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file:///C:/6EA4254D/zzzITEMWRITINGSTRATEGIESFORMED.EDappallcia(032706)fgm_files/slide0025.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" SURGICAL ITEM-WRITING LABORATORY
Objectives of this Program
lReview the relationship between blueprint specifications and test development and test construction
lSuggest the importance of content, construct and score-inferenced validity
lHighlight the Seven Osteopathic Competencies
lReview Why Test Items are Flawed
lReview the Types of Test Item Formats available for use in test construction and How to Use Them Effectively <= /span>
lEmploy Techniques to improve the Construction of Test Items
lUse Blooms Taxonomy as an aid to Item Construction =
lReview Levels of Evidence as they apply to testing =
lUse Test Item Patterning
lCreate the Item Writing Assignment
lTest Item Generation and Cloning
lExamine Previously Written Test Items for Quality and Suitability = ;
l
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“For inadequate as the scales are, the errors they = introduce into educational measurements are far le= ss serious than the errors associated with the defini= tion of the knowledge to be measured and with the selection and presentation of tasks to be included= in the test.”

“The basic problems of educational measurement are not so much problems of scaling or scoring,= but rather problems of test planning and item writing.” 

Robert L. Ebel
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What Does a Test Do
lA test attempts to quantify or sample what an candidate knows = and/or knows how to do within a particular knowled= ge domain on the day tha= t the test is administered.  <= /span>
lIn effect, the series of test items selected for the test represent a= = “snap shot” of the candidates knowledg= e base at the given point the test was administered.
lThe content and construct of the test are crucial in determining what= the candidate knows about the domain. <= /span>
lHow individual test items are written and selected for the test is critical in effectiveness of the test in measuring= what it purports to measure= .
lIdeally the test could or should predict future performance or = outcomes, if well designed.
lThe results of the test can be used for formative or summative = purposes depending on design and intent
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3D"Radial
THE TESTING EXPERIENCE
= STIMULUS
= RESPONSE
TEST
PREPARATION
TESTING <= /div>
ENVIRONMENT
RECALL
RETRIEVAL
APPLICATION
ANALYSI S
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Average Time Students Take Per Test Item (Type A)=
1.0 – 1.5 minutes per item
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Appropriate Item Content
lUse concepts t= hat are accepted as current and correct but not necessarily controversial
lCandidates sho= uld have universal access to the references and concepts used in the examination
lMake the conte= nt appropriate to the  level of = the examinee
lItems should be verifiable in standard (medical) publications, the web or in the course materials
<= span style=3D'font-size:80%'>l= Items should reflect the current standard of care&= #13;
lItems should m= atch an established blueprint that reflects the course or curriculum objectives
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Why Are Test Items Flawed?
lChoice of inappropriate content
lDisparity between what is tested for and what has been taught, stressed or deemed important =
lIrrelevant difficulty in the test items
lTechnical considerations
lFailure to follow established test item construction guidelines
lFailure to consider the prior psychometric performance of the test items
lFailure to pre-test items or measure item infit
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What Areas Should be Assessed?
lExamination content should parallel the = curriculum and objectives of the training program&= #13;
lImportant topics should be weighted appropriately in the designed grid or blueprint= 3;
lThe test items should reflect the instructional goals of the course or program or rotation
lContent areas may be selected based on expert consensus, desired outcomes, competencies <= /span>(assessment of anticipated behaviors), and /or job (or task) analysis.
l
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=
= Seven Core Competencies
of the Osteopathic Profession
SCHOOL
&
BOARD
EXAMS
Osteopathic Philosophy and = Osteopathic Manipulative Medicine<= /span>
Medical Knowledge
Patient Care
Interpersonal and Communication Skills
Professionalism
Practice-Based = = Learning and = Improvement
Systems-Based <= span style=3D'position:absolute;top:48.0%;left:0%;width:100.0%;height:52.0%'>Practice
=
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Match the Assessment with     <= /span><= span style=3D'font-size:103%;font-weight:normal'>the Competency
l (Miller,GE. Acad Med 1990,65,S63-S67.)
