the patterns were the same or different across attempts. In addition, they tested whether any across-session score gains could be explained by the first-attempt within-session score trajectory.
For the first and second attempts, the authors attributed examinees' within-session score gains to a pattern of score increases over the first three to six SP encounters followed by a leveling off. Model predictions revealed that the authors could not attribute the across-session score gains to the first-attempt within-session score gains.
The within-session score gains over the first three to six SP encounters of both attempts indicate that there is a temporary "warm-up" effect on performance that "resets" between attempts. Across-session gains are not due to this warm-up effect and likely reflect true improvement in performance.
先前关于标准化患者（SP）考试的研究报告称，当考生失败并重新参加考试时，无论是在多次尝试中还是在一次考试的多个 SP 接触中，他们的分数都有所提高。作者分析了重复参加美国医师执照考试第 2 步临床技能考试的考生在单次考试期间的分数提高情况，以回答两个问题：在一次考试中分数提高了多少？首次尝试分数的增加模式能否解释整个考试期间的分数提高？
数据包括 2005 年 4 月 1 日至 2010 年 12 月 31 日期间两次参加第 2 步临床技能考试的 2165 名美国和加拿大医学生和毕业生的考试次数水平得分。作者使用平滑和回归技术对考生的分数模式进行建模，并应用统计检验来确定模式在尝试之间是否相同或不同。此外，他们还测试了任何整个考试期间的分数提高是否可以通过首次尝试的单次考试分数轨迹来解释。
对于第一次和第二次尝试，作者将考生的单次考试分数提高归因于在最初的三到六次 SP 接触中分数逐渐增加然后趋于平稳的模式。模型预测表明，作者无法将整个考试期间的分数提高归因于首次尝试的单次考试分数提高。
两次尝试的最初三到六次 SP 接触中的单次考试分数提高表明，在尝试之间存在对表现的临时“预热”效应。整个考试期间的提高并不是由于这种预热效应，而很可能反映了表现的真正提高。
