Sources of Measurement Error in an ECG Examination: Implications for Performance-Based Assessments

Solomon, David J and Frerenchick, Gary (2004) Sources of Measurement Error in an ECG Examination: Implications for Performance-Based Assessments. [Journal (Paginated)]

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Objective: To assess the sources of measurement error in an electrocardiogram (ECG) interpretation examination given in a third-year internal medicine clerkship. Design: Three successive generalizability studies were conducted. 1) Multiple faculty rated student responses to a previously administered exam. 2) The rating criteria were revised and study 1 was repeated. 3) The examination was converted into an extended matching format including multiple cases with the same underlying cardiac problem. Results: The discrepancies among raters (main effects and interactions) were dwarfed by the error associated with case specificity. The largest source of the differences among raters was in rating student errors of commission rather than student errors of omission. Revisions in the rating criteria may have helped increase inter-rater reliability slightly however, due to case specificity, it had little impact on the overall reliability of the exam. The third study indicated the majority of the variability in student performance across cases was in performance across cases within the same type of cardiac problem rather than between different types of cardiac problems. Conclusions: Case specificity was the overwhelming source of measurement error. The variation among cases came mainly from discrepancies in performance between examples of the same cardiac problem rather than from differences in performance across different types of cardiac problems. This suggests it is necessary to include a large number of cases even if the goal is to assess performance on only a few types of cardiac problems.

Item Type:Journal (Paginated)
Keywords:electrocardiogram, educational, measurement, generalizability, performance based assessment, reliability
Subjects:Psychology > Cognitive Psychology
ID Code:4671
Deposited By:Solomon, David J
Deposited On:06 Jan 2006
Last Modified:11 Mar 2011 08:56

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

Brennan, R.L. (2001). Generalizability Theory. St. Paul Mn: Assessment Systems Corporation.

Crick, J.E. & Brennan, R.L. (1984). A General Purpose Analysis of Variance System, Version 2.2.

American College Testing Service.

Downing, S. (2000). Assessment of knowledge with written test forms. In G.R. Norman C.P.M. van

der Vleuten & D.I. Newble (eds.), International Handbook of Research in Medical Education.

Dordrecht/Boston/London: Kluwer Academic Publishers, pp. 647–672.

Hancock, E.W., Norcini, J.J. & Webster, G.D. (1987). A standardized exam in the interpretation of

electrocardiograms. JACC 10(4): 882–886.

Mavis, B.E., Henry, R.C., Ogle, K.S. & Hoppe, R.B. (1996). The emperor’s new clothes: the OSCE

reassessed. Academic Medicine 71(5) (May): 447–453.

Norman, G.R., Tugwell, P., Feightner, J.W., Muzzin, L.J. & Jacoby, L.L. (1985). Knowledge and

clinical problem-solving. Medical Education 19: 344–35


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