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Area of Science:

  • Medical Education
  • Assessment Science

Background:

  • Medical school assessments benefit from best practices in item writing and blueprint alignment.
  • Few studies evaluate if exam redesign enhances psychometric quality and external validity in the Step 1 pass/fail era.
  • This study examined the impact of consolidating two gastroenterology (GI) exams into a single vignette-based exam.

Purpose of the Study:

  • To assess how consolidating two moderate-reliability GI examinations into a single vignette-based exam affected exam reliability.
  • To evaluate the relationship between the redesigned GI exam and the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE).

Main Methods:

  • Retrospective analysis of six cohorts (2019-2025; N=867) who completed GI exams and the CBSE.
  • Obtained item statistics and KR-20 reliability coefficients from the examination platform.
  • Used Spearman correlations to evaluate associations between exam average and CBSE scores; Welch-corrected ANOVA for cohort trends.

Main Results:

  • Mean exam average declined modestly (91.6-86.1), while CBSE means remained stable (≈57-67).
  • Exam reliability (KR-20) increased from 0.51 to 0.75, with significant gains after blueprint revision (0.55-0.69).
  • Exam average showed moderate correlations with CBSE total (ρ=0.44) and GI subsection (ρ=0.36) scores, strengthening over time.

Conclusions:

  • A clinician-led, vignette-rich, blueprint-driven redesign enhanced exam reliability and alignment with national benchmarks.
  • Clinically integrated assessments can improve "step-readiness" without increasing the overall assessment burden.
  • The redesigned exam demonstrated improved predictive validity, particularly in cohorts with higher reliability (KR-20 ≥ 0.65).