Prinsip-prinsip Dasar “Item Review” Kiki Lukman Fakultas Kedokteran Universitas Padjadjaran Bandung
Objektif
Menjelaskan prinsip-prinsip dasar penyusunan dan proses review MCQ
Menjelaskan Item Review pada Uji Kompetensi Dokter Indonesia
Melaksanakan workshop item review MCQ
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Strategi ujian dan evaluasi The student ( doctor) begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as a means to an end”. Assessments are patient-based
Sir William Osler – “the natural method of learning”
Kesalahan pada soal pilihan ganda (MCQ)
Hanya menguji kemampuan mengingat – sering hanya hal yang trivia Tidak menguji aplikasi atau integrasi pengetahuan Tidak menguji kemampuan daya nalar dan pemecahan masalah Tidak konsisten dengan prinsip-prinsip pendidikan masa kini Lebih meningkatkan kemampuan memorisasi dari pada pemahaman
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Hindari kesalahan dalam menyusun “MCQ”
Hindari pertanyaan “recall” simpel : jawaban yang dapat diperoleh dari suatu halaman buku ajar. Hindari pertanyaan yang mendorong memorisasi sederhana Selalu menguji kemampuan aplikasi , integrasi, atau pemahaman Gunakan skenario yang relevan sebagai stem
Prinsip-prinsip dasar
Nilai aplikasi dan integrasi pengetahuan Gunakan skenario klinik untuk menyajikan masalah Uji kemampuan daya nalar dan pemecahan masalah Fokuskan pada materi yang penting – hindari “trivia” Sediakan satu jawaban “paling benar “ Buatlah distraktor homogen Hindari memorisasi fakta sederhana
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Vignette: Klinik, Masalah kedokteran keluarga (1)
Sebuah vignette antara lain berisi deskripsi kondisi pasien, dan skenario klinik dengan beberapa informasi, yaitu: Umur, Jenis kelamin (e.g. laki-laki 45 tahun) Tempat pelayanan (IGD)
NBME, p.38 or p.56
Vignette: Klinik, Masalah kedokteran keluarga (2) Keluhan utama Durasi
Riwayat Pasien Diagnostik fisik
• +/- hasil diagnostik • +/- terapi awal, temuan selanjutnya
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Panduan umum konstruksi MCQ (1) 1. Yakinkan bahwa setiap soal dapat dijawab tanpa harus melihat pilihan jawaban atau yakinkan bahwa pilihan jawaban adalah 100 % benar atau salah. 2. Usahakan agar data atau informasi penting seoptimal mungkin dicantumkan pada soal ( stem), sedangkan pilihan jawaban usahakan sesingkat mungkin.
Panduan umum konstruksi MCQ (2)
Hindari informasi berlebihan pada soal. Hindari soal-soal yang bersifat menjebak dan terlalu kompleks serta tidak relevan. Gunakan pilihan jawaban yang secara gramatikal konsisten dan secara logis kompatibel dengan soal.
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Panduan umum konstruksi MCQ (3)
Hindari kata-kata absolut seperti, selalu, tidak pernah, dan semua pada pilihan jawaban, dan hindari pula istilah yang tidak jelas (meragukan) seperti biasanya atau sering. Hindari kalimat atau frase negatif seperti KECUALI, TIDAK, atau BUKAN. Fokuskan soal pada konsep-konsep penting, dan hindari hanya menguji kemampuan mengingat fakta.
Panduan umum konstruksi MCQ (4)
Fokuskan soal-soal pada konsep penting dan kasuskasus yang sering serta memiliki potensi masalah serius. Setiap soal diusahakan agar menilai aplikasi pengetahuan, tidak hanya menguji daya ingat terhadap fakta terisolasi. Seluruh distraktor (pengecoh= jawaban salah) dibuat homogen (dari sisi gramatikal, taksonomi).
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Panduan umum konstruksi MCQ (5)
Hindari kesalahan teknis membuat soal, seperti : Pilihan jawaban terlau panjang, kompleks, atau ganda. Istilah yang rancu pada pilihan jawaban. Bahasa pada jawaban tidak parallel. Pilihan jawaban tidak menurut urutan logik. Bukan salah satu di atas atau semua benar digunakan sebagai pilihan jawaban
Panduan umum konstruksi MCQ (6) Pilihan pada jawaban memberikan petunjuk logik pada jawaban yang benar. Pilihan jawaban yang benar adalah frase atau kalimat terpanjang. Penggunaan kata-kata yang diulang atau memiliki makna sama baik pada soal maupuin pilihan jawaban. Strategi konvergens pada pilihan jawaban.
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Apa saja yang perlu ditelaah ?
Materi : Blue print Relevansi: Kongruensi Bahasa Tingkat kesulitan (tingkat kompetensi) Klasifikasi : e.g. Dasar atau klinik?
Apa saja yang perlu ditelaah ?
