• Edward J Palmer, Paul Duggan, Peter G Devitt, and Rohan Russell.
• Department of Surgery, University of Adelaide, and Royal Adelaide Hospital, Adelaide, Australia.
• Med Teach. 2010 Jan 1; 32 (7): e300-7.

BackgroundExit examinations in medicine are 'high stakes' examinations and as such must satisfy a number of criteria including psychometric robustness, fairness and reliability in the face of legal or other challenges.AimsWe have undertaken a critical review of the exit examination from the University of Adelaide focussing on the written components. This examination consisted of an objective structure clