User menu

Accès à distance ? S'identifier sur le proxy UCLouvain

Is case-specificity content-specificity? : an analysis of data from extended-matching questions

Primary tabs

Dory, Valérie [UCL] Gagnon, Robert Charlin, Bernard

Case-specificity, i.e., variability of a subject's performance across cases, has been a consistent finding in medical education. It has important implications for assessment validity and reliability. Its root causes remain a matter of discussion. One hypothesis, content-specificity, links variability of performance to variable levels of relevant knowledge. Extended-matching items (EMIs) are an ideal format to test this hypothesis as items are grouped by topic. If differences pertaining to content knowledge are the main cause of case-specificity, variability across topics should be high and variability across items within the same topic low. We used generalisability analysis on results of a written test composed of 159 EMIs sat by two cohorts of general practice trainees at one university. Two hundred and twenty-seven trainees took part. The variance component attributed to subjects was small. Variance attributed to topics was smaller than variance attributed to items. The main source of error was interaction between subjects and items, accounting for two-thirds of error. The generalisability D study revealed that for the same total number of items, increasing the number of topics results in a higher G coefficient than increasing the number of items per topic. Topical knowledge does not seem to explain case-specificity observed in our data. Structure of knowledge and reasoning strategy may be more important, in particular pattern-recognition which EMIs were designed to elicit. The causal explanations of case-specificity may be dependent on test format. Increasing the number of topics with fewer items each would increase reliability but also testing time.

