A Follow-Up Study of "Dangerous Answers" in Four Medical Specialties

Abstract

We undertook this study to obtain further validation of a latent trait for dangerousness, identified by Mankin, Lloyd, and Rovinelli (1987), on certification examinations for medical specialists. "Dangerousness " was defined as any act of omission, or commission, in treatment which could result in a patient's death or injury. The method we employed involved asking panels of experts to retrospectively evaluate items on specilty examinationsfor dangerous answers. We then analyzed candidates' choices of dangerous answers. Four specialties participated in the study, and data from each were analyzed separately. Our results failed to support a latent trait for dangerousness. Nevertheless, we suggest that future studies employing alternative evaluation methods could yield support for a dangerousness trait, but consideration must be given to the potential costs of these studies.

Get full access to this article

View all access options for this article.

References

Allan, D.M.E. (1986). The rationale for the interactive videodisc in continuing education. Mobius, 6, 3-8.

Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297-334.

Kassirer, J. P. , & Kopelman, R. I. (1989). Cognitive errors in diagnosis: Instantiation, classification, and consequences. American Journal of Medicine, 86, 433-441.

Lloyd, J. S. (Ed.). (1982). Evaluation of noncognitive skills and clinical performance. Chicago: American Board of Medical Specialties.

Lloyd, J. S. (Ed.). (1983). Oral examinations in medical specialty board certification. Chicago: American Board of Medical Specialties.

Lord, F. M. , & Novick, M. R. (1968). Statistical theories of mental test scores. Reading, MA: Addison-Wesley.

Mankin, H. J. , Lloyd, J. S. , & Rovinelli, R. J. (1987). Pilot study using "dangerous answers" as a scoring technique on certifying examinations. Journal of Medical Education, 62, 621-624.

Slogoff, S. , & Hughes, F. P. (1987). Validity of scoring "dangerous answers" on a written certification examination. Journal of Medical Education, 62, 625-631.

Swanson, D. B. , & Stillman, P. L. (1990). Use of standardized patients for teaching and assessing clinical skills. Evaluation & the Health Professions, 13, 79-103.