SIMPLE Key Features Exam FAQs

IRB clearance will be required for each validation site, as de-identified student responses will be used to assess reliability and validity of individual examination items during this year-long process. Clerkship directors must also be willing to include brief discussion of the examination in orientation, with student informed consent obtained  to use of their de-idenitified  response data for the purposes of validation. IRB application documents will be provided by MedU to make the process as easy as possible for each validation site.

No, students do not need to complete all of SIMPLE to use this exam.

The exam is based directly on the Clerkship Directors in Internal Medicine (CDIM) national curriculum used to create SIMPLE, which details common and important presentations that all medical students should experience during their third year medicine clerkship. For example, whether a student has completed a case on acute coronary syndromes or not, the CDIM learning objectives outline the key decisions in diagnosis and management appropriate to their level of training that they should be able to complete by the time they are finished with the third year clerkship. Thus, this examination is best used as a supplementary assessment of your third year clerkship students’ level of medical knowledge and clinical decision-making.

We do not currently provide customized exams.

We recognize that medicine clerkships cover a vast amount of content. The utility of a key features exam is that it can assess critically important clinical decision-making skills efficiently while covering a wide range of the diagnoses, management, and treatment scenarios that should be mastered by all students completing a medicine clerkship.

We welcome your feedback and suggestions at examscoring@i-intime.org.

During the validation phase we are unable to provide comparative performance data. We plan to have a validated SIMPLE Key Features exam available by July 2012. We will then be able to provide normative data, including mean, median, and standard deviation of student performance from all schools that are using the exam.   

The SIMPLE exam cannot be compared directly with other assessment tools. The SIMPLE key features exam was developed via group consensus on student level competencies, knowledge, and skills within the CDIM curriculum. The Key Features Exam format assesses student’s clinical decision making ability within specific scenarios that are accepted as critical to competent patient care. The SIMPLE exam can be used independently or in conjunction with other assessment tools. Individual institutions are also welcome to conduct their own data analysis comparing their students’ performance on the SIMPLE exam as it compares and/or correlates to performance on other exams.
In contrast to exams created at individual institutions, the SIMPLE exam items have been extensively reviewed by a national committee and are being vetted via a rigorous validation process.

The SIMPLE Key Features problems were developed by internal medicine medical educators meeting the following criteria:

•    CDIM member in good standing
•    Involvement in the development and maintenance of the SIMPLE virtual patient cases

Each key features problem writer participated in five full days of training and developed Key Features to support eight assigned cases. The training was conducted by Georges Bordage, University of Illinois – Chicago, an international expert on assessment and Key Features examination development who is the trainer for the Medical Council of Canada’s Key Features examination. The nine members of the group each wrote eight exam items, edited another eight items and re-reviewed sixteen additional items. Georges Bordage, M.D. also reviewed every key features problem and scoring rubric after each iteration. Finally, a medical editor reviewed, edited, and formatted every question according to guidelines determined by the group before they were uploaded into the software.

The SIMPLE Key Features exam is available online only.

The SIMPLE Key Features exam using specialized software and scoring algorithms that are not supported by either Blackboard or Moodle.

Each validation site will be required to give the examination to third year students during their rotation on the medicine clerkship. Students with more clinical exposure will perform better on the examination, so students will be asked to identify how many weeks they have been on the clerkship at the time they are sitting for the exam, as well as how many clinical rotations they have completed. Students will have to contract to keep examination contents confidential prior to proceeding with the exam. In addition, the exam must be given online in a single room in a secure manner as would occur during an NBME exam, with a physical proctor preventing students from academic dishonesty such as copying exam items or opening browser windows in an attempt to look up information. (Our software is not yet adapted to “lock down” other computer functions as the examination is being taken) Open-book use of the examination, or taking the examination on the students’ own time without a proctor, will not be allowed.

During validation, there will be different items on the exam for each clerkship rotation.

We are not able to recommend a passing score cut-off for this exam. Until the exam is validated, we recommend that this exam be used as an additional method of assessing clinical decision-making, but not as a significant or summative component of clerkship grades.

Since this exam is different than any other national-level examination students have taken, we recommend students review a powerpoint presentation orienting them to the exam as well as a short in-person orientation and online instructions before taking the exam. An orientation script will also be provided to exam proctors for use during face-to-face exam orientation.

On average, a Key Features exam item requires 5 minutes for candidates to complete. Thus, for an 11-item exam, we ask that you limit student to one hour of time.

Clinical decision-making is one of the most important things students learn from clinical clerkships—not from textbooks-- and is one of the most difficult practice skills medical teachers are asked to  assess. This exam provides a valuable opportunity for your students to experience a patient’s case as a series of critical decisions. The exam collects student responses in the fields of data acquisition, data interpretation, and clinical management in a way that correlates with long-term maintenance of licensure and provision of quality patient care. In this validation phase, it is important to include as many students of varying ability level, geographic and cultural distribution,  and clinical experience as possible so that meaningful interpretation of scores is possible in the future. Click here to read more about the evidence supporting use of key features exams.

This examination measures student decision making without the expense and faculty time required for validation of OSCE examinations. In addition, this examination will allow clerkship directors an new measure of student performance that can be compared across schools to stratify struggling or high-performing students for the purposes of academic progress review or residency application.

During validation, there is no cost to the SIMPLE exam.

To be considered as a SIMPLE Exam Validation site, e-mail examscoring@i-intime.org with “SIMPLE Validation” in the subject line. Be sure to include the appropriate following information in the body of your email.

Contact information
# Medicine Clerkships during the 2011/12 academic year
End date of your first clerkship
Average # students per clerkship
Description of facilities available for administering an online test. (It’s O.K. if you are unsure about this. We can help you determine this information as needed.)

Once the request has been successfully processed, you will receive an e-mail