Journal of Educational Evaluation for Health Professions

Technical reports

Development of examination objectives based on nursing competency for the Korean Nursing Licensing Examination: a validity study: Sujin Shin, Gwang Suk Kim, Jun-Ah Song, Inyoung Lee; J Educ Eval Health Prof. 2022;19:19. Published online August 22, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.19

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Abstract PDF Supplementary Material: Purpose
This study aimed to develop the examination objectives based on nursing competency of the Korean Nursing Licensing Examination.
Methods
This is a validity study to develop the examination objectives based on nursing competency. Data were collected in December 2021. We reviewed the literature related to changing nurse roles and on the learning objectives for the Korea Medical Licensing Examination and other health personnel licensing examinations. Thereafter, we created a draft of the nursing problems list for examination objectives based on the literature review, and the content validity was evaluated by experts. A final draft of the examination objectives is presented and discussed.
Results
A total of 4 domains, 12 classes, and 85 nursing problems for the Korean Nursing Liscensing Examination were developed. They included the essentials of objectives, related factors, evaluation goals, related activity statements, related clients, related settings, and specific outcomes.
Conclusion
This study developed a draft of the examination objectives based on clinical competency that were related to the clinical situations of nurses and comprised appropriate test items for the licensing examination. Above results may be able to provide fundamental data for item development that reflects future nursing practices.

Improvement of the qualification system in Korea for foreign nurses eligible to take Korean nursing licensing examination: Young Whee Lee, Yeon Ok Suh, Kyoung Sook Chae; J Educ Eval Health Prof. 2019;16:26. Published online September 4, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.26

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Abstract PDF Supplementary Material: Purpose
We aimed to review and provide a quality improvement for the document utilized by the relevant Korean government body to verify and evaluate foreign university/college graduates’ eligibility for nursing and qualification to take the Korean nursing licensing examination.
Methods
This was a descriptive study. We analyzed the current Korean qualification system for foreign graduates to Korean nursing licensing examination and the same system utilized in some other countries. Then, we created a draft of the reviewed qualification standards document based on the 2 prior analyses and their comparisons, and applied a questionnaire in an open hearing with 5 experts to enhance the draft’s quality. Finally, we presented and discussed the final draft.
Results
The reviewed criteria of the qualification standards included confirming whether the foreign graduate’s university has an accreditation provided by its relevant government body, the exclusion of foreign graduates’ provision of several documents previously required, a minimum number of credits (1,000 hours) for their original course, a 3-year minimum enrollment period for their original course, and a mandatory reassessment of the foreign graduates’ university recognition in a 5-year cycle.
Conclusion
We believe that by creating a review draft that addresses the flaws of the current document utilized to determine the qualification for foreign graduates to take the Korean nursing licensing examination, we have simplified it for a better understanding of the application process. We hope that this draft will contribute to a more objective and equitable qualification process for foreign university nurse graduates in Korea.

Item development process and analysis of 50 case-based items for implementation on the Korean Nursing Licensing Examination: In Sook Park, Yeon Ok Suh, Hae Sook Park, So Young Kang, Kwang Sung Kim, Gyung Hee Kim, Yeon-Hee Choi, Hyun-Ju Kim; J Educ Eval Health Prof. 2017;14:20. Published online September 11, 2017; DOI: https://doi.org/10.3352/jeehp.2017.14.20

