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MDCB Examination: A History Robert D. Adams Assistant Professor UNC School of Medicine Department of Radiation Oncology Recognition Damien Pusey Lisette Smith Dr. Elaine Zeman MDCB Board of Directors: Past and Present Why Give a Certification Board Exam?

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MDCB Examination: A History

Robert D. Adams

Assistant Professor

UNC School of Medicine

Department of Radiation Oncology


Recognition

  • Damien Pusey

  • Lisette Smith

  • Dr. Elaine Zeman

  • MDCB Board of Directors: Past and Present


Why Give a Certification Board Exam?

  • Has grown exponentially last 100 years (Flexnor Report)

  • Is a very important issue: judge knowledge and abilities

  • Advances the standards and determines competence in health care delivery

  • Encompasses both level of education and work qualifications of a medical professional


Why Give a Certification Board Exam?

  • Helps shape the scope and practice of medical professionals and the care they provide

  • Influences the way health insurance sets standards for reimbursement practices


What is Certification?

  • “Program and process where a learner completes prescribed training and passes and assessment with a minimal score.”

  • Increases the validity of the profession


What is training?

  • Developing skills that will be used more by society than for the self (education)

  • Very important concept in higher education

  • Must be increased as we progress from an industrial society to a technological society


Training Vs. Education

  • Training deals with learning specific skills

  • Education focuses more on the development of the mind and broad-based thinking


Importance of Board Certified Medical Dosimetrists

  • Play an integral role in the treatment of cancer

  • Require high accuracy and precision to fulfill the job responsibilities

  • Important for credibility of profession


The Importance of Board Certification for Medical Dosimetrists

  • The role of a medical dosimetrist is important and, although a part of a team, is autonomous for billing purposes

  • Due to a high job responsibility, it is in our best interest that medical dosimetrists are board certified


Importance of Board Certification with Training

  • Utilizes specific skill sets

  • Impacts public health

  • Impacts the quality of health care delivery


Importance of Board Certification

  • Enhances the utility of society

  • Allows us to define ourselves, our skill levels, and our profession through a board certification examination


Why is the Dosimetry Exam Autonomous?

  • Why not under the AAPM?

  • Why not under ASTRO?

  • Why not under the ARRT?


Vision

  • Members of the AAMD had a different vision 25 years ago

  • Not to have the exam as being under someone else

  • The vision was to have an autonomous exam run by peers


Vision

  • In order to achieve the vision, there had to be great leadership

  • Members stepped up to create an autonomous exam, run by peers, with the help of professional company

  • The driving force to do this came from your professional society, the AAMD


MDCB

  • Incorporated in 1988

  • Mandated to create and implement standards of certification in medical dosimetry


Goals of MDCB

Goal 1: Elevate the standards and advance the cause of medical dosimetry by encouraging its study and improving its practice


Goal 2: Determine the competence of medical dosimetrists and to conduct examinations to test the qualifications of voluntary candidates


Goal 3: To grant and issue certifications in the field of medical dosimetry to eligible voluntary applicants and maintain a registry of holders of such certificates


Goal 4: To serve medical dosimetrists and the associated health care community by maintaining a Registry of Certified Medical Dosimetry


The Exam

  • First given in 1988

  • Have given 21 exams

  • Given annually

  • Given in June because it coincides with the AAMD meeting

  • Written format


2008 Exam Statistics

  • Physics3118.84.57

  • Dose Calculation3924.45.46

  • Treatment Planning4727.34.94

  • Localization128.11.85

  • Brachytherapy 83.91.31

  • Radiation Protection31.90.77

  • Quality Assurance53.11.01

  • Prof. Responsibility32.60.40

  • Computers / Network73.21.15

    Totals 155 93.3


Exam Lingo

  • R-Biserial scores (internal)

  • Subkoviak scores (twice)

  • Kuder Richardson Formula 20 scores (candidate differentiation)

  • Measuring the reliability and validity of the examb


The MDCB Board of Directors

  • Comprised of 12 members:

    • 6 CMDs

    • 2 Medical Physicists

    • 2 Radiation Oncologists

    • 1 Testing Person

    • 1 Community at Large Person


The MDCB Board

  • Each person volunteers to serve on the Board

  • Depending on the Board position and type of work, Board Members volunteer anywhere between 100 to 400 individual hours per year to better serve its members


The MDCB Board

The MDCB Board employs TWO separate companies:

1) Association Headquarters

  • Management Company

  • Does renewals, handles your questions, gives out the certifications, tracks continuing education


The MDCB Board

2) Prometric

  • Testing Company

  • Also gives the MCAT, LSAT, and is a part of ETS

  • The MDCB works with this company to give a professional examination

  • As testing chair, this is who I primarily work with throughout the year


The Exam: Facts

  • 155 Questions (potential for increase)

  • All questions are written or peer-reviewed by the MDCB Board of Directors

  • Item bank of over 1,000 questions

  • Each Board Member required to write 20 questions each year

  • MDCB looking for question writers


The Exam: Review

  • The MDCB Board of Directors meets 3 times per year:

    1) January: review new questions

    2) March: review upcoming examination

    3) August: review June exam results and prospectively begin for the next year’s exam


The Exam: Content

  • Content areas

  • 9 areas

  • The most recent area of inclusion is computer questions (2005)

  • Content areas are based upon surveys sent to working medical dosimetrists and their job tasks


The Exam: Content (cont.)

