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HOME > J Educ Eval Health Prof > Volume 22; 2025 > Article
Correspondence
 Item difficulty index, discrimination index, and reliability of the 26 health professions licensing examinations in 2024, Korea: a psychometric study
Yoon Hee Kim*orcid, Bo Hyun Kimorcid, Joonki Kimorcid, Bokyoung Jungorcid, Sangyoung Baeorcid

DOI: https://doi.org/10.3352/jeehp.2025.22.38
Published online: December 15, 2025

Research and Development Division, Korea Health Personnel Licensing Examination Institute, Seoul, Korea

*Corresponding email: yhkim@kuksiwon.or.kr

Editor: Sun Huh, Hallym University, Korea

• Received: November 26, 2025   • Accepted: December 4, 2025

© 2025 Korea Health Personnel Licensing Examination Institute

This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The Korea Health Personnel Licensing Examination Institute administers national licensing examinations annually to determine whether candidates meet the essential competencies required for healthcare practice. To ensure that these examinations remain valid and appropriate, post-exam analyses of item difficulty, discrimination, and reliability are routinely conducted. Questions with extremely high or low difficulty or discrimination scores may require review and revision, offering meaningful insights for improving future tests. This study evaluated the item difficulty, discrimination, and reliability of 26 health personnel licensing exams held in Korea in 2024 to assess their overall suitability. It also explored the relationship between the average item difficulty and average item discrimination indices. This work follows a previous report covering the 2022 and 2023 licensing exams [1,2].
Since this study involved analyzing test results rather than human subjects, institutional review board approval and informed consent were not required.
Item analysis was performed on the 26 examinations using classical test theory. Item difficulty (P) was defined as the proportion of examinees who answered an item correctly, ranging from 0 to 1. Item discrimination was measured using the upper and lower 27% method, which compares the difference in difficulty between the top and bottom 27% of examinees, as well as the correlation of individual item scores with total test scores. Discrimination indices and reliability were calculated only for exams with more than 100 participants. Statistical analyses were conducted using IBM SPSS ver. 21.0 (IBM Corp.).
Pass rates across the 26 examinations varied widely, ranging from 25.0% to 100%. The number of examinees per exam ranged from 12 (for health educators–level 1 and midwives) to 181,890 (for care workers). Exams for physicians, dentists, midwives, nurses, doctors of Korean medicine, and pharmacists all had pass rates exceeding 90%. Notably, the midwives’ exam had a 100% pass rate, although it included only 12 candidates (Table 1).
Table 2 summarizes the results of the item analysis for the 2024 examinations. All exams showed high reliability, with the lowest reliability observed for the emergency medical technicians–level 2 exam (0.880). The average difficulty indices ranged from 53.1% (health educators–level 2) to 80.1% (physicians), while the average item-total correlations ranged from 0.19 (doctors of Korean medicine) to 0.43 (opticians).
According to classical test theory, average difficulty indices are classified as moderate (50%–60%), somewhat easy (60%–70%), easy (70%–80%), and very easy (80% or above). Based on these categories, the 2024 exams’ difficulty indices were rated as very easy for the occupational therapists and physicians exams, easy for 14 exams, and somewhat easy for 13 exams. For medical professions such as physicians (80.1%), dentists (77.3%), nurses (79.5%), and doctors of Korean medicine (74.6%), the difficulty indices fell into the very easy or easy categories, with corresponding pass rates exceeding 90%.
In classical test theory, discrimination indices below 0.30 are generally considered low. Seventeen examinations demonstrated low discrimination, whereas 11 showed good discrimination. For example, the doctors of Korean medicine exam had a relatively low discrimination index (average item-total correlation of 0.19), while the opticians exam demonstrated good discrimination (average item-total correlation of 0.41). All tests maintained high reliability, with Cronbach’s alpha values of 0.880 or higher, ensuring consistent measurement across examinations.
In 2022, the national licensing examinations had 468,352 candidates with an 89.4% pass rate. In 2023, there were 446,054 candidates with an 87.0% pass rate. In 2024, both the number of candidates (286,922) and the number of successful examinees (244,205) decreased, resulting in an 85.1% pass rate. The pass rate range shifted from 52.2%–100.0% in 2023 to 25.0%–100.0% in 2024. Analysis of difficulty indices for both years showed that most exams remained relatively easy. Twenty examinations in 2024 showed decreased difficulty compared to 2023, mainly shifting among the easy, very easy, and somewhat easy categories, without major overall changes. Additionally, the Care Workers Qualification Examination transitioned to computer-based testing in 2023, leading to non-disclosure of test items and analysis results, which limited direct comparisons.
In 2024, 17 examinations had lower discrimination indices than in 2023, and 12 showed decreases in item-total correlation coefficients. Despite these declines, the overall discrimination indices for 2024 did not differ significantly from those in 2023, suggesting no substantial reduction in discriminative capacity. Confidentiality policies restrict the release of detailed item analyses and test results, limiting comparisons with previous years and constraining broader academic discussion of these examinations.
In summary, Korea’s 2024 national health personnel licensing examinations exhibited satisfactory levels of difficulty, discrimination, and reliability. Nonetheless, 5 of the 26 exams had low discrimination indices despite having appropriate difficulty levels.

