Assessing Physicians’ Competence in Choosing Wisely® and Patient Safety Management

May 17, 2016 9:45 AM – 11:15 AM

Hao Song PhD, Qiongqiong Liu, MS
National Board of Osteopathic Medical Examiners

The National Board of Osteopathic Medical Examiners adds the computer-based Clinical Decision-Making (CDM)/Key Feature (KF) cases to the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) series. The CDM/KF cases are not meant to simply assess factual knowledge, but rather to assess the ability to apply medical knowledge and clinical skills at specific decision points (key features) in patient care, including choosing appropriate medical tests, procedures and treatments as promoted by Choosing Wisely and ensuring patient safety in patient treatment and management.

The format of a CDM/KF case is a clinical scenario followed by several questions, which are typically in short answer (SA) and extended multiple choice (EMC, one or multiple correct) format. The SA and EMC items allow for multiple response selections or entries, as may be appropriate to patient diagnosis or management. Many items contain media. If candidates choose one or multiple responses which might harm the patient (i.e., "killer" options), they get no credit for the question. In EMC questions, candidates are instructed to choose up to a certain number of laboratory or diagnostic tests, and will get zero credit if exceeding the upper limit of choices allowed.

This study analyzed about 900 COMLEX-USA Level 3 candidates' responses to 44 CDM/KF cases measuring 156 key features presented in SA/EMC format. Of all 156 key features, 39 key features saw candidates scored zero because a killer option was hit, while another 40 key features where the maximum number of options was exceeded. Detailed analysis of the content, psychometric quality of CDM/KF cases, the residents, and their characteristics will be presented at conference.