‘Disease Class-Specific, Typicality-Graded’ Test Case Vignettes: Towards ‘Construct-Referenced’ Assessments of Diagnostic Performance

Abstract

The more precise our assessment measures and instructional feedback, the more likely both students and training institutions can take those steps necessary to developing and refining the knowledge base constructs underlying diagnostic competency. This paper provides a theoretical description of how literature elucidating the factors underlying diagnostic performance could be used to produce more valid assessments of diagnostic competency. More specifically, literature suggesting that diagnostic performance is disease class-specific, coupled with evidence of a positive relationship between a case’s typicality and diagnostic accuracy represent a potentially important breakthrough for medical educators. Use of disease class-specific, typicality-graded test items may make it possible to more directly link assessment measures with the constructs or latent traits responsible for observed performance. Such items make possible the development of construct-referenced as opposed to norm-referenced assessments of diagnostic performance. Construct-referenced assessments of diagnostic performance could prove to be more appropriate, meaningful and useful testing procedures for students, faculty and society.