Nephrology Knowledge Based Assessment

(Specialist Examination, MRCPUK(Nephrology))

Jonathan Fox

March 2008

Specialist Examinations: purpose

• To ensure that certified specialists have sufficient knowledge to practise competently and safely as consultants

• To complement workplace-based assessments• To work with specialist societies and SACs

provide a rigorous national assessment to establish public confidence

• To offer a challenge similar to subspeciality certification exams in North America

Specialist Examinations: delivery

• 1 diet per year (was to be 2 per year)• Computer-based testing (www.pearsonview.com)

• 2 papers in each diet• 100 best-of-five questions in each paper• Assess core knowledge and application of this

knowledge in a clinical setting• Strict distribution of questions in accordance with

blueprint derived from specialty curriculum• To be taken in ST4 usually and required for CCT

Specialties

First wave

• Dermatology• Gastroenterology• Geriatric Medicine• Neurology

First diet June 2008

Second wave

• Acute medicine• Cardiology• CPT• Endocrinology/diabetes• ID• Medical oncology• Renal medicine• Respiratory medicine• Rheumatology

First diet November 2008

Timeline: medical specialties

• 2004-6: JCHMT Pilot (report Oct 2006)

• late 2006: MRCP(UK)/Federation of Medical Royal Colleges proposed partnership with specialist societies

• early 2007: Appointment of Examination Board Chairs & Secretaries

• June 2008: First wave examinations

• November 2008: Second wave examinations

Timeline: Nephrology

• March 2007 Appointment of Chair (J Fox) & Secretary (J Levy)

• March 2007 advertisement for QWG members (41 responses, 5 not requiring training)

• 18 July 2007: first training day – 24 attended• 5 Sept 2007: second training day – 11 attended• 8-9 Jan 2008: Question Writing Group meeting – 26

attended, approx. 333 questions produced• 3-4 June 2008: Board meeting• Aug/Sept 2008: Standard Setting Group meeting• November 2008: KBA

Question Writing Groups

• 2-day meetings twice a year initially• Consultants• Wide geographical spread • Some from MRCP SQG• Attended workshop• 30 questions per year per member• Guidance from Secretary/Chair on topics• Stand down if fail to fulfil commitment

A 34-year-old woman was referred for the investigation of bloody diarrhoea. She was opening her bowels four times daily. On examination, she was well. Her pulse was 64 beats per minute and her abdomen was soft and non-tender. Colonoscopy revealed an active colitis, limited to the sigmoid colon. Biopsies confirmed a diagnosis of ulcerative colitis.

Investigations:

haemoglobin 132 g/L (115 - 165)white cell count 11.5 x 109/L (4 - 11)platelet count 323 x 109/L (150 - 400)serum albumin 40 g/L (37 - 49)serum C-reactive protein 13 mg/L (<10)

What is the most appropriate initial treatment?

A mesalazine enemasB oral azathioprine C oral mesalazineD oral modified-release budesonide E oral prednisolone

Answer Key: A

The Challenge of Question-Writing

• 200 questions per year• Curriculum coverage• Each question should not be re-used more often

than once every 3 years• Question bank should contain at least 1000

usable questions

To generate one re-usable question for MRCP(UK) requires 3-5 questions to be drafted

Question production process

QWG members

QWG secretaries

Final vetting by chairman/secretary

Non-medical editors

Examination Board Standard Setting Group

Question Bank

Examination

QWG meeting

Board

Roles:• To set papers for each examination• To oversee delivery of examinations• To be responsible for academic matters, misconduct,

complaints, regulatory matters

Composition:• 10 members incl. chairman & secretary

2 represent SAC4 from the Question Writing Group 4 non-writing members

Meets for 2 days a year

Standard Setting Group

Role:• To set pass mark for the exam (modified Angoff method,

Hofstee compromise applied after exam)• To develop assessment strategy

Membership:• 6 members incl. Board Chair & Secretary• No-one else should belong to both QWG & Board• Chair should have experience of standard setting

Meets for 2 days a year

Why collaborate with MRCP(UK)?

• Common approach for 13 medical specialties

• Format used since 2002:

Part 1: 3 diets of 2 papers (200 Qs) per year

Part 2: 3 diets of 3 papers (~270 Qs) per year

• Medical experience: SQG, Board, Standard Setting

• Statistical & psychometric support

• Administration: non-medical editors, organisation of meetings, etc

• IT: question bank & CBT

Reliability (Cronbach’s alpha): MRCP(UK) Part 2 Written Examination

0.4

0.45

0.5

0.55

0.6

0.65

0.7

0.75

0.8

0.85

0.9

2002/1 2002/2 2002/3 2003/1 2003/2 2003/3 2004/1 2004/2 2004/3 2005/1 2005/2 2005/3 2006/1 2006/2

Pass rate

Proposed:

>85% per diet

~98% overall

Desired pass mark?

Challenges

• Heavy workload for a relatively small specialty

• Small number of candidates (cf 1245 candidates for MRCP Part 2, 2007/2) will make pass mark setting, reliability assessment and pre-testing of questions difficult

• Name (MRCPUK(Nephrology))

• Cost to candidates/affordability to RA

Links

• http://www.jrcptb.org.uk/assessment/Pages/MRCP(UK)KnowledgeBasedAssessment.aspx

• http://www.jrcptb.org.uk/SiteCollectionDocuments/KBA%20Project%20Final%20Report.pdf

• www.pmetb.org.uk/fileadmin/user/QA/Assessment/Assessment_good_practice_v0207.pdf

• http://www.mrcpuk.org/Pages/Home.aspx