a Department of Assessment and Evaluation, Institute of Medical Education Bern , University of Bern , Bern, Switzerland.
b Department of Pediatric Cardiology and Intensive Care Medicine , Klinikum Stuttgart, Stuttgart , Germany.
Med Teach. 2017 May;39(5):476-485. doi: 10.1080/0142159X.2017.1297525. Epub 2017 Mar 10.
It remains unclear which item format would best suit the assessment of clinical reasoning: context-rich single best answer questions (crSBAs) or key-feature problems (KFPs). This study compared KFPs and crSBAs with respect to students' acceptance, their educational impact, and psychometric characteristics when used in a summative end-of-clinical-clerkship pediatric exam.
Fifth-year medical students (n = 377) took a computer-based exam that included 6-9 KFPs and 9-20 crSBAs which assessed their clinical reasoning skills, in addition to an objective structured clinical exam (OSCE) that assessed their clinical skills. Each KFP consisted of a case vignette and three key features using a "long-menu" question format. We explored students' perceptions of the KFPs and crSBAs in eight focus groups and analyzed statistical data of 11 exams.
Compared to crSBAs, KFPs were perceived as more realistic and difficult, providing a greater stimulus for the intense study of clinical reasoning, and were generally well accepted. The statistical analysis revealed no difference in difficulty, but KFPs resulted more reliable and efficient than crSBAs. The correlation between the two formats was high, while KFPs correlated more closely with the OSCE score.
KFPs with long-menu exams seem to bring about a positive educational effect without psychometric drawbacks.
目前尚不清楚哪种项目格式最适合评估临床推理：情境丰富的单项最佳答案问题（crSBAs）还是关键特征问题（KFPs）。本研究比较了 KFPs 和 crSBAs，以了解它们在一项总结性临床实习后儿科考试中的学生接受程度、教育影响以及心理测量学特征。
五年级医学生（n=377）参加了一项计算机考试，其中包括 6-9 个 KFPs 和 9-20 个 crSBAs，评估他们的临床推理技能，此外还有一项评估他们临床技能的客观结构化临床考试（OSCE）。每个 KFP 都由一个病例简介和三个使用“长菜单”问题格式的关键特征组成。我们在八个焦点小组中探讨了学生对 KFPs 和 crSBAs 的看法，并对 11 次考试的统计数据进行了分析。
与 crSBAs 相比，KFPs 被认为更具现实性和难度，为深入研究临床推理提供了更大的刺激，并且普遍受到欢迎。统计分析显示，两种格式在难度上没有差异，但 KFPs 比 crSBAs 更可靠、更高效。两种格式之间的相关性很高，而 KFPs 与 OSCE 分数的相关性更高。
使用长菜单的 KFPs 似乎带来了积极的教育效果，而没有心理测量学上的缺陷。
