Medical specialist examinations: item format types and minimising error

Examinations such as those within anaesthesia and intensive care are used to identify candidates who are able to progress through their training programs or on to specialist practice. Examinations that are valid, reliable, fair, practical and generalisable are useful tools for determining the underlying anaesthesia and intensive care related abilities of candidates. However, medical specialty examinations are only indirect indicators of candidate competency or mastery. It is possible for error to enter examination decision making and to adversely affect examination processes and results. This article presents an effective method for viewing examination content, procedures and processes for the purposes of minimising error. The article also describes the six question (or item) formats currently utilised within the examinations used by the Australian and New Zealand College of Anaesthetists and/or the Joint Faculty of Intensive Care Medicine. The article includes summaries of the advantages and disadvantages of each of these formats.