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
Second wave
•
•
•
•
•
•
•
•
•
•
•
•
•
Dermatology
Gastroenterology
Geriatric Medicine
Neurology
First diet June 2008
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
white cell count
platelet count
serum albumin
serum C-reactive protein
132 g/L (115 - 165)
11.5 x 109/L (4 - 11)
323 x 109/L (150 - 400)
40 g/L (37 - 49)
13 mg/L (<10)
What is the most appropriate initial treatment?
A mesalazine enemas
B oral azathioprine
C oral mesalazine
D 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
Non-medical editors
QWG secretaries
QWG meeting
Final vetting by chairman/secretary
Question Bank
Examination Board
Examination
Standard Setting Group
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 SAC
4 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
0.9
0.85
0.8
0.75
0.7
0.65
0.6
0.55
0.5
0.45
0.4
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)KnowledgeB
asedAssessment.aspx
• http://www.jrcptb.org.uk/SiteCollectionDocuments/KBA%20Project%
20Final%20Report.pdf
• www.pmetb.org.uk/fileadmin/user/QA/Assessment/Assessment_go
od_practice_v0207.pdf
• http://www.mrcpuk.org/Pages/Home.aspx