Essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss federal licensing examination for human medicine.

Purpose: This report describes the essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss Federal Licensing Examination for Human Medicine (FLE) and the insights gained since its introduction in 2011. Methods: Based on existing scientific evidence, international expertise, and experience gained from previous examinations, the FLE is developed by experts from all five medical faculties in Switzerland with the support of the Institute for Medical Education and is held simultaneously at five locations. The exam organisers document and review every examination held and continuously optimise the processes; they have summarised the results in this report. Results: The essential steps comprise the development, revision and translation of questions; construction of the exam and production of materials; candidate preparation; implementation and analysis. The quality assurance measures consist of guideline coherence in the development of the questions and implementation of the exam, revision processes, construction of the exam based on the national blueprint, multiphase review of the translations and exam material, and statistical analysis of the exam and the comments from candidates. The intensive collaboration, especially on the part of representatives from all the participating faculties and a central coordination unit, which provides methodological support throughout and oversees the analysis of the exam, has proven successful. Successfully completed examinations and reliable results in the eleven examinations so far implemented represent the outcomes of the quality assurance measures. Significant insights in recent years are the importance of appreciating the work of those involved and the central organisation of exam development, thus ensuring the long-term success of the process. Conclusion: Common guidelines and workshops, quality assurance measures accompanied by the continuous improvement of all processes, and appreciation of everyone involved, are essential to carrying out such an examination at a high-quality level in the long term.

Measurement precision at the cut score in medical multiple choice exams: Theory matters.

INTRODUCTION: In high-stakes assessment, the measurement precision of pass-fail decisions is of great importance. A concept for analyzing the measurement precision at the cut score is conditional reliability, which describes measurement precision for every score achieved in an exam. We compared conditional reliabilities in Classical Test Theory (CTT) and Item Response Theory (IRT) with a special focus on the cut score and potential factors influencing conditional reliability at the cut score. METHODS: We analyzed 32 multiple-choice exams from three Swiss medical schools comparing conditional reliability at the cut score in IRT and CCT. Additionally, we analyzed potential influencing factors such as the range of examinees' performance, year of study, and number of items using multiple regression. RESULTS: In CTT, conditional reliability was highest for very low and very high scores, whereas examinees with medium scores showed low conditional reliabilities. In IRT, the maximum conditional reliability was in the middle of the scale. Therefore, conditional reliability at the cut score was significantly higher in IRT compared with CTT. It was influenced by the range of examinees' performance and number of items. This influence was more pronounced in CTT. DISCUSSION: We found that conditional reliability shows inverse distributions and conclusions regarding the measurement precision at the cut score depending on the theory used. As the use of IRT seems to be more appropriate for criterion-oriented standard setting in the framework of competency-based medical education, our findings might have practical implications for the design and quality assurance of medical education assessments.

Great project management=IT success.

Discover how creating a formal project management office can help a health care organization achieve on-time information technology projects that stay within their budgets.

IT management and governance systems and their emergence in healthcare.

Today's healthcare IT departments are challenged with understanding the total service demand imposed by their user communities and how much of their limited resources are available to meet that demand. This challenge is being addressed through the use of new IT management and governance (IT-MG) systems. This software supports IT governance and project and portfolio management. IT-MG is a relatively new term to healthcare; it entails reviewing and managing demand for IT services from inception to completion through the application of IT resources. These systems help save time through automated reporting and quicker delivery of services; they save money by more effectively addressing resource needs on time and on budget. The systems also reduce the number of administrative tasks through process automation; increase customer satisfaction by communicating services and deliverables more quickly and accurately; and help executives make better and more informed decisions about priorities and expectations through reporting that was previously nonexistent. This article will explore IT-MG systems and present a case study of a hospital that rapidly implemented this type of system.

Demand management in healthcare IT. Controlling IT demand to meet constrained IT resource supply.

Healthcare is behind other industries in the ability to manage and control increasing demand for IT services, and to ensure that IT staff are available when and where needed. From everyday support requests to large capital projects, the IT department's ability to meet demand is limited. Organizational and IT leaders need to proactively address this issue and do a better job of predicting when services will be needed and whether appropriate resources will be available. This article describes the common issues that healthcare IT departments face in the efficient delivery of services as a result of factors such as budget constraints, skill sets and project dependencies. Best practices for controlling demand are discussed, including resource allocation, governance processes and a graphical analysis of forecasted vs. actual thresholds. Using specific healthcare provider examples, the article intends to provide IT management with an approach to predicting and controlling resource demand.

Teledermatology: just cool or a real tool?

Telemedicine is the practice of healthcare using interactive audio, visual and data communication. This includes healthcare delivery, diagnoses, consultation and treatment as well as education and transfer of medical data. The transmission of multimedia streams has remained a major challenge. Although the Internet remains basically insecure, technology allows today to define and implement complete security profiles for specific (medical) communities. Data security is a must as in all other areas of applied medicine. Teledermatology offers possibilities in consulting, continuous medical education or teleteaching. In the future, consulting and asking for a second opinion will be the gold standard of medical care. The quality of healthcare will be improved without saving direct costs. However, indirect costs such as time and effort for the patient and the citizen will be reduced.

How shall we meet online? Choosing between videoconferencing and online meetings.

Collaborating online can be accomplished with several tools, including e-mail, videoconferencing, online presentations, virtual offices, instant messaging, and bulletin boards or forums. Among their benefits are reducing travel time and expense, effectively organizing and disseminating knowledge, and increasing physician satisfaction by reducing required meeting time.