Document type Article de périodique (Journal article) – Article de recherche – Journal Article
Access type Accès restreint
Publication date 2010
Language Anglais
Journal information "Advances in Health Sciences Education" - Vol. 15, no. 1, p. 55-63; erratum 147-148 (2010)
Peer reviewed yes
Publisher Springer Netherlands ((Netherlands) Dordrecht)
issn 1382-4996
e-issn 1573-1677
Publication status Publié
Affiliation UCL - SSS/IRSS - Institut de recherche santé et société
MESH Subject Reproducibility of Results ; Problem Solving ; Internship and Residency - organization & administration ; Humans ; Educational Measurement - methods ; Cohort Studies ; Clinical Competence
Links
  1. Beullens, J., Van Damme, B., Jaspaert, H., & Janssen, P. J. (2002). Are extended-matching multiple-choice items appropriate for a final test in medical education? Medical Teacher, 24(4), 390–395. doi: 10.1080/0142159021000000843 .
  2. Beullens, J., Struyf, E., & Van Damme, B. (2005). Do extended matching multiple-choice questions measure clinical reasoning? Medical Education, 39(4), 410–417. doi: 10.1111/j.1365-2929.2005.02089.x .
  3. Case, S. M., & Swanson, D. B. (1993). Extended-matching items: A practical alternative to free-response questions. Teaching and Learning in Medicine, 5(2), 107–115.
  4. Case, S. M., Swanson, D. B., & Stillman, P. L. (1988). Evaluating diagnostic pattern recognition: The psychometric characteristics of a new item format. Paper presented at the Annual Meeting of the Eastern Educational Research Association, Miami Beach, FL, February 24–27, 1988.
  5. Charlin, B., Boshuizen, H. P., Custers, E. J., & Feltovich, P. J. (2007). Scripts and clinical reasoning. Medical Education, 41(12), 1178–1184.
  6. Coderre, S., Mandin, H., Harasym, P. H., & Fick, G. H. (2003). Diagnostic reasoning strategies and diagnostic success. Medical Education, 37(8), 695–703. doi: 10.1046/j.1365-2923.2003.01577.x .
  7. Custers, E. J., Regehr, G., & Norman, G. R. (1996). Mental representations of medical diagnostic knowledge: A review. Academic Medicine, 71(10), S55–S61. doi: 10.1097/00001888-199610000-00044 .
  8. Eva, K. W. (2003). On the generality of specificity. Medical Education, 37(7), 587–588. doi: 10.1046/j.1365-2923.2003.01563.x .
  9. Eva, K. W. (2005). What every teacher needs to know about clinical reasoning. Medical Education, 39(1), 98–106. doi: 10.1111/j.1365-2929.2004.01972.x .
  10. Eva, K. W., Neville, A. J., & Norman, G. R. (1998). Exploring the etiology of content specificity: Factors influencing analogic transfer and problem solving. Academic Medicine, 73(10), S1–S5. doi: 10.1097/00001888-199810000-00028 .
  11. Heemskerk, L., Norman, G., Chou, S., Mintz, M., Mandin, H., & McLaughlin, K. (2008). The effect of question format and task difficulty on reasoning strategies and diagnostic performance in Internal Medicine residents. Advances in health sciences education: Theory and practice, 13(4), 453–462.
  12. Kreiter, C. (2008). A comment on the continuing impact of case specificity. Medical Education, 42(6), 548–549. doi: 10.1111/j.1365-2923.2008.03085.x .
  13. Kreiter Clarence D., Bergus George R., Case Specificity: Empirical Phenomenon or Measurement Artifact?, 10.1080/10401330701542776
  14. Mattick, K., Dennis, I., Bradley, P., & Bligh, J. (2008). Content specificity: Is it the full story? Statistical modelling of a clinical skills examination. Medical Education, 42(6), 589–599. doi: 10.1111/j.1365-2923.2008.03020.x .
  15. Norman, G. (2005). Research in clinical reasoning: Past history and current trends. Medical Education, 39(4), 418–427. doi: 10.1111/j.1365-2929.2005.02127.x .
  16. Norman, G. R., & Eva, K. W. (2003). Doggie diagnosis, diagnostic success and diagnostic reasoning strategies: An alternative view. Medical Education, 37(8), 676–677. doi: 10.1046/j.1365-2923.2003.01528.x .
  17. Norman, G. R., Tugwell, P., Feightner, J. W., Muzzin, L. J., & Jacoby, L. L. (1985). Knowledge and clinical problem-solving. Medical Education, 19(5), 344–356. doi: 10.1111/j.1365-2923.1985.tb01336.x .
  18. Norman, G., Bordage, G., Page, G., & Keane, D. (2006). How specific is case specificity? Medical Education, 40(7), 618–623. doi: 10.1111/j.1365-2929.2006.02511.x .
  19. Schmidt, H. G., & Boshuizen, H. P. (1993). On acquiring expertise in medicine. Educational Psychology Review, 5(3), 205–221. doi: 10.1007/BF01323044 .
  20. Schmidt, H. G., Boshuizen, H. P., & Norman, G. (1992). Reflections on the nature of expertise in medicine. In Keravnou, E. (Ed.), Deep models for medical knowledge engineering (pp. 231–248). Amsterdam: Elsevier.
  21. Swanson, D. B., Holtzman, K. Z., Allbee, K., & Clauser, B. E. (2006). Psychometric characteristics and response times for content-parallel extended-matching and one-best-answer items in relation to number of options. Academic Medicine, 81(10), S52–S55. doi: 10.1097/01.ACM.0000236518.87708.9d .
  22. van der Vleuten, C. P., & Newble, D. I. (1995). How can we test clinical reasoning? Lancet, 345(8956), 1032–1034. doi: 10.1016/S0140-6736(95)90763-7 .
  23. Wimmers, P. F., & Fung, C. C. (2008). The impact of case specificity and generalisable skills on clinical performance: A correlated traits-correlated methods approach. Medical Education, 42(6), 580–588. doi: 10.1111/j.1365-2923.2008.03089.x .
  24. Wimmers, P., Splinter, T., Hancock, G., & Schmidt, H. (2007). Clinical competence: General ability or case-specific? Advances in Health Sciences Education, 12(3), 299–314. doi: 10.1007/s10459-006-9002-x .
Bibliographic reference Dory, Valérie ; Gagnon, Robert ; Charlin, Bernard. Is case-specificity content-specificity? : an analysis of data from extended-matching questions. In: Advances in Health Sciences Education, Vol. 15, no. 1, p. 55-63; erratum 147-148 (2010)
Permanent URL http://hdl.handle.net/2078.1/22489