Authors’ contributions

Conceptualization: YHK. Data curation: YHK. Methodology/formal analysis/validation: YHK, BHK, JK, BJ, SB. Project administration: YHK. Funding acquisition: none. Writing–original draft: YHK. Writing–review & editing: YHK, BHK, JK, BJ, SB.

Conflict of interest

All authors are employees of the Korea Health Personnel Licensing Examination Institute. However, they were not involved in the peer review or decision process. Otherwise, no potential conflict of interest relevant to this article was reported.

Funding

None.

Data availability

The raw data are unavailable due to the Korea Health Personnel Licensing Examination Institute’s policy. For a more detailed analysis, please contact the corresponding author. Some data are available at http://www.kuksiwon.or.kr/notice/brd/m_51/list.do

Acknowledgments

None.

Supplementary materials

Not applicable.

Table 1.
Pass rates for examinees in the 26 national health professions licensing examinations in Korea, 2024
Job titles No. of examinees No. of successful candidates Pass rate (%)
Assistive technology professionals (6th) 349 290 83.1
Care workersa) 181,890 156,081 85.8
Dental hygienists (52nd) 4,837 4,182 86.5
Dental technicians (52nd) 910 762 83.7
Dentists (77th) 778 721 93.3
Dietitians (48th) 5,065 3,538 69.9
Emergency medical technicians–level 1 (30th) 1,629 1,206 74.0
Emergency medical technicians–level 2 (30th) 1,172 989 84.4
Health educators–level 1 (15th) 12 3 25.0
Health educators–level 2 (15th) 135 77 57.0
Health educators–level 3 (15th) 884 638 72.2
Health information managers (41st) 2,268 1,360 60.0
Oriental medicine pharmacists (24th) 146 128 87.7
Medical technologists (52nd) 2,975 2,489 83.7
Midwives (35th) 12 12 100.0
Nurses (64th) 24,377 23,567 96.7
Nursing aides (1st half) 16,370 14,830 90.6
Nursing aides (2nd half) 15,428 13,639 88.4
Occupational therapists (52nd) 1,774 1,591 89.7
Opticians (37th) 1,466 1,043 71.1
Doctors of Korean medicine (79th) 797 773 97.0
Oriental medicine dispensers (31st) - -
Pharmacists (75th) 2,071 1,879 90.7
Physical therapists (52nd) 5,176 3,974 76.8
Physicians (88th) 3,231 3,045 94.2
Prosthetists and orthotists (25th) 123 85 69.1
Radiological technologists (52nd) 2,787 2,181 78.3
Rehabilitation counselors–level 1 (8th) 488 361 74.0
Rehabilitation counselors–level 2 (8th) 119 99 83.2
Sanitary technicians (46th) 7,610 3,514 46.2
Speech-language pathologists–level 1 (13th) 987 507 51.4
Speech-language pathologists–level 2 (13th) 1,056 641 60.7

a) In 2023, the Care Workers Qualification Examination transitioned to a computer-based test with continuous availability. In 2024, paper-based testing was not conducted.