Does
Shows How
Knows How
Knows
Performance measures, logs, profiles, outcomes data=
OSCE, SP exam, CSE, Virtual Medicine, Simulaids
Oral exam, essay, M= CQ, Type B, C, R
Case simulations, Multi-media items
Oral exam, essay, MCQ, Type B, C, R
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Using Test Item Fo= rmats that  = Fit Test Items to Content
<= span style=3D'font-size:60%'>l= Type  A – MCQ
<= span style=3D'font-size:60%'>l= Type A extended - MCQ
<= span style=3D'font-size:60%'>l= Type  K - MCQ
<= span style=3D'font-size:60%'>l= Matching (Type B)
<= span style=3D'font-size:60%'>l= Extended Matching (Type R)
<= span style=3D'font-size:60%'>l= Case Scenarios (Type C) <= /div>
<= span style=3D'font-size:60%'>l= Independent
<= span style=3D'font-size:60%'>l= Cascaded (Dependent)
<= span style=3D'font-size:60%'>l= Case Simulation
<= span style=3D'font-size:60%'>l= Essay (on the comeback) <= /div>
<= span style=3D'font-size:60%'>l= Oral
<= span style=3D'font-size:60%'>l= Task or Skill Performance
§ SPs
§ OSCEs
§ Simulaids
§ Controlled or Supervised Observation of Performance on Live  Patients
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Ideal Item Appearance =
l(Moderate Length Stem with clear interrogatory)
lA 40 year old male presents with xxxxxx xxxxxxxxx = xxxxxxxxxxx xxx xxxxxxxxx  x  xxxx xxxxxxxxxxxx xxxx.  What is the most likely cause of = this = presentation ?
l
l(Short Distracters of approximately equal length)
l a) aaaaaa aa aaaa
l b) bbb bb bbbbb bbb
l c) ccccc ccc ccccccc
l d) ddddd dd ddddd dd
l e) eeeeeee eee eeeeee
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Suggested Visuals
lEKG strips
lRhythm  strips
lX-rays
lCT, MRI and Nuclear scans
lDiagrams/tables
lGram stains
lPathology slides
lClear photos of gross pathology or clinical situations
lGross specimens
lLaparoscopic photos
lSkin lesions and wounds
lGraphs
l
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aC5HOAhJCGrs9xo5qGVPOCxRWAhTaHctyAB9gGbIRy1byIU/SIU3iABhuGVjqIVlSAgWEAEAOw== ------=_NextPart_01C77AB7.652313F0 Content-Location: file:///C:/6EA4254D/zzzITEMWRITINGSTRATEGIESFORMED.EDappallcia(032706)fgm_files/slide0008.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" SURGICAL ITEM-WRITING LABORATORY
Using Item Patterning
l A (describe = the patient with age, gender, and ethnicity, if pertinent) presents with (give the<= /i> signs , s= ymptoms or other pertinent findings) to the (list sit= e of presentat= ion) in (describe the condition of the patient).  Which of the following is the most = = likely caused this presentation?
l =
l List 4 or 5 Appropriate Distracters of roughly <= /span>equal length (list of five drugs or conditions or disorders <= /i>= responsible for the presentation cited).
l
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Item Patterning
l
<= span style=3D'font-size:73%;visibility:hidden'>l
l    A (patient descri= ption) presents compla= ining of (somatic/visceral symptoms). A structural examination reveals (structural and palpatory findings). The most likely diagnosis is (list five = diagnoses as distractors) or the most appropriate treatment for this presentat= ion is (list five treatments as distractors).
