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Sequential Objective Structured Clinical Examination based on item response theory in Iran.

Sara Mortaz Hejri1,2, Mohammad Jalili3,2

  • 1Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Journal of Educational Evaluation for Health Professions
|September 9, 2017
PubMed
Summary

This study introduces item response theory (IRT) for designing sequential objective structured clinical examinations (OSCEs). IRT-based screening OSCEs efficiently identify students, reducing exam costs while maintaining accuracy.

Keywords:
CostItem response theoryObjective structured clinical examinationSequential

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Area of Science:

  • Medical Education
  • Psychometrics
  • Assessment Design

Background:

  • Sequential objective structured clinical examinations (OSCEs) are used to assess clinical skills.
  • Previous sequential OSCE designs relied on classical test theory.
  • Item response theory (IRT) offers a more advanced framework for test design and analysis.

Purpose of the Study:

  • To design and evaluate screening OSCEs utilizing item response theory (IRT).
  • To compare the effectiveness and efficiency of IRT-based screening OSCEs against traditional methods.
  • To determine the predictive validity and cost-effectiveness of IRT-based screening OSCEs.

Main Methods:

  • A retrospective observational study was conducted using a 10-station OSCE with Likert-scale grading.
  • Polytomous data were analyzed using a graded response model to calculate difficulty, discrimination, and ability parameters.
  • Screening OSCEs were designed by selecting stations based on difficulty and discrimination, with varying cut-scores.

Main Results:

  • The main OSCE was passed by 95.1% of students.
  • Screening tests showed pass rates from 72.6% to 94.4%.
  • Positive predictive values (PPV) ranged from 0.98 to 1.00, and negative predictive values (NPV) ranged from 0.18 to 0.59. Two screening tests accurately predicted main exam results, yielding 34%-40% financial savings.

Conclusions:

  • Utilizing high-discrimination IRT stations and stringent cut-scores in screening tests enhances sequential OSCE efficiency.
  • IRT-based screening OSCEs provide a convenient and effective method for conducting assessments.
  • This approach optimizes resource allocation in medical education assessments.