Struktur : Stem Lead in Option
Kesimpulan Komentar umum dan saran Diterima/ revisi/ dikembalikan
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Struktur Soal : Item Flaws
Grammatical Cues Logical Cues Istilah yang absolut Jawaban benar yang panjang Pengulangan kata dari badan soal ke jawaban Konvergensi soal Pilihan jawaban yang panjang, kompleks, atau duplikasi
( ) Ya ( ) Ya ( ) Ya ( ) Ya
( ) Tidak ( ) Tidak ( ) Tidak ( ) Tidak
( ) Ya ( ) Ya
( ) Tidak ( ) Tidak
( ) Ya
( ) Tidak
Struktur Soal : Item Flaws
Pilihan yang berupa angka tidak diurut sesuai dengan besarnya Pilihan yang mengandung unsur frekuensi suatu kejadian bersifat multi interpretasi Pilihan jawaban tidak paralel dan urutan tidak logis Penggunaan BSSD (bukan salah satu di atas pada pilihan jawaban) Badan soal terlalu panjang, sulit, dan kompleks
( ) Ya
( ) Tidak
( ) Ya
( ) Tidak
( ) Ya
( ) Tidak
( ) Ya
( ) Tidak
( ) Ya
( ) Tidak
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Komentar Umum Reviewer
ID Soal : Kesimpulan Hasil Review ( ) Diterima tanpa perbaikan ( ) Diterima dengan perbaikan ( ) Perlu konfirmasi pembuat soal ( ) Tidak perlu konfirmasi dengan pembuat soal ( ) Dikembalikan kepada pembuat soal ( ) memerlukan perbaikan keseluruhan ( ) Berpotensi diterima dengan perbaikan
Saran Perbaikan
Tanggal: (DD) / (MM) / (YY)
Tanda Tangan Reviewer Nama Jelas :
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A 60-year-old man is brought to the emergency department by the police, who found him lying unconscious on the sidewalk. After ascertaining that the airway is open, the first step in management should be intravenous administration of A. B. C. D. E.
Examination of cerebrospinal fluid Glucose with vitamin B1 (thiamine) CT scan of the head Phenytoin diazepam
Grammatical cues: one or more distracters don’t follow grammatically from the stem A 60-year-old man is brought to the emergency department by the police, who found him lying unconscious on the sidewalk. After ascertaining that the airway is open, the first step in management should be intravenous administration of A. B. C. D. E.
Examination of cerebrospinal fluid Glucose with vitamin B1 (thiamine) CT scan of the head Phenytoin diazepam
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In patients with advanced dementia, Alzheimer’s type, the memory defect A. can be treated adequately with phosphatidylcholine (lecithin) B. could be a sequela of early parkinsonism C. is never seen in patients with neurofibrillary tangles at autopsy D. is never severe E. possibly involves the cholinergic system
Absolute terms: terms such as “always” or “never” are used in options In patients with advanced dementia, Alzheimer’s type, the memory defect A. can be treated adequately with phosphatidylcholine (lecithin) B. could be a sequela of early parkinsonism C. is never seen in patients with neurofibrillary tangles at autopsy D. is never severe E. possibly involves the cholinergic system
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Secondary gain is A. synonymous with malingering B. a frequent problem in obsessive-compulsive disorder C. a complication of a variety of illnesses and tends to prolong many of them D. never seen in organic brain damage
Long correct answer: correct answer is longer, more specific, or more complete than other options Secondary gain is A. synonymous with malingering B. a frequent problem in obsessive-compulsive disorder C. a complication of a variety of illnesses and tends to prolong many of them D. never seen in organic brain damage
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A 58-year-old man with a history of heavy alcohol use and previous psychiatric hospitalization is confused and agitated. He speaks of experiencing the world as unreal. This symptom is called A. depersonalization B. derailment C. derealization D. focal memory deficit E. signal anxiety
Word repeats : a word or phrase is included in the stem and in the correct answer A 58-year-old man with a history of heavy alcohol use and previous psychiatric hospitalization is confused and agitated. He speaks of experiencing the world as unreal. This symptom is called A. depersonalization B. derailment C. derealization D. focal memory deficit E. signal anxiety
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Local anesthetics are most effective in the A. Anionic form, acting from inside the nerve membrane B. Cationic form, acting from inside the nerve membrane C. Cationic form, acting from outside the nerve membrane D. Uncharged form, acting from inside the nerve membrane E. Uncharged form, acting from outside the nerve membrane
Convergence strategy : the correct answer includes the most elements in common with the other options Local anesthetics are most effective in the A. Anionic form, acting from inside the nerve membrane B. Cationic form, acting from inside the nerve membrane C. Cationic form, acting from outside the nerve membrane D. Uncharged form, acting from inside the nerve membrane E. Uncharged form, acting from outside the nerve membrane