<= span style=3D'font-size:87%;visibility:hidden'>l
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Guidelines that Make for
Better Test Items
lSimple and concise presentation
lThe interrogatory portion of the item must be clear
lResponses (distracters) should parallel the stem
lAll distracters should be plausible
lDistracters should be of roughly equal length
lAvoid often, never, always (“most likely” is acceptable <= /span>in most instances)
lAvoid double negatives
lAvoid abbreviations
lUse proper grammar in stems and distracters (do not give hints with improper tense usage) <= /span>
l
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Guidelines for Better Items
lAvoid regional influences (for national exams)
lWhen numerical responses are used arrange in increasing order
lAvoid numerical ranges that overlap
lDo not teach in the stem
lArrange distracters alphabetically
lUse positively written items rather than negative ones
lCapitalize only proper nouns and for grammar purposes
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Guidelines for Better Items =
lDistracters should not be opposites
lDistracters should be independent
lDistracters should be real
lBe sure items follow the blueprint or item assignments
lTest items should be properly referenced
lItem writers should attempt to require higher thought <= span style=3D'position:absolute;top:56.0%;left:12.17%;width:91.19%;height:5.0%'= >processes of test takers (use taxonomy to advantage)
lAvoid “syndrome” names or acronyms where possible
lAvoid one word options when matching sets to trailers
lHave a general sense of how much time it will take the = = examinee to complete the item and the test
lHave a general sense as to how many will likely get the item right (or wrong)
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CLUES IN THE DISTRACTOR LIST
lRepeated words from the s= tem appear in the distractor
lOpposites suggest the one= of the answers may be one correct
lSame answer-two choices s= ay the same thing in different ways
lOdd Man Out – the o= ne answer very different from the rest may be correct
lUmbrella Answer – o= ne answer is better than the others in that it includes many or all of the others
lAbsolutes – absolute words are likely to be incorrect
lLong Story- frequently the longest distractor is the correct one
lGrammar- can sometimes of= fer a clue to the answer by use of improper tenses
lTeaching- some times ther= e is teaching in the stem that can be helpful in = other items
lForget these- likely to be incorrect choices
lAll
lEvery
lAlways
lNever
lNone
lNobody
lAny
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Example of an Test Item Assignment
lSubject: Acute abdo= men (AB 1034)
lSub-Topic: Acute Diverticulitis (AB 1134)
lEtiology: Rupture o= f (RA 1044)
lSetting: ER
lPresentation: Acute=
lAge: 25-45 =
lSex: not specific&#= 13;
lEthnic: not specifi= c
lType Format: Single= Best Answer Type A
lCompetency: Medical Knowledge
lTaxonomy: Applicati= on
lGraphic: Use CT demonstrating pathology
lUse: Summative =
lReminder: Please ut= ilize construction guidelines supplied
lFeedback: 4 items previously supplied met selection criteria; 1 item submitted did not meet taxonomy requi= rement requested
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References
lAll test items used in moderate to high-stakes testing should be referenced
l
lReferences should be:
lAccepted as an authority in the domain being teste= d
lCurrent in concept, classification, criteria, and/= or requirement
lUniversally available to the population being tested
lUse the highest level of evidence practicable =
lQuoted accurately as to title, author, edition and= year of publication
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Item Generation
lSubject: Colon Cancer (or Symptom or Presentation or System or Disease)
lVariations:
l <= /span>Basic Science Application
l Systems-Based Approach
l Practice Enhancement
l Informatics Issue
l Ethical Issue/Professionalism/Confidentiality
l Demographics Issue
l Health Care Delivery Issue
l Diagnostic Principle
l Physical Finding
l History and Data Gathering Issue
l OMM issue
l Treatment Issue
l Death and Dying Issue
l Procedural or Technique Issue
l Critical Care Issue
l Management Issue
l Complication Issue
l Genetics and Counseling Issues
l Follow-up
l Disease Prevention
lCreate Stems or Test Item Patterns
lConsider Cloning Test Items
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Taxonomy Le= vels or Thinking    About Raising the Level of the = Thought Process (Bloom)<= /span>
