Detecting cross-cultural differential item functioning for increasing validity: An example from the American board of family medicine in-training examination

Abstract

Background: The present study describes the process used to detect items for cross-cultural differential item functioning (cc-DIF) and attempts to understand cc-DIF by both statistical analysis and content review using a cultural lens. Methods: Data from the 2014 American Board of Family Medicine (ABFM) In-Training Examination (ITE). Results: cc-DIF existed in ten items on the 2014 ABFM ITE and could not be eliminated over the residency program years. International medical school graduates were benefited by seven items, whereas the United States medical school graduates (USMGs) were benefited by three items. Discussion: Cultural specificities and differential content familiarity likely are the primary reasons for items exhibiting cc-DIF. Conclusions: Investigating cc-DIF is recommended for any examination involving multicultural groups. Further, items exhibiting cc-DIF offer opportunities for students to reflect on their implicit cultural differences that may ultimately affect how they practice medicine in a multicultural society.