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Employing a Root Cause Analysis Process to Improve Examination Quality.

Sally A Santen1, Karri L Grob, Seetha U Monrad

  • 1S.A. Santen is currently senior associate dean of assessment, evaluation, and scholarship and professor, Department of Emergency Medicine, Virginia Commonwealth School of Medicine, Richmond, Virginia, and at the time of this work was assistant dean for educational research and quality improvement and professor, Departments of Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0002-8327-8002. K.L. Grob is assistant director of preclinical evaluation and assessment, Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan. S.U. Monrad is clinical associate professor, Departments of Internal Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan. C.M. Stalburg is division chief and associate professor, Division of Professional Education, Department of Learning Health Sciences, and associate professor, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan. G. Smith is professor, Departments of Obstetrics and Gynecology, Molecular & Integrative Physiology, and Urology, University of Michigan Medical School, Ann Arbor, Michigan. R.R. Hemphill is chief quality and safety officer, Virginia Commonwealth University Health System, and associate dean for quality and safety and clinical professor, Department of Emergency Medicine, Virginia Commonwealth School of Medicine, Richmond, Virginia. N.L. Bibler Zaidi is associate director of advancing scholarship, Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan.

Academic Medicine : Journal of the Association of American Medical Colleges
|September 7, 2018
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Summary
This summary is machine-generated.

Medical schools can improve multiple-choice question (MCQ) assessments by using root cause analysis (RCA) to systematically address unexpected outcomes. This method helps identify and resolve issues in assessment quality and alignment.

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Area of Science:

  • Medical Education
  • Assessment Quality Improvement
  • Educational Psychology

Background:

  • Multiple-choice question (MCQ) examinations are a cornerstone of medical school assessment.
  • Producing high-quality, content-aligned, and psychometrically sound MCQs presents significant challenges for faculty.
  • Current assessment best practices lack a systematic framework for addressing discrepancies between expected and actual examination outcomes.

Purpose of the Study:

  • To propose and demonstrate the application of root cause analysis (RCA) as a systematic method for reviewing unexpected educational outcomes in medical assessments.
  • To identify contributing factors to a specific instance of unexpectedly low examination performance.

Main Methods:

  • The study employed a real-world case example of unexpectedly low reproduction examination scores.
  • Root Cause Analysis (RCA) techniques, including system flow diagrams, fishbone diagrams, and the 5 Whys, were utilized.
  • The RCA process systematically investigated the contributors to lower-than-expected student performance.

Main Results:

  • Multiple factors contributing to low examination scores were identified, including inadequate quality improvement (QI) for poorly constructed items.
  • Misalignment between content, questions, and pedagogical assessments was a key finding.
  • Issues related to the learning environment and human factors were also implicated.

Conclusions:

  • Root Cause Analysis (RCA) offers a systematic and adaptable approach to improving the quality and effectiveness of educational assessments in medical schools.
  • Addressing identified issues, such as enhancing the examination QI process, can prevent recurrence of systematic problems.
  • The application of RCA in assessment is novel, presenting opportunities for further development and broader implementation.