American Board of Ophthalmology Emeritus Director David J. Wilson, MD, and Psychometrician Sarah Schnabel, PhD, recently co-authored an editorial for Ophthalmology exploring the assessment of what's known as minimal or "threshold competence."
In it, the authors explain why a threshold competence test, such as the United States Medical Licensing Examination (USMLE) Step 1, is designed differently than other tests. The authors also recounted, for example, that residency programs used scores from the USMLE Step 1 examination for student selection, which is not a purpose for which that test was validated. When the USMLE cosponsors decided to discontinue providing scores, residency program directors were displeased with the receipt of less data on which to base their decisions about program admission, but ultimately best practices in test design support this change to pass/fail reporting.
The editorial advises that the use of an objective knowledge assessment of resident applicants should assess potential for success in residency training and should be designed with this purpose in mind. Drs. Wilson and Schnabel suggest that the competencies required for success in an ophthalmology residency (which may include not only medical knowledge but also communication, leadership, service to the community, or even aptitude for microsurgery), if reliably measurable, might be more appropriate for this purpose.
Click here to read the editorial.