All ABP examinations adhere to a content outline. The outline, which is developed by a committee of pediatricians and educators, defines the categories and the percentage of questions assigned to each category contained on every certification exam. Each content outline is developed and periodically reviewed by content experts based on analyses of practice (as determined by the content experts) and modified to reflect the breadth and relative importance of the clinical situations that pediatricians encounter.
Question Review and Editing Process
All examination questions are written and reviewed by committees of board-certified academicians and practitioners. This is to ensure that item content is accurate and reflective of current practice. Prior to writing questions, all new committee members are trained on question writing best practices, which include avoiding unnecessarily long question stems, unclear question queries, and the use of sensitive content that may lead to bias in questions. Newly written questions are assigned to a test committee for review. A subgroup of the committee first reviews and revises each question virtually. Next, the questions are reviewed, revised, and approved by the entire committee at an in-person meeting. During this review, questions considered problematic are deleted. Only questions that are approved by the entire committee as being accurate and important to test are moved to the next step of the approval process. After committee approval, each question is given final approval by a medical editor to ensure accuracy, and by staff editors who standardize question style, format, and terminology; correct grammar; and eliminate ambiguity and technical flaws.
Once the process is complete, approved questions are made available for selection in future exams. All approved questions are reviewed periodically for accuracy, currency, and relevance. This review also includes any questions that have been previously used on an exam.
Exam questions are written in a single-best-answer multiple-choice format. This is the most widely used format in the testing industry as it allows for greatest coverage of content within a specified amount of time. Most exam questions are preceded by a clinical stem that provides information about a patient (including laboratory and diagnostic findings). Each question is followed by four or five answer options, one of which is the correct answer. Part of the question review process is to ensure that the designated answer is clearly correct, uncontroversial, evidence-based, and a better choice than any of the other options. The other options ("distractors") are designed to reflect plausible responses likely to be selected by less knowledgeable candidates. Questions may require the interpretation of a graphical illustration, such as x-ray studies, growth charts, and photographs, to answer correctly.
The exam selection process incorporates new questions as well as questions that have performed well on prior exams. Test development staff select the questions for each exam using several criteria and quality metrics including test content outline weightings, difficulty of previously used questions, and ability of previously used questions to discriminate between lower- and higher-ability examinees. After initial selection, a test committee reviews the exam, including all questions and associated question graphics, to ensure all previously approved questions and graphics are still current and accurate. Additionally, the test committee ensures during this review that enemy content (questions which clue each other or duplicate content) and overrepresentation of rare conditions are removed from the exam.
After exam administration, statistical analyses are conducted, and questions may be flagged for their statistical performance. Each flagged question is then reviewed by the medical editor, who determines if the question is accurate and has a single correct answer. During this process, a question may be found to have two correct answers, in which case both would be counted as correct when calculating a candidates' final score. Any question which is found to be inaccurate is removed from scoring and not included when calculating candidates' final scores. Questions that are inaccurate or have multiple correct answers are returned to the exam committee for revisions or deletion after final scoring decisions are determined.
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