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Original Research: INTERVENTIONAL PULMONOLOGY |

Reliability of a 25-Item Low-Stakes Multiple-Choice Assessment of Bronchoscopic Knowledge

Silvia Quadrelli, MD, PhD, MEd, FCCP; Mohsen Davoudi, MD; Fernando Galíndez, MD; Henri G. Colt, MD, FCCP
Author and Funding Information

*From the Instituto de Investigaciones Médicas Alfredo Lanari (Dr. Quadrelli), Buenos Aires, Argentina; the Department of Pulmonary and Critical Care Medicine (Drs. Davoudi and Colt), University of California Irvine, UCI Medical Center, Orange, CA; and Hospital María Ferrer (Dr. Galíndez), Buenos Aires, Argentina.

Correspondence to: Henri Colt, MD, FCCP, Professor of Medicine, UCI Medical Center, 101 The City Dr, Building 53, Room 119, Orange, CA 92868; e-mail: hcolt@uci.edu


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

For editorial comment see page 256


Chest. 2009;135(2):315-321. doi:10.1378/chest.08-0867
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Background:  A need for improved patient safety, quality of care, and accountability has prompted the development of competency-based educational processes. Assessment tools related to bronchoscopy training, however, have not yet been developed or validated.

Purpose:  To determine whether 25 multiple-choice questions (MCQs) extracted from the free, Web-based Essential Bronchoscopist (EB) learning guide qualify in their original form as a preliminary pool of questions for a low-stakes assessment of bronchoscopic knowledge.

Materials and Methods:  Twenty-five randomly selected MCQs from among the top 70 question-answer sets of the EB were administered to 40 self-declared novice bronchoscopists (n = 13), experienced bronchoscopists (n = 21), and expert bronchoscopists (n = 6). A difficulty index and a discrimination index (DI) were calculated for each item. Internal consistency reliability was calculated using item-total correlation and Cronbach α. Content validity was determined by five independent experts. Ideal test items based on a difficulty index and item-total correlation were administered to a different group of 24 bronchoscopists to prospectively reassess internal consistency reliability.

Results:  The mean (± SD) score for the 40 participants was 16.47 ± 3.72 (median score, 17; score range, 7 to 22). The mean difficulty index was 0.65 ± 0.22, and the mean DI was 0.52 ± 0.28. Item total-correlations ranged from − 0.01 to + 0.71. Test content was unanimously validated. The Cronbach α was 0.69. There was no significant correlation between scores and the number of bronchoscopies performed or self-declared expertise. Eleven ideal test MCQs were identified. The internal consistency of these items remained satisfactory (Cronbach α = 0.75) when assessed prospectively in a different cohort.

Conclusion:  Reliable and valid MCQs were identified to initiate a preliminary pool of questions for a low-stakes assessment of bronchoscopic knowledge.

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