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Abstract PDF

Purpose
The purpose of this study was to improve the quality of items on the Korean Nursing Licensing Examination by developing and evaluating case-based items that reflect integrated nursing knowledge.
Methods
We conducted a cross-sectional observational study to develop new case-based items. The methods for developing test items included expert workshops, brainstorming, and verification of content validity. After a mock examination of undergraduate nursing students using the newly developed case-based items, we evaluated the appropriateness of the items through classical test theory and item response theory.
Results
A total of 50 case-based items were developed for the mock examination, and content validity was evaluated. The question items integrated 34 discrete elements of integrated nursing knowledge. The mock examination was taken by 741 baccalaureate students in their fourth year of study at 13 universities. Their average score on the mock examination was 57.4, and the examination showed a reliability of 0.40. According to classical test theory, the average level of item difficulty of the items was 57.4% (80%–100% for 12 items; 60%–80% for 13 items; and less than 60% for 25 items). The mean discrimination index was 0.19, and was above 0.30 for 11 items and 0.20 to 0.29 for 15 items. According to item response theory, the item discrimination parameter (in the logistic model) was none for 10 items (0.00), very low for 20 items (0.01 to 0.34), low for 12 items (0.35 to 0.64), moderate for 6 items (0.65 to 1.34), high for 1 item (1.35 to 1.69), and very high for 1 item (above 1.70). The item difficulty was very easy for 24 items (below −2.0), easy for 8 items (−2.0 to −0.5), medium for 6 items (−0.5 to 0.5), hard for 3 items (0.5 to 2.0), and very hard for 9 items (2.0 or above). The goodness-of-fit test in terms of the 2-parameter item response model between the range of 2.0 to 0.5 revealed that 12 items had an ideal correct answer rate.
Conclusion
We surmised that the low reliability of the mock examination was influenced by the timing of the test for the examinees and the inappropriate difficulty of the items. Our study suggested a methodology for the development of future case-based items for the Korean Nursing Licensing Examination.

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Automating assessment of Design exams: A case study of novelty evaluation
Nandita Bhanja Chaudhuri, Debayan Dhar, Pradeep G. Yammiyavar
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Levels, antecedents, and consequences of critical thinking among clinical nurses: a quantitative literature review
Yongmi Lee, Younjae Oh
Journal of Educational Evaluation for Health Professions.2020; 17: 26. CrossRef
Factors Influencing the Success of the National Nursing Competency Examination taken by the Nursing Diploma Students in Yogyakarta
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Technical Reports

The job analysis of Korean nurses as a strategy to improve the Korean Nursing Licensing Examination: In Sook Park, Yeon Ok Suh, Hae Sook Park, Soo Yeon Ahn, Ahn Kang, Il Sun Ko; J Educ Eval Health Prof. 2016;13:24. Published online June 7, 2016; DOI: https://doi.org/10.3352/jeehp.2016.13.24

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Purpose
This study aimed at characterizing Korean nurses’ occupational responsibilities to apply the results for improvement of the Korean Nursing Licensing Examination. Methods: First, the contents of nursing job were defined based on a focus group interview of 15 nurses. Developing a Curriculum (DACOM) method was used to examine those results and produce the questionnaire by 13 experts. After that, the questionnaire survey to 5,065 hospital nurses was done. Results: The occupational responsibilities of nurses were characterized as involving 8 duties, 49 tasks, and 303 task elements. Those 8 duties are nursing management and professional development, safety and infection control, the management of potential risk factors, basic nursing and caring, the maintenance of physiological integrity, medication and parenteral treatments, socio-psychological integrity, and the maintenance and improvement of health. Conclusion: The content of Korean Nursing Licensing Examination should be improved based on 8 duties and 49 tasks of the occupational responsibilities of Korean nurses.

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Item development process and analysis of 50 case-based items for implementation on the Korean Nursing Licensing Examination
In Sook Park, Yeon Ok Suh, Hae Sook Park, So Young Kang, Kwang Sung Kim, Gyung Hee Kim, Yeon-Hee Choi, Hyun-Ju Kim
Journal of Educational Evaluation for Health Professions.2017; 14: 20. CrossRef
The Knowledge of Nurses on Standards of Job Description at the Intensive Care Units of Broujerd Hospitals, 2016
Kobrs Rashidi, Mahoush Kalhor, Mahdi Berjandi
Iranian Journal of Nursing Research.2017; 12(4): 32. CrossRef
Relevance of the test content of the Korean Nursing Licensing Examination to nursing job
In Sook Park, Yeon Ok Suh, Hae Sook Park, Soo Yeon Ahn, So Young Kang, Kwang Sung Kim
Journal of Educational Evaluation for Health Professions.2016; 13: 23. CrossRef