lLevel 1 - Knowledge & Memory
lDefining
lRecalling
lIdentifying
l
lLevel 2 - Comprehension
lDetermining
lExplaining
lInferring
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Taxonomy Levels
l= Level 3 - Application
lApplying= 3;
lChoosing= 3;
lOrganizing&= #13;
l
l= Level 4 - Analysis
lComparing&#= 13;
lContrasting=
lDistinguish= ing
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Taxonomy Levels
lLevel 5 - Synthesis
lCombining
lDeriving
lSpecifying
l
lLevel 6 - Pure Reasoning
lAssessing
lArguing
lConsidering
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How to use Bloom’s Taxonomy to Advantage
lThink about making the candidate think harder and = use more thought processes&#= 13;lRemember: you may = not necessarily increase the difficulty of the item by elevating to the next taxonomy level&#= 13;lCan be used to pro= be how your candidates are thinking about the material you have given them lHelps prepare students to look at the same subject= in different ways
lCan create another dimension for your grid
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Recall to Application
<= span style=3D'font-size:80%'>lRecall item= :
l
l Which one of the following is the definitive test f= or gestational diabete= s:
l a) FBS
l b) 3 hour glucose tolerance test
l c) Hb A1c
l d) Serum acetone and ketone level
l e) 2 hour post-prandial glucose
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Recall to Application
lApplication item:
l
l A patient is administered a 3 hour glucose tolerance test at 30 weeks gestation with the following results:
l FBS    90 mg%
l 1 Hour     180 mg%
l 2 Hour     170 mg%
l          3 Hour     120 mg%
l This patient should be advised that
l
l a) the results are within normal limits
l b) the test should be repeated with a 200 Gm glucose load
l c) she should come to the office for diet counseling
l d) the patient should be retested after delivery
l e) she  should begin insulin the= rapy immediately
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Application to Analysis
<= span style=3D'font-size:87%'>lApplication item:&= #13;
<= span style=3D'font-size:87%;visibility:hidden'>l= 3;
l A 30 year old male with symptomatic hemorrhoids presents with rectal bleedi= ng. His father was diagnosed with colon cancer within the past 5 years. The best management approach for this patie= nt is to treat his hemmor= rhoids and:
l
l a) reassure him
l b) order a serial occult blood for  3 days
l c) order a CEA and CA 19-9
l d) arrange for a barium enema
l e) order a colonoscopy
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Application to Analysis
lAnalysis item:
l
l A 30 year old male patient is concerned about the strong <= span style=3D'position:absolute;top:37.5%;left:11.42%;width:89.88%;height:4.25%= '>family history of colon carcinoma. The earliest= age of a first de= gree relative to have colon cancer was age 50. He is currently asymptomatic. The best course of acti= on in this case is:=
l
l a) reassurance and genetic counseling
l b) screening barium enema
l c) immediate colonoscopy
l d) a screening CA 19-9, with follow-up exam in one year
l e) a rectal exam for occult blood and colonoscopy before age     40 or if symptom= atic 
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Levels of Evidence (Therapeutic)
l1a: Systematic rev= iews of homogenous randomized
l controlled trials
l1a:  Systematic review of randomized trials with worrisom= e heterogeneity
l1b:  Individual randomized controlled studies =
l1c:  All or none randomized controlled trials =
l
l2a:  Systematic reviews with homogeneity of cohort studies
l2b:  Systematic review of cohort studies displaying worri= some heterogeneity
l2b:  Individual cohort study or low quality randomized trial
l2c:  Outcomes research; ecological studies<= /div>
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Levels of Evidence
l3a:  Systematic review w= ith homogeneity of case-controlled
l        = ;    studies
l3a:  Systematic review of case-controlled studies with
l        wor= risome heterogeneity
l3b:  Individual case-controlled study
l
l4:    Case-ser= ies (and poor quality cohort and case-controlled
l        studies
l5:  Expert opinion without explicit critical appraisal,= or based on physiology, bench research or “first principles”
l
•From the Centre for Evidence-Based Medicine, Oxford
•Varies slightly for prognosis, diagnosis, and therapy & prevention=
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