Table 2.
Difficulty index, upper and lower group discrimination index, item-total correlation, and reliability index presented as Cronbach α for 26 health professional licensing examinations in Korea, 2024
Job title No. of subjects No. of items Difficulty index (%) Upper and lower group discriminationa) Item-total correlationa) Reliability (Cronbach α)
Assistive technology professionals (6th) 2 170 66.8±26.6 0.20±0.14 0.22±0.11 0.880
Care workersb) 2 80
Dental hygienists (52nd) 2 200 74.3±18.1 0.26±0.12 0.28±0.10 0.945
Dental technicians (52nd) 3 205 73.9±18.5 0.31±0.15 0.33±0.12 0.962
Dentists (76th) 13 321 77.3±22.5 0.20±0.14 0.22±0.10 0.944
Dietitians (48th) 4 220 66.7±21.1 0.33±0.17 0.30±0.13 0.959
Emergency medical technicians–level 1 (30th) 5 230 67.0±21.0 0.27±0.14 0.25±0.11 0.941
Emergency medical technicians–level 2 (30th) 5 140 69.3±20.6 0.22±0.13 0.21±0.10 0.880
Health educators–level 1 (15th)a) 3 60 53.1±29.4 - - -
Health educators–level 2 (15th) 8 180 61.9±20.2 0.27±0.19 0.27±0.15 0.925
Health educators–level 3 (15th) 4 110 66.6±22.4 0.28±0.17 0.27±0.14 0.889
Health information managers (41st) 3 230 65.5±20.7 0.35±0.17 0.32±0.12 0.964
Medical technologists (52nd) 4 280 75.7±16.5 0.34±0.13 0.37±0.11 0.977
Midwives (35th)a) 4 165 77.7±23.8 - - -
Nurses (64th) 8 295 79.5±20.1 0.18±0.12 0.23±0.09 0.936
Nursing aides (1st half) 4 100 79.7±19.2 0.30±0.18 0.36±0.12 0.932
Nursing aides (2nd half) 4 100 78.4±16.7 0.31±0.15 0.37±0.11 0.932
Occupational therapists (52nd) 4 240 80.0±16.2 0.27±0.15 0.32±0.11 0.964
Opticians (37th) 4 250 70.8±16.3 0.43±0.17 0.41±0.14 0.981
Doctors of Korean medicine (79th) 11 340 74.6±23.0 0.16±0.12 0.19±0.10 0.925
Oriental medicine pharmacists (25th) 3 250 73.0±23.4 0.24±0.15 0.31±0.17 0.958
Pharmacists (75th) 4 350 71.2±22.4 0.21±0.11 0.25±0.11 0.953
Physical therapists (52nd) 5 260 69.5±20.4 0.27±0.17 0.28±0.12 0.955
Physicians (88th) 3 320 80.1±20.1 0.18±0.13 0.23±0.11 0.942
Prosthetists and orthotists (25th) 7 210 65.0±21.4 0.30±0.19 0.26±0.15 0.945
Radiological technologists (52nd) 4 250 73.5±16.9 0.36±0.16 0.36±0.13 0.975
Rehabilitation counselors–level 1 (8th) 7 150 67.5±23.2 0.24±0.14 0.25±0.11 0.896
Rehabilitation counselors–level 2 (8th) 7 120 73.6±19.2 0.26±0.17 0.27±0.14 0.892
Sanitary technicians (46th) 6 220 61.7±20.9 0.31±0.17 0.28±0.14 0.950
Speech-language pathologists–level 1 (13th) 6 140 60.9±22.9 0.28±0.16 0.26±0.13 0.903
Speech-language pathologists–level 2 (13th) 5 150 63.3±19.9 0.36±0.15 0.33±0.12 0.947

Values are presented as number or mean±standard deviation unless otherwise stated.

a)Discrimination indices and reliability were not calculated for examinations with fewer than 100 candidates. b)The item analysis results for the Care Workers Qualification Examination were not disclosed.

