The test developer's dilemma: Evaluating the balance of feasibility and empiric performance of test development techniques for repeated written assessments.

PURPOSE: Written assessments face challenges when administered repeatedly, including resource-intensive item development and the potential for performance improvement secondary to item recall as opposed to understanding. This study examines the efficacy of three-item development techniques in addressing these challenges. METHODS: Learners at five training programs completed two 60-item repeated assessments. Items from the first test were randomized to one of three treatments for the second assessment: (1) Verbatim repetition, (2) Isomorphic changes, or (3) Total revisions. Primary outcomes were the stability of item psychometrics across test versions and evidence of item recall influencing performance as measured by the rate of items answered correctly and then incorrectly (correct-to-incorrect rate), which suggests guessing. RESULTS: Forty-six learners completed both tests. Item psychometrics were comparable across test versions. Correct-to-incorrect rates differed significantly between groups with the highest guessing rate (lowest recall effect) in the Total Revision group (0.15) and the lowest guessing rate (highest recall effect) in the Verbatim group (0.05), p = 0.01. CONCLUSIONS: Isomorphic and total revisions demonstrated superior performance in mitigating the effect of recall on repeated assessments. Given the high costs of total item revisions, there is promise in exploring isomorphic items as an efficient and effective approach to repeated written assessments.[Box: see text].

Does the Addition of M-Mode to B-Mode Ultrasound Increase the Accuracy of Identification of Lung Sliding in Traumatic Pneumothoraces?

OBJECTIVES: It is unknown whether the addition of M-mode to B-mode ultrasound (US) has any effect on the overall accuracy of interpretation of lung sliding in the evaluation of a pneumothorax by emergency physicians. This study aimed to determine what effect, if any, this addition has on US interpretation by emergency physicians of varying training levels. METHODS: One hundred forty emergency physicians were randomized via online software to receive a quiz with B-mode clips alone or B-mode with corresponding M-mode images and asked to identify the presence or absence of lung sliding. RESULTS: The sensitivity, specificity, and accuracy of the diagnosis of lung sliding with and without M-mode US were compared. Overall, the sensitivities, specificities, and accuracies of B-mode + M-mode US versus B-mode US alone were 93.1% and 93.2% (P = .8), 96.0% and 89.8% (P < .0001), and 91.5% and 94.5% (P = .0091), respectively. A subgroup analysis showed that in those providers with fewer than 250 total US scans done previously, M-mode US increased accuracy from 88.2% (95% confidence interval, 86.2%-90.2%) to 94.4% (92.8%-96.0%; P = .001) and increased the specificity from 87.0% (84.5%-89.5%) to 97.2% (95.4%-99.0%; P < .0001) compared with B-mode US alone. There was no statistically significant difference observed in the sensitivity, specificity, and accuracy of B-mode + M-mode US compared with B-mode US alone in those with more than 250 scans. CONCLUSIONS: The addition of M-mode images to B-mode clips aids in the accurate diagnosis of lung sliding by emergency physicians. The subgroup analysis showed that the benefit of M-mode US disappears after emergency physicians have performed more than 250 US examinations.

Ureteral Obstruction and Ureteral Jet Identification-A Case Report.

Point-of-care ultrasound is often used as first line imaging for the evaluation of flank pain in the emergency department and can potentially expedite diagnosis or decrease the use of abdominal CT scans, preventing unnecessary radiation exposure. This is a case report of a 77-year-old female who presented with acute flank pain. Point-of-care ultrasound revealed the absence of a ureteral jet on the right side, supporting the diagnosis of ureteral obstruction, which was confirmed on computed tomography. This case report aims to demonstrate the value of identification of ureteral jets when using point-of-care ultrasound to diagnose ureteral obstruction. Knowledge of more subtle and specific ultrasound findings such as this can help expedite more precise diagnoses. Topics: Ureteral obstruction, ureteral jets, hydronephrosis, renal colic, renal calculi, point-of-care ultrasound, flank pain.