Development of the knowledge-based standard for the written certification examination of the American Board of Anesthesiology.

In 1988 and 1989, the American Board of Anesthesiology (ABA) developed a knowledge-based standard for its written certification examination. In brief, 13 "judges" developed a construct of a "borderline candidate," i.e., a candidate who was neither ideal nor clearly failing but rather had sufficient knowledge to just pass. In 1989, this construct was applied to 90 questions from the 1989 ABA examination to estimate candidate's score on that subset. When extended to the entire examination, the use of the construct resulted in a knowledge-based standard of 57% correct. (The 1988 exercise, also using the construct of a borderline candidate but with a totally different subset of questions, produced an identical standard). This standard resulted in higher success rates among the actual examinees taking the ABA examination (84% in 1989 and 90% in 1990) than had the normative standard used previously (80%). The authors suggest that the process they describe permits development of a reproducible criterion for success that is based entirely on mastery of a relevant body of knowledge rather than on normative considerations.

A demonstration of validity for certification by the American Board of Anesthesiology.

PURPOSE: To investigate the validity of the certification process of the American Board of Anesthesiology. Specifically, does board certification in anesthesiology identify physicians judged to be clinically superior by evaluators who are not part of the certification process? METHOD: All 154 U.S. anesthesiology program directors (or faculty members they chose to represent them), unaware of the study's intent, were asked whether they would permit each of their residents completing training in 1991 to administer three increasingly complex anesthetic regimens to the directors themselves. This clinical skills rating was compared with the residents' performances in the certification process in 1992. A list of personal characteristics was also provided to the directors so they could identify reasons for less-than-optimal clinical skills ratings. A total of 1,310 residents participated in the certification process in 1992. RESULTS: A total of 146 programs responded. The directors would have accepted anesthetic care for all three increasingly complex operations from 828 (63.2%) of their own residents; for only the two less complex procedures, from 262 (20%); and for only the least complex procedure, from 127 (9.7%). In addition, 93 residents (7.1%) would not have been accepted to administer anesthesia to their directors for any of these operations. Certification success rates for these groups were 74.6%, 53.8%, 44.9%, and 49%, respectively (p < .00001). The personal characteristics believed important to the practice of anesthesiology were strongly linked to the clinical skills ratings; these included motivation, adaptability, clinical judgment, manual dexterity, several work habits, response to criticism, and handling of stressful situations. CONCLUSION: These data support validity for certification in anesthesiology and identify characteristics considered necessary for high-quality practice of the specialty.

The American Board of Anesthesiology.

The American Board of Anesthesiology (ABA) has been in existence since 1937 for the purpose of advancing the practice of anaesthesiology in the United States. It is a credentialling organization which requires anaesthesiology residency training, medical licensure, and successful completion of written and oral examinations in order for an individual physician to be granted a diploma. Residency training requires four years and must culminate with a satisfactory certificate of clinical competence. The written and oral examinations follow residency training. The ABA also issues subspecialty certificates in critical care medicine and pain management. There is a voluntary mechanism for diplomates to demonstrate continuing qualifications. This is accomplished by peer review and a written examination.

The relationship between spatial and logical functioning in the child.

A standard multiple classification problem (simple intersection) was modified so that measurement ability, as well as the ability to attend to two dimensions at once, was required for its solution. This was administered to 20 boys and girls at each of three age levels in conjunction with a Piagetian landscape test of spatial functioning to determine the degree of relationship between logical and sublogical operations by defining their common cognitive components. A significant intertask relationship was expected, since both apparently require the same cognitive abilities. Performance on both tasks improved significantly with age, and the relationship between them was significant. The sequence and pattern of development of the individual cognitive skills required to solve the tasks were discussed.

Stress as a predictor of the quality of parent-infant interactions.

Three predictor variables--vulnerability to stress, expectations for parenting stress, and low power attributions--were assessed for 21 couples during pregnancy. In-home observations of parent-infant interactions occurred 4 months postnatally. Stepwise multiple regression analyses, calculated separately for mothers and fathers, revealed that prenatal stress factors were more successful in predicting father-infant interactions. On the interaction variable basic care, 67% of the variance was explained by fathers' parenting stress expectations, stress vulnerability, and attributions for low power, whereas only 2% of the variance on basic care was explained by maternal scores on the same variables. Results of this study indicated that parent-infant interactions are affected by parental attitudes and personality characteristics. The present research also underscored the continued need to study the differential effects of gender on parent-infant interactions.

Validity of scoring 'dangerous answers' on a written certification examination.

The American Board of Anesthesiology (ABA) investigated the possibility that selection of a disproportionately high number of incorrect "dangerous answers" by candidates who would otherwise pass the board's written certification examination might relate to dangerous clinical practice by the candidates. In that case, scoring the examination for dangerous answers would provide an alternate scoring method. Twenty-nine multiple-choice questions in the 1983 written examination were identified by a panel of judges as containing incorrect answers with "truly, not potentially" dangerous consequences. The 1,036 candidates who passed the 1983 examination selected an average of 1.6 dangerous answers, and the 1,413 who failed the examination selected an average of 3.4 (p less than .001). Ninety-two candidates who passed and who selected four or more dangerous answers were tracked through the certification process to learn whether labeling them as "smart but dangerous" was justified. Reports of their clinical competence from their residency programs did not relate dangerous behavior for any of these candidates. The 86 of these 92 candidates who subsequently took the ABA oral examination had pass rates that were identical to those of all candidates in 1983 and that were completely independent of the candidates' absolute and relative frequency of choosing dangerous answers. It is concluded that selection of dangerous answers in a multiple-choice test is the result of lack of information rather than a purposeful action and implementation of the scoring system for dangerous answers would likely be unjustified and unfairly punitive.