  • 1. Kim YH, Kim BH, Kim J, Jung B, Bae S. Item difficulty index, discrimination index, and reliability of the 26 health professions licensing examinations in 2022, Korea: a psychometric study. J Educ Eval Health Prof 2023;20:31. https://doi.org/10.3352/jeehp.2023.20.31 ArticlePubMedPMC
  • 2. Kim YH, Kim BH, Kim J, Jung B, Bae S. Item difficulty index, discrimination index, and reliability of the 26 health professions licensing examinations in 2023, Korea: a psychometric study. J Educ Eval Health Prof 2024;21:40. https://doi.org/10.3352/jeehp.2024.21.40 ArticlePubMedPMC

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      Item difficulty index, discrimination index, and reliability of the 26 health professions licensing examinations in 2024, Korea: a psychometric study
      Item difficulty index, discrimination index, and reliability of the 26 health professions licensing examinations in 2024, Korea: a psychometric study
      Job titles No. of examinees No. of successful candidates Pass rate (%)
      Assistive technology professionals (6th) 349 290 83.1
      Care workersa) 181,890 156,081 85.8
      Dental hygienists (52nd) 4,837 4,182 86.5
      Dental technicians (52nd) 910 762 83.7
      Dentists (77th) 778 721 93.3
      Dietitians (48th) 5,065 3,538 69.9
      Emergency medical technicians–level 1 (30th) 1,629 1,206 74.0
      Emergency medical technicians–level 2 (30th) 1,172 989 84.4
      Health educators–level 1 (15th) 12 3 25.0
      Health educators–level 2 (15th) 135 77 57.0
      Health educators–level 3 (15th) 884 638 72.2
      Health information managers (41st) 2,268 1,360 60.0
      Oriental medicine pharmacists (24th) 146 128 87.7
      Medical technologists (52nd) 2,975 2,489 83.7
      Midwives (35th) 12 12 100.0
      Nurses (64th) 24,377 23,567 96.7
      Nursing aides (1st half) 16,370 14,830 90.6
      Nursing aides (2nd half) 15,428 13,639 88.4
      Occupational therapists (52nd) 1,774 1,591 89.7
      Opticians (37th) 1,466 1,043 71.1
      Doctors of Korean medicine (79th) 797 773 97.0
      Oriental medicine dispensers (31st) - -
      Pharmacists (75th) 2,071 1,879 90.7
      Physical therapists (52nd) 5,176 3,974 76.8
      Physicians (88th) 3,231 3,045 94.2
      Prosthetists and orthotists (25th) 123 85 69.1
      Radiological technologists (52nd) 2,787 2,181 78.3
      Rehabilitation counselors–level 1 (8th) 488 361 74.0
      Rehabilitation counselors–level 2 (8th) 119 99 83.2
      Sanitary technicians (46th) 7,610 3,514 46.2
      Speech-language pathologists–level 1 (13th) 987 507 51.4
      Speech-language pathologists–level 2 (13th) 1,056 641 60.7
      Job title No. of subjects No. of items Difficulty index (%) Upper and lower group discriminationa) Item-total correlationa) Reliability (Cronbach α)
      Assistive technology professionals (6th) 2 170 66.8±26.6 0.20±0.14 0.22±0.11 0.880
      Care workersb) 2 80
      Dental hygienists (52nd) 2 200 74.3±18.1 0.26±0.12 0.28±0.10 0.945
