SIMPLE Exam Development

The Simulated Internal Medicine Patient Learning Experience (SIMPLE) virtual patient cases are in use in the Internal Medicine Clerkship at 75 medical schools. The 36 virtual patient cases in SIMPLE are designed to encompass the learning objectives of the Clerkship Directors in Internal Medicine (CDIM) – Society for General Internal Medicine Core Medicine Clerkship Curriculum and focus on teaching core internal medicine knowledge and clinical reasoning. Based on extensive feedback from the 75 schools that use SIMPLE, the SIMPLE Editorial Board developed an exam to assess student understanding of the content of the 36 virtual patient cases for Internal Medicine. But it's not just any assessment, the SIMPLE Exam will uses Key Features problems to assess students' ability to apply what they have learned to clinical decision making...and it will be administered online!

Key feature problems consist of a case scenario followed by one or more questions pertaining to the problem’s key features, or critical steps in the resolution of the problem. According to Page and Bordage a key feature “focuses on a step in which examinees are most likely to make errors in the resolution of the problem”, and represents “a difficult aspect of the identification and management of the problem in practice”.  Key features examinations have been shown to effectively assess the ability to make correct clinical decisions and are used in the Medical Council of Canada’s national qualifying examination, the Royal Australian College of General Practitioners certification examination for fellowship, and the American Society of Colon and Rectal Surgeons’ Colon and Rectal Surgery Educational Program Self-assessment Examination. A version of a key features examination has been developed for Canadian medical students, but there are no reports of key features examinations developed for on-line assessment of U.S. medical students.

Most medical schools, utilize the National Board of Medical Examiners Medicine Subject Exam to assess students’ knowledge at the end of the Medicine Clerkship.10  The majority of questions are constructed in a standard multiple-choice question format, and the exam is administered on paper.  The online Key Features Examination differs from the Subject Exam in its focus on clinical decision-making, alignment with the SIMPLE virtual patient cases and the CDIM curriculum, question format, and delivery method.  Therefore, the first step in validating the examination requires a study of the acceptability and feasibility of the examination.  Information from this study may be used to revise the examination delivery method, procedures, and orientation, or content.

References

  1. Page G.  Bordage.  Allen T.  Developing key-feature problems and examinations to assess clinical decision-making skills.  Academic Medicine.  1995;70:194-201.
  2. Page G.  Bordage G.  The Medical Council of Canada’s key features project:  A more valid written examination of clinical decision-making skills.  Academic Medicine.  1995;7(2):104-110.
  3. Tamblyn R. Abrahamowicz M. Dauphinee D.  Wenghofer E. Jacques A. Klass D. Smee S. Blackmore D. Winslade N. Girard N. Du Berger R. Bartman I. Buckeridge DL. Hanley JA.  Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities.  JAMA.  2007;298(9):993-1001.
  4. Trudel JL.  Bordage G.  Downing SM.  Reliability and validity of key feature cases for the self-assessment of conol and rectal surgeons.  Annals of Surgery.  2008;248:252-258.
  5. Wenghofer E. Klass D. Abrahamowicz M.  Dauphinee D. Jacques A. Smee S. Blackmore D. Winslade N. Reidel K. Bartman I. Tamblyn R.  Doctor scores on national qualifying examinations predict quality of care in future practice.  Medical Eduation.  2009;43:1166-1173.
  6. Farmer EA.  Hinchy J.  Assessing general practice clinical decision-making skills:  the key features approach.  Australian Family Physician, 2005.  34(12):1059-1061.