Relevance of the test content of the Korean Nursing Licensing Examination to nursing job: In Sook Park, Yeon Ok Suh, Hae Sook Park, Soo Yeon Ahn, So Young Kang, Kwang Sung Kim; J Educ Eval Health Prof. 2016;13:23. Published online June 2, 2016; DOI: https://doi.org/10.3352/jeehp.2016.13.23

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Purpose
This study aimed at identifying if there is a relevance of content of the Korean Nursing Licensing Examination (KNLE) revised in 2014 to nursing job. It will be able to provide the validity of revised content of the KNLE. Methods: From October 13 to November 13, 2015, print version of 8 duties with 49-tasks, 155-job item questionnaires were distributed to 1,305 hospital nurses and 202 nursing faculties in Korea. Results were treated by descriptive statistics and comparison analysis. There were responses from 946 nurses or professors (72.5%). Results: The relevance of test content of KNLE to nursing job was shown to be valid with over 3 points out of 4 point Likert scale in all items: from 3.23 at lowest to 3.64 at top. Conclusion: Above results showed that the revised version of KNLE in 2014 was valid to test the nursing students’ knowledge for job performance.

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Nursing Students’ Experiences on Clinical Competency Assessment in Ghana
Oboshie Anim-Boamah, Christmal Dela Christmals, Susan Jennifer Armstrong
Nurse Media Journal of Nursing.2021; 11(3): 278. CrossRef
Item development process and analysis of 50 case-based items for implementation on the Korean Nursing Licensing Examination
In Sook Park, Yeon Ok Suh, Hae Sook Park, So Young Kang, Kwang Sung Kim, Gyung Hee Kim, Yeon-Hee Choi, Hyun-Ju Kim
Journal of Educational Evaluation for Health Professions.2017; 14: 20. CrossRef

Calibrating the Medical Council of Canada’s Qualifying Examination Part I using an integrated item response theory framework: a comparison of models and designs: Andre F. De Champlain, Andre-Philippe Boulais, Andrew Dallas; J Educ Eval Health Prof. 2016;13:6. Published online January 20, 2016; DOI: https://doi.org/10.3352/jeehp.2016.13.6

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Abstract PDF

Purpose
The aim of this research was to compare different methods of calibrating multiple choice question (MCQ) and clinical decision making (CDM) components for the Medical Council of Canada’s Qualifying Examination Part I (MCCQEI) based on item response theory.
Methods
Our data consisted of test results from 8,213 first time applicants to MCCQEI in spring and fall 2010 and 2011 test administrations. The data set contained several thousand multiple choice items and several hundred CDM cases. Four dichotomous calibrations were run using BILOG-MG 3.0. All 3 mixed item format (dichotomous MCQ responses and polytomous CDM case scores) calibrations were conducted using PARSCALE 4.
Results
The 2-PL model had identical numbers of items with chi-square values at or below a Type I error rate of 0.01 (83/3,499 or 0.02). In all 3 polytomous models, whether the MCQs were either anchored or concurrently run with the CDM cases, results suggest very poor fit. All IRT abilities estimated from dichotomous calibration designs correlated very highly with each other. IRT-based pass-fail rates were extremely similar, not only across calibration designs and methods, but also with regard to the actual reported decision to candidates. The largest difference noted in pass rates was 4.78%, which occurred between the mixed format concurrent 2-PL graded response model (pass rate= 80.43%) and the dichotomous anchored 1-PL calibrations (pass rate= 85.21%).
Conclusion
Simpler calibration designs with dichotomized items should be implemented. The dichotomous calibrations provided better fit of the item response matrix than more complex, polytomous calibrations.