      Dental technicians (52nd) 3 205 73.9±18.5 0.31±0.15 0.33±0.12 0.962
      Dentists (76th) 13 321 77.3±22.5 0.20±0.14 0.22±0.10 0.944
      Dietitians (48th) 4 220 66.7±21.1 0.33±0.17 0.30±0.13 0.959
      Emergency medical technicians–level 1 (30th) 5 230 67.0±21.0 0.27±0.14 0.25±0.11 0.941
      Emergency medical technicians–level 2 (30th) 5 140 69.3±20.6 0.22±0.13 0.21±0.10 0.880
      Health educators–level 1 (15th)a) 3 60 53.1±29.4 - - -
      Health educators–level 2 (15th) 8 180 61.9±20.2 0.27±0.19 0.27±0.15 0.925
      Health educators–level 3 (15th) 4 110 66.6±22.4 0.28±0.17 0.27±0.14 0.889
      Health information managers (41st) 3 230 65.5±20.7 0.35±0.17 0.32±0.12 0.964
      Medical technologists (52nd) 4 280 75.7±16.5 0.34±0.13 0.37±0.11 0.977
      Midwives (35th)a) 4 165 77.7±23.8 - - -
      Nurses (64th) 8 295 79.5±20.1 0.18±0.12 0.23±0.09 0.936
      Nursing aides (1st half) 4 100 79.7±19.2 0.30±0.18 0.36±0.12 0.932
      Nursing aides (2nd half) 4 100 78.4±16.7 0.31±0.15 0.37±0.11 0.932
      Occupational therapists (52nd) 4 240 80.0±16.2 0.27±0.15 0.32±0.11 0.964
      Opticians (37th) 4 250 70.8±16.3 0.43±0.17 0.41±0.14 0.981
      Doctors of Korean medicine (79th) 11 340 74.6±23.0 0.16±0.12 0.19±0.10 0.925
      Oriental medicine pharmacists (25th) 3 250 73.0±23.4 0.24±0.15 0.31±0.17 0.958
      Pharmacists (75th) 4 350 71.2±22.4 0.21±0.11 0.25±0.11 0.953
      Physical therapists (52nd) 5 260 69.5±20.4 0.27±0.17 0.28±0.12 0.955
      Physicians (88th) 3 320 80.1±20.1 0.18±0.13 0.23±0.11 0.942
      Prosthetists and orthotists (25th) 7 210 65.0±21.4 0.30±0.19 0.26±0.15 0.945
      Radiological technologists (52nd) 4 250 73.5±16.9 0.36±0.16 0.36±0.13 0.975
      Rehabilitation counselors–level 1 (8th) 7 150 67.5±23.2 0.24±0.14 0.25±0.11 0.896
      Rehabilitation counselors–level 2 (8th) 7 120 73.6±19.2 0.26±0.17 0.27±0.14 0.892
      Sanitary technicians (46th) 6 220 61.7±20.9 0.31±0.17 0.28±0.14 0.950
      Speech-language pathologists–level 1 (13th) 6 140 60.9±22.9 0.28±0.16 0.26±0.13 0.903
      Speech-language pathologists–level 2 (13th) 5 150 63.3±19.9 0.36±0.15 0.33±0.12 0.947
      Table 1. Pass rates for examinees in the 26 national health professions licensing examinations in Korea, 2024

      In 2023, the Care Workers Qualification Examination transitioned to a computer-based test with continuous availability. In 2024, paper-based testing was not conducted.

      Table 2. Difficulty index, upper and lower group discrimination index, item-total correlation, and reliability index presented as Cronbach α for 26 health professional licensing examinations in Korea, 2024

      Values are presented as number or mean±standard deviation unless otherwise stated.

      a)Discrimination indices and reliability were not calculated for examinations with fewer than 100 candidates. b)The item analysis results for the Care Workers Qualification Examination were not disclosed.

      Table 1.

      Table 2.

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