NATIONAL BOARD OF MEDICAL EXAMINERS Subject

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NATIONAL BOARD OF MEDICAL EXAMINERS Subject Examination ProgramAdvanced Clinical Science ExaminationScore Interpretation Guide NBME Advanced Clinical examinations provide medical schools with a tool for measuring examinees' understanding ofthe clinical sciences. Items on this examination were written and reviewed by national test committees. Prior topublication, test forms are reviewed by a panel of course directors from this discipline. Although these examinations aredesigned to be broadly appropriate as part of overall examinee assessment, course objectives vary across schools, andthe congruence between subject examination content and course objectives should be considered when interpreting testscores and determining grading standards. Specifically, subject examination scores should not be used alone, but ratherin conjunction with other indicators of examinee performance in determination of grades.Subject Examination ScoresThe subject examination score is scaled to have a mean of 70 and a standard deviation of 8 for a group of 1,070 fourthyear first-time taker examinees from 40 LCME-accredited medical schools who took the Emergency Medicine AdvancedClinical Examination during 2013. As a result, the vast majority of scores range from 45 to 95, and although the scoreshave the “look and feel” of percent-correct scores, they are not. The subject examination scores are statistically equatedacross test administrations and are statistically adjusted for shifts in test difficulty. Consequently, these scores can beused to track school and examinee performance over time.This scale provides a useful tool for comparing the scores of your examinees with those of a large, nationallyrepresentative group taking the examination as an end-of-course or end-of-clerkship examination.Precision of ScoresMeasurement error is present on all tests, and the standard error of measurement (SEM) provides an index of the(im)precision of scores. The SEM indicates how far an examinee’s score on the examination might stray from his/her“true” proficiency level across repeated testing using different sets of items covering the same content. Using the SEM, itis possible to calculate a score interval that will encompass about two thirds of the observed scores for a given true scoreby adding and subtracting the SEM from that score. For this examination, the SEM is approximately 4 points. If anexaminee’s true proficiency on the examination is 60, the score he/she achieved on the examination will usually (twotimes out of three) fall between 56 and 64 (60 - 4 and 60 4).Score and Performance FeedbackSummary information on the examinee group tested, examination purpose and number of items scored is provided oneach page of the feedback. The Roster of Scaled Scores reports a total test scaled score for each examinee. Reportedscores also appear in a comma separated text file that can be downloaded. An Examinee Performance Profile, whichgraphically displays content areas of strength and weakness, is provided for each examinee.If there were at least 2 examinees, Scaled Score Descriptive Statistics for reported scores are provided along with aFrequency Distribution of the total test scaled score. If there were at least 10 examinees for a single form administration,a detailed Content Area Item Analysis Report summarizing the general content of each item on the exam along with groupitem performance is provided. Content area item descriptors and group item performance also appear in a file that can bedownloaded. If there were at least 10 examinees for a single form administration or 20 examinees for a multiple formadministration, a Summary Content Area Item Analysis Report is provided.If examinees were tested at your school in the previous academic year, a Year-End Report is provided. The reportsummarizes the performance of first-time takers and is posted annually in November to the NBME Services Portal (NSP).Grading GuidelinesGrading guidelines for this exam have been developed by a nationally representative group of clerkship directors to assistschools and institutions in setting fair and valid passing and honors standards for students taking this exam. Anabbreviated summary of the grading guidelines is provided and the full study with a list of participating schools is reportedon NSP.GRPID:EMERMED

NATIONAL BOARD OF MEDICAL EXAMINERS Subject Examination ProgramAdvanced Clinical Science ExaminationScore Interpretation GuideNormsNorms are provided to help aid in the interpretation of examinee performance. The norms reflect the performance of firsttime taker examinees who took a form of this examination. The most recent sets of norms that have been developed forthis examination are provided for your convenience. If sufficient data is available, norms will be updated after the end ofststthe reported academic year (June 1 - May 31 ) to reflect the most recent year of data. Norms can also be found on NSP.GRPID:EMERMED