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Plus ça change, plus c’est pareil: Making a continued case for the use of MCQs in medical education
Debra Pugh, André De Champlain, Claire Touchie
Medical Teacher.2019; 41(5): 569. CrossRef
Identifying the Essential Portions of the Skill Acquisition Process Using Item Response Theory
Saseem Poudel, Yusuke Watanabe, Yo Kurashima, Yoichi M. Ito, Yoshihiro Murakami, Kimitaka Tanaka, Hiroshi Kawase, Toshiaki Shichinohe, Satoshi Hirano
Journal of Surgical Education.2019; 76(4): 1101. CrossRef
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Aleksandras Krylovas, Natalja Kosareva, Julija Karaliūnaitė
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Technical report

Varying levels of difficulty index of skills-test items randomly selected by examinees on the Korean emergency medical technician licensing examination: Bongyeun Koh, Sunggi Hong, Soon-Sim Kim, Jin-Sook Hyun, Milye Baek, Jundong Moon, Hayran Kwon, Gyoungyong Kim, Seonggi Min, Gu-Hyun Kang; J Educ Eval Health Prof. 2016;13:5. Published online January 15, 2016; DOI: https://doi.org/10.3352/jeehp.2016.13.5

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Abstract PDF

Purpose
The goal of this study was to characterize the difficulty index of the items in the skills test components of the class I and II Korean emergency medical technician licensing examination (KEMTLE), which requires examinees to select items randomly.
Methods
The results of 1,309 class I KEMTLE examinations and 1,801 class II KEMTLE examinations in 2013 were subjected to analysis. Items from the basic and advanced skills test sections of the KEMTLE were compared to determine whether some were significantly more difficult than others.
Results
In the class I KEMTLE, all 4 of the items on the basic skills test showed significant variation in difficulty index (P< 0.01), as well as 4 of the 5 items on the advanced skills test (P< 0.05). In the class II KEMTLE, 4 of the 5 items on the basic skills test showed significantly different difficulty index (P< 0.01), as well as all 3 of the advanced skills test items (P< 0.01).
Conclusion
In the skills test components of the class I and II KEMTLE, the procedure in which examinees randomly select questions should be revised to require examinees to respond to a set of fixed items in order to improve the reliability of the national licensing examination.

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Multimedia-Based online Test on Indonesian Language Receptive Skills Development
M Sudaryanto, D Mardapi, S Hadi
Journal of Physics: Conference Series.2019; 1339(1): 012120. CrossRef

Technical Reports

An assessment blueprint for the Advanced Medical Life Support two-day prehospital emergency medical services training program in the United States: Les R. Becker, Matt Vassar; J Educ Eval Health Prof. 2015;12:43. Published online August 7, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.43

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Purpose
Traditional approaches to blueprint creation may focus on fine-grained detail at the expense of important foundational concepts. The purpose of this study was to develop a method for constructing an assessment blueprint to guide the creation of a new post-test for a two-day prehospital emergency medical services training program. Methods: In order to create the blueprint, we first determined the proportions of the total classroom and home-study minutes associated with the lower- and higher-order cognitive objectives of each chapter of the textbook and the two-day classroom activities during training courses conducted from January to April 2015. These proportions were then applied to a 50-question test structure in order to calculate the number of desired questions by chapter and content type. Results: Our blueprint called for the test to contain an almost even split of lower- and higher-order cognitive questions. One-best-answer multiple choice items and extended matching-type items were written to assess lower- and higher-order cognitive content, respectively. Conclusion: We report the first known application of an assessment blueprint to a prehospital professional development education program. Our approach to blueprint creation is computationally straightforward and could be easily adopted by a group of instructors with a basic understanding of lower- and higher-order cognitive constructs. By blueprinting at the chapter level, as we have done, item-writers should be more inclined to construct questions that focus on important central themes or procedures.