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Peer review committees in HMOs may move to take action against a physician’s credentials to care for participants of the HMO. There is an associated requirement to assure that the physician receives due process in the course of these activities. Due process must include which of the following A. Notice, an impartial forum, council, a chance to hear and confront evidence against him/her B. Proper notice, a tribunal empowered to make decision, a chance to confront witnesses against him/her, and a chance to present evidence in defense C. Reasonable and timely notice, impartial panel empowered to make a decision, a chance to hear evidence against himself/herself and to confront witnesses, and the ability to present evidence in defense
Options are long, complicated, or double Peer review committees in HMOs may move to take action against a physician’s credentials to care for participants of the HMO. There is an associated requirement to assure that the physician receives due process in the course of these activities. Due process must include which of the following A. Notice, an impartial forum, council, a chance to hear and confront evidence against him/her B. Proper notice, a tribunal empowered to make decision, a chance to confront witnesses against him/her, and a chance to present evidence in defense C. Reasonable and timely notice, impartial panel empowered to make a decision, a chance to hear evidence against himself/herself and to confront witnesses, and the ability to present evidence in defense
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Severe obesity in early adolescence A. Usually responds dramatically to dietary regimens B. Often is related to endocrine disorders C. Has a 75% chance of clearing spontaneously D. Shows a poor prognosis E. Usually responds to pharmacotherapy and intensive psychotherapy
Frequency terms in the options are vague (e.g. rarely, usually) Severe obesity in early adolescence A. Usually responds dramatically to dietary regimens B. Often is related to endocrine disorders C. Has a 75% chance of clearing spontaneously D. Shows a poor prognosis E. Usually responds to pharmacotherapy and intensive psychotherapy
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In a vaccine trial, 200 2-year-old boys were given a vaccine against a certain disease and the monitored for five years for occurrence of the disease. Of this group, 85% never contacted the disease. Which of the following statements concerning these results is correct?
A. No conclusion can be drawn, since no follow-up was made of nonvaccinated children B. The number of cases (ie, 30 cases over five years) is too small for statistically meaningful conclusions C. No conclusions can be drawn because the trial involved only boys D. Vaccine efficacy (%) is calculated as 85 – 15/100
Language in the options is not parallel; options are in non-logical order In a vaccine trial, 200 2-year-old boys were given a vaccine against a certain disease and the monitored for five years for occurrence of the disease. Of this group, 85% never contacted the disease. Which of the following statements concerning these results is correct? A. No conclusion can be drawn, since no follow-up was made of nonvaccinated children B. The number of cases (ie, 30 cases over five years) is too small for statistically meaningful conclusions C. No conclusions can be drawn because the trial involved only boys
D. Vaccine efficacy (%) is calculated as 85 – 15/100
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The diagnosis of a large ovarian cyst is most strongly suggested by A. an anterior dullness, lateral tympany B. a decreased peristalsis C. a fluid wave D. a shifting dullness E. none of the above
None of the above is used as an option The diagnosis of a large ovarian cyst is most strongly suggested by A. an anterior dullness, lateral tympany B. a decreased peristalsis C. a fluid wave D. a shifting dullness E. none of the above
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Arrange the parents of the following children with Down’s syndrome in order of highest to lowest risk of occurrence. Assume that the maternal age in all cases is 22 years and that a subsequent pregnancy occurs within 5 years. The karyotypes of the daughters are : I. II. III. IV. V.
46, XX, -14, +T (14q21q) pat 46, XX, -14, +T (14q21q) de novo 46, XX, -14, +T (14q21q) mat 46, XX, -21, +T (14q21q) pat 47, XX, -21, +T (21q21q) (parents not karyotyped) A. B. C. D. E.
III, IV, I, V, II IV, III, V, I, II III, I, IV, V, II IV, III, I, V, II III, IV, I, II, V
Stems are tricky or unnecessarily complicated Arrange the parents of the following children with Down’s syndrome in order of highest to lowest risk of occurrence. Assume that the maternal age in all cases is 22 years and that a subsequent pregnancy occurs within 5 years. The karyotypes of the daughters are : I. II. III. IV. V.
46, XX, -14, +T (14q21q) pat 46, XX, -14, +T (14q21q) de novo 46, XX, -14, +T (14q21q) mat 46, XX, -21, +T (14q21q) pat 47, XX, -21, +T (21q21q) (parents not karyotyped) A. B. C. D. E.
III, IV, I, V, II IV, III, V, I, II III, I, IV, V, II IV, III, I, V, II III, IV, I, II, V
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Kesimpulan
“Item review” pada soal-soal pilihan berganda tipe A meliputi evaluasi terhadap materi dan struktur soal.
Soal-soal yang diterima di dalam proses “Item review” akan menjadi bagian dari “ Item Bank” UKDI
Reference:
Case and Swanson – Constructing Written Test Questions www.nbme.org
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