  • Based only on the medical dosimetry work surveys and the percentages of work

  • Updated every 5 years

  • Currently being completed is a job task analysis (work survey) will be implemented for the 2010 exam


The Exam: Qualifications

  • To take the MDCB Certification Exam you must:

    • Graduate from an accredited education program AND have 6 months clinical experience (up for discussion)

    • Have 24 months OJT and 12 continuing education hours coupled with a baccalaureate degree in the physical sciences or a radiation therapy certification (entry level examination) (possibly lengthen)

    • Route 3: possibly delete this route


The Exam: Pass Rates

  • Most controversial component of the Exam

  • Current pass rates are around 57% (past 5 years)

  • Pass rates are higher for examinees who attend JRCERT accredited educational programs versus on the job training


The Exam: Difficulty

  • The Exam is difficult

  • It fits in the ‘middle’ of certification exams nationwide. For example:

    • The CPA exam has a 27% pass rate

    • The ARRT Radiation Therapy Exam has a 90% pass rate


Why is the exam so difficult?

  • Not an entry level examination; it is written and there is no oral component to the exam

  • Assumes a high level of clinical competence coupled with high didactic abilities

  • For example, the ARRT Radiation Therapy Examination is an entry level examination, thus the higher percentage pass rate


Why is the exam so difficult? (cont.)

  • The MDCB Board makes no excuses about the complexity of this examination

  • The examination is not designed to be an entry level examination

  • The examination is designed for skilled, trained, and educated (theory) medical dosimetrists

  • The bar is set high and it will remain high


The Exam: Goals for the Future

  • A major goal of the MDCB Board of Directors is to take the exam from a Written format (pencil and paper) to a Computer Based Testing format

  • This goal is close to being achieved


The Exam: Goals (cont.)

  • Pilot testing will begin this year with the MDCB Board Members taking the computer based exam

  • Pilot testing will continue through 2010

  • The goal is for the first comprehensive computer based exam to be given in 2011 during the June administration


The Exam: Goals (cont.)

  • Achieving this goal has required lots of volunteer individual work from both present and past board members


Computer Based Testing


Testing Models

I. Linear CBT

  • Predetermined, linear order

  • Sequentially administered

  • Like our current paper exam given on a computer

  • Weakness: security concerns in that everyone has the same questions


Testing Models

II. Linear on the Fly Testing (LOFT)

  • Build models based on content and psychometric targets

  • The items are scrambled

  • For example, Candidates A and B will not have the same questions


Testing Models

III. Computer Adaptive Testing (CAT)

  • Adaptive to the candidates performance on the exam

  • Post-tested items are placed on the exam

  • Exam can be reduced by 50%

  • Increases security dramatically


Scoring Models

I. Classical Test Theory (CTT)

  • This is what we currently use

  • Single performance score +% error

  • P values for item difficulty

  • Score correlations: R biserial

  • Simple to do and understand


Scoring Models

II. Item Response Theory Model (IRT)

  • One Parameter and Three Parameter models

    • One Parameter is based on the items and a total score

    • Three parameter is based on item responses and not the total score: two candidates with the same score; one might pass and one might not if one candidate only answers simple versus medium or hard questions


CBT

  • Goals:

    • Examinees will be able to test at over 100 sites

      2) The time from taking the exam to receiving a score within 5 years will be automatic (versus 10 to 8 to 7 to 6 weeks)

      3) You may not have to take the entire exam; it will cut off when you have passed


CBT

4) Exam will become more secure

  • No paper

  • Eventually fewer questions

  • Different questions given to various test takers

    5) Exam given multiple times throughout the year

    The CBT is going to literally take the exam to a different level of testing and scoring


Where we have been, where we are, where we are going; then?

  • Biggest Threat to Your Exam?

  • Exam Security


Security

  • External countries question writers

  • Therapy Exam story

  • Prometric and the FBI

  • Review courses: questions

  • Your responsibility

  • Your credential


Computer Based Testing


Final Thoughts

  • Storied history

  • Exam continues to be reliable and valid

  • Exam is moving in a forward direction

  • Security is the biggest deterrent to keeping the exam


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