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Evaluation of Emergency First Response’s Competency in Undergraduate College Students: Enhancing Sustainable Medical Education in the Community for Work Occupational Safety
Graciano Dieck-Assad, Omar Israel González Peña, José Manuel Rodríguez-Delgado
International Journal of Environmental Research and Public Health.2021; 18(15): 7814. CrossRef
Quality assurance of test blueprinting
Ghada Eweda, Zakeya Abdulbaqi Bukhary, Omayma Hamed
Journal of Professional Nursing.2020; 36(3): 166. CrossRef

Visualizing the qualitative: making sense of written comments from an evaluative satisfaction survey: Keith V. Bletzer; J Educ Eval Health Prof. 2015;12:12. Published online April 16, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.12

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23 Citations

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Purpose
Satisfaction surveys are common in the field of health education, as a means of assisting organizations to improve the appropriateness of training materials and the effectiveness of facilitation-presentation. Data can be qualitative of which analysis often become specialized. This technical article aims to reveal whether qualitative survey results can be visualized by presenting them as a Word Cloud. Methods: Qualitative materials in the form of written comments on an agency-specific satisfaction survey were coded and quantified. The resulting quantitative data were used to convert comments into “input terms” to generate Word Clouds to increase comprehension and accessibility through visualization of the written responses. Results: A three-tier display incorporated a Word Cloud at the top, followed by the corresponding frequency table, and a textual summary of the qualitative data represented by the Word Cloud imagery. This mixed format adheres to recognition that people vary in what format is most effective for assimilating new information. Conclusion: The combination of visual representation through Word Clouds complemented by quantified qualitative materials is one means of increasing comprehensibility for a range of stakeholders, who might not be familiar with numerical tables or statistical analyses.

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Best-fit model of exploratory and confirmatory factor analysis of the 2010 Medical Council of Canada Qualifying Examination Part I clinical decision-making cases: André F. Champlain; J Educ Eval Health Prof. 2015;12:11. Published online April 15, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.11

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Purpose
This study aims to assess the fit of a number of exploratory and confirmatory factor analysis models to the 2010 Medical Council of Canada Qualifying Examination Part I (MCCQE1) clinical decision-making (CDM) cases. The outcomes of this study have important implications for a range of domains, including scoring and test development. Methods: The examinees included all first-time Canadian medical graduates and international medical graduates who took the MCCQE1 in spring or fall 2010. The fit of one- to five-factor exploratory models was assessed for the item response matrix of the 2010 CDM cases. Five confirmatory factor analytic models were also examined with the same CDM response matrix. The structural equation modeling software program Mplus was used for all analyses. Results: Out of the five exploratory factor analytic models that were evaluated, a three-factor model provided the best fit. Factor 1 loaded on three medicine cases, two obstetrics and gynecology cases, and two orthopedic surgery cases. Factor 2 corresponded to pediatrics, and the third factor loaded on psychiatry cases. Among the five confirmatory factor analysis models examined in this study, three- and four-factor lifespan period models and the five-factor discipline models provided the best fit. Conclusion: The results suggest that knowledge of broad disciplinary domains best account for performance on CDM cases. In test development, particular effort should be placed on developing CDM cases according to broad discipline and patient age domains; CDM testlets should be assembled largely using the criteria of discipline and age.

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The key-features approach to assess clinical decisions: validity evidence to date
G. Bordage, G. Page
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Reforms of the Korean Medical Licensing Examination regarding item development and performance evaluation: Mi Kyoung Yim; J Educ Eval Health Prof. 2015;12:6. Published online March 17, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.6

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4 Citations

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Purpose
The Korean Medical Licensing Examination (KMLE) has undergone a variety of innovative reforms implemented by the National Health Personnel Licensing Examination Board (NHPLEB) in order to make it a competency-based test. The purpose of this article is to describe the ways in which the KMLE has been reformed and the effect of those innovations on medical education in Korea. Methods: Changes in the KMLE were traced from 1994 to 2014 by reviewing the adoption of new policies by the NHPLEB and the relevant literature. Results: The most important reforms that turned the examination into a competency-based test were the following: First, the subjects tested on the exam were revised; second, R-type items were introduced; third, the proportion of items involving problem-solving skills was increased; and fourth, a clinical skills test was introduced in addition to the written test. The literature shows that the above reforms have resulted in more rigorous licensure standards and have improved the educational environment of medical schools in Korea. Conclusion: The reforms of the KMLE have led to improvements in how the competency of examinees is evaluated, as well as improvements in the educational system in medical schools in Korea.

