Comparison of Certification and Recertification Examinee Performance on Multiple-Choice Items in Forensic Psychiatry

Research on the association between age and performance on tests of medical knowledge has generally shown an inverse relationship, which is of concern because of the positive association between measures of knowledge and measures of clinical performance. Because the certification and maintenance of certification (MOC) examinations in the subspecialty of forensic psychiatry draw on a common item bank, performance of the two groups of examinees on the same items could be compared. In addition, the relationship between age and test performance was analyzed. Performance on items administered to certification and MOC examinees did not differ significantly, and the mean amount of time spent on each item was similar for the two groups. Although the majority (five of eight) of the correlations between age and test score on the certification and MOC examinations were negative, only three were significant, and the amount of variance explained by age was small. In addition, examination performance for those younger than 50 was similar to those 60 and older, and diplomates recertifying for the second time outperformed those doing so for the first time. These results indicate that in this subspecialty, there is no clear evidence of an age-related decline in knowledge as assessed by multiple-choice items.