NATIONAL BOARD OF MEDICAL EXAMINERSSubject Examination Program Advanced Clinical Science ExaminationGrading Guidelines(Reported as a Scaled Score)In 2015, the NBME conducted a webcast standard setting study for the Emergency Medicine Advanced Clinical Examination(ACE) with medical school faculty from across the United States. For the study, medical school faculty who were past orpresent clerkship directors (100%) in Emergency Medicine participated as expert judges in webcast sessions that utilized theinternet and conference calling to train participants in the standard setting procedure. Judges reviewed the content and ratedthe difficulty of each item on a current form of the examination. The study employed both a Modified Angoff content-basedprocedure and the Hofstee Compromise standard setting method. These two procedures together provide proposed passingstandards that are based on an in-depth item-by-item analysis of the examination content, as well as, a more global analysisof the content. The results were summarized for the examination components administered and the proposed standardswere expressed as the proportion of the content required for a candidate to pass and to receive honors status. Table 1provides a summary of the medical school faculty who served as expert judges and their school information for the webcaststudy conducted by the NBME.Table 1 – Demographics of Expert Judges and Schools Participating in the Webcast StudyStandardSetting StudyNumberof JudgesYears ofExperienceNumberofSchools2015271 – 2027Pre-clinicalSchool CurriculumUse lerkshipLength92%23%54%2 - 4 weeksThe data shown below represent a compilation of the opinions of the medical school faculty who participated in the webcaststudies. Although the study results were computed on a percent correct score scale, the results reported below have beenconverted to the subject exam score scale reported on the Roster of Scaled Scores, with a mean of 70 and a standarddeviation of 8 for the scaling group. This scale is used because it is an equated score; scores from one form of the test arecomparable to scores on other forms of the test. The study results are provided to assist you in setting fair and validstandards for this examination.Table 2 provides a summary of the results for passing scores from the Modified Angoff and Hofstee Compromise procedures.The recommended minimum passing score based on the Angoff results is a scaled score of 57. This score fell well within theacceptable range of minimum passing scores (53 to 62) computed from the Hofstee results, which suggest that any standardselected within this range would be reasonable. The recommended minimum passing score based on the Hofstee results is asubject exam score of 59.Table 2 – Grading Guidelines for Passing (Mean Scaled Scores)Standard SettingStudyNumberofJudgesModified AngoffHofstee CompromiseRecommendedPassing ScoreRange of AcceptableMinimum Passing ScoresRecommendedPassing Score2015275753 to 6259Table 3 provides a summary of the Hofstee results for honors. The study results indicate that the minimum acceptable scorefor honors should fall between a score of 74 and 91.Table 3 – Grading Guidelines for Honors (Mean Scaled Scores)2015Hofstee CompromiseNumber ofJudgesRange of Acceptable Minimum Honors Scores2774 to 91

NATIONAL BOARD OF MEDICAL EXAMINERS Subject Examination ProgramEmergency Medicine Advanced Clinical ExaminationYYY1-YYY2 Academic Year NormsThe table below provides norms to aid in the interpretation of examinee performance. These norms enable you tocompare your examinees’ scores with the performance of a nat ionally representative group of examinees taking theexamination at a s imilar stage of training. The norms reflect the performance of fourth-year students from LCMEaccredited medical schools who took this examination for the first time as an end-of-course examination during the 2013stst2014 academic year. The academic year is defined for this exam as test dates between June 1 and May 31 .The sample size (N), mean, standard deviation (SD), and standard error of measurement (SEM) of the norm group foreach examination score computed are listed below.ExaminationEmergency Medicine Advanced ClinicalNMeanSDSEM3,06668.28.44To use the norm table, locate an examinee’s score in the column labeled "Score" and note the entry in the adjacentcolumn labeled "Percentile Ranks". For example, if an examinee’s score is 70, the corresponding percentile rank entry of61 indicates that 61% of the national group of examinees taking the examination as a final clerkship examination hadscores at or below 70.Percentile RankScore(N 3,066)Score(N 3,066)93 6775835567954 andbelow474

NATIONAL BOARD OF MEDICAL EXAMINERS Subject Examination ProgramEmergency Medicine Advanced Clinical ExaminationYYY2-YYY3 Academic Year NormsPercentile RanksThird YearFourth YearStudentsStudentsThe table provides norms to aid in theinterpretation of examinee performance. Thesenorms enable you to compare your examinees’scores with the performance of a nationallyrepresentative group of examinees taking theexamination for the first time at a similar stage oftraining.These norms reflect the performance of studentsfrom LCME-accredited medical schools who tookthis examination for the first-time as an end-ofcourse or end-of-clerkship examination during theacademic year. The academic year is defined forstthis exam as test dates between June 1 and Mayst31 .To use the table, locate an examinee’s score inthe column labeled “Scaled Score” and note theentry in the adjacent column labeled “PercentileRanks” for the examinee group of interest. Thisnumber indicates the percentage of examineesthat scored at or below the examinee’s scaledscore.The mean and standard deviation of the scores foreach norm group reported are listed below.Scaled ScoresThird YearStudentsFourth YearStudentsN5803,770Mean65.170.9SD8.87.7Scaled Score93 or 069686766656463626160595857565554 and below(n 58279767268666257544946393634292220171412(n 56054484338342925211812108632211

from LCME-accredited medical schools who took this examination for the first-time as an end-of-course or end-of-clerkship examination during the academic year. The academic year is defined for this e

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