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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

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  • Damien Pusey

  • Lisette Smith

  • Dr. Elaine Zeman

  • MDCB Board of Directors: Past and Present

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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

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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

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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

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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

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Training Vs. Education

  • Training deals with learning specific skills

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

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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

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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

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Importance of Board Certification with Training Dosimetrists

  • Utilizes specific skill sets

  • Impacts public health

  • Impacts the quality of health care delivery

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Importance of Board Certification Dosimetrists

  • Enhances the utility of society

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

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Why is the Dosimetry Exam Autonomous? Dosimetrists

  • Why not under the AAPM?

  • Why not under ASTRO?

  • Why not under the ARRT?

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Vision Dosimetrists

  • 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

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Vision Dosimetrists

  • 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

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MDCB Dosimetrists

  • Incorporated in 1988

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

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Goals of MDCB Dosimetrists

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

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

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

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

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The Exam Dosimetrists

  • First given in 1988

  • Have given 21 exams

  • Given annually

  • Given in June because it coincides with the AAMD meeting

  • Written format

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2008 Exam Statistics Dosimetrists

  • Physics 31 18.8 4.57

  • Dose Calculation 39 24.4 5.46

  • Treatment Planning 47 27.3 4.94

  • Localization 12 8.1 1.85

  • Brachytherapy 8 3.9 1.31

  • Radiation Protection 3 1.9 0.77

  • Quality Assurance 5 3.1 1.01

  • Prof. Responsibility 3 2.6 0.40

  • Computers / Network 7 3.2 1.15

    Totals 155 93.3

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Exam Lingo Dosimetrists

  • R-Biserial scores (internal)

  • Subkoviak scores (twice)

  • Kuder Richardson Formula 20 scores (candidate differentiation)

  • Measuring the reliability and validity of the examb

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The MDCB Board of Directors Dosimetrists

  • Comprised of 12 members:

    • 6 CMDs

    • 2 Medical Physicists

    • 2 Radiation Oncologists

    • 1 Testing Person

    • 1 Community at Large Person

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The MDCB Board Dosimetrists

  • 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

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The MDCB Board Dosimetrists

The MDCB Board employs TWO separate companies:

1) Association Headquarters

  • Management Company

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

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The MDCB Board Dosimetrists

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

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The Exam: Facts Dosimetrists

  • 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

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The Exam: Review Dosimetrists

  • 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

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The Exam: Content Dosimetrists

  • 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

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The Exam: Content (cont.) Dosimetrists

  • 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

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The Exam: Qualifications Dosimetrists

  • 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

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The Exam: Pass Rates Dosimetrists

  • 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

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The Exam: Difficulty Dosimetrists

  • 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

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Why is the exam so difficult? Dosimetrists

  • 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

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Why is the exam so difficult? (cont.) Dosimetrists

  • 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

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The Exam: Goals for the Future Dosimetrists

  • 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

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The Exam: Goals (cont.) Dosimetrists

  • 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

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The Exam: Goals (cont.) Dosimetrists

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

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Testing Models Dosimetrists

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

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Testing Models Dosimetrists

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

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Testing Models Dosimetrists

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

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Scoring Models Dosimetrists

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

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Scoring Models Dosimetrists

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

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CBT Dosimetrists

  • 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

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CBT Dosimetrists

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

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

  • Biggest Threat to Your Exam?

  • Exam Security

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Security Dosimetrists

  • External countries question writers

  • Therapy Exam story

  • Prometric and the FBI

  • Review courses: questions

  • Your responsibility

  • Your credential

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Final Thoughts Dosimetrists

  • 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