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Joo Hee Kim, Ju-Yeun Lee, Young Sook Lee, Chul-Soon Yong, Nayoung Han, Hye Sun Gwak, Jungmi Oh, Byung Koo Lee, Sukhyang Lee
Journal of Educational Evaluation for Health Professions.2017; 14: 6. CrossRef
Is there an agreement among the items of the Korean physical therapist licensing examination, learning objectives of class subjects, and physical therapists’ job descriptions?
Min-Hyeok Kang, Oh-Yun Kwon, Yong-Wook Kim, Ji-Won Kim, Tae-Ho Kim, Tae-Young Oh, Jong-Hyuk Weon, Tae-Sik Lee, Jae-Seop Oh
Journal of Educational Evaluation for Health Professions.2016; 13: 3. CrossRef
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Sang Yun Han, Hee Young Kim, Jung Hwa Lim, Jinhong Cheon, Young Kyu Kwon, Hyungwoo Kim, Gi Young Yang, Han Chae
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Medical students’ satisfaction with the Applied Basic Clinical Seminar with Scenarios for Students, a novel simulation-based learning method in Greece
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North Korean defectors seeking health certification to take the national medical licensing examination in the Republic of Korea: figures and procedures: Yoon Hee Kim; J Educ Eval Health Prof. 2012;9:12. Published online December 1, 2012; DOI: https://doi.org/10.3352/jeehp.2012.9.12

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In May 2011, the Ministry of Unification of the Republic of Korea (Korea) announced that 21,165 defectors from Democratic People's Republic of Korea (North Korea) had settled in Korea. Since healthcare workers are counted among these defectors, it is necessary to provide them with a pathway to certification to work in Korea. This report summarizes the vetting and approval process defectors from North Korea must pass through to be eligible to take the national medical licensing examination. Defectors must pass an oral test conducted by the National Health Personnel Licensing Examination Board to be eligible to sit for the exam. From 2002 to August 2011, 41 North Korean defectors applied for the approval process to take the exam. Twenty-nine were approved (70.7%): 23 physicians, 1 dentist, 2 oriental medical doctor, 1 nurse, and 2 pharmacists. Out of 29 approved, 11 passed the licensing examination (39.3%). This report also highlights the difficulty in assessing North Korean defectors' eligibility by oral test, and suggests that adequate competency should be emphasized to recognize their unique abilities as healthcare personnel.

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Shin Ha, Hui Ran Choi, Jong Koo Lee, Yo Han Lee
Journal of Continuing Education in the Health Professions.2019; 39(2): 112. CrossRef
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Introduction and Administration of the Clinical Skill Test of the Medical Licensing Examination, Republic of Korea (2009): Kun Sang Kim; J Educ Eval Health Prof. 2010;7:4. Published online December 3, 2010; DOI: https://doi.org/10.3352/jeehp.2010.7.4

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The first trial of the clinical skill test as part of the Korean Medical Licensing Examination was done from September 23 to December 1, 2009, in the clinical skill test center located in the National Health Personnel Licensing Examination Board (NHPLEB) building, Seoul. Korea is the first country to introduce the clinical skill test as part of the medical licensing examination in Asia. It is a report on the introduction and administration of the test. The NHPLEB launched researches on the validity of introducing the clinical skill test and on the best implementation methods in 2000. Since 2006, lists of subjects of test items for the clinical skill test has been developed. The test consisted of two types of evaluation, i.e., a clinical performance examination (CPX) with a standardized patient (SP) and objective structured clinical examination (OSCE). The proctor (medical faculty member) and SP rate the examinees??proficiency for the OSCE and CPX respectively. Out of 3,456 applicants, 3,289 examinees (95.2%) passed the test. Out of 167 examinees who failed the clinical skill test, 142 passed the written test. This means that the clinical skill test showed characteristics independent from the written test. This successful implementation of the clinical skill test is going to improve the medical graduates??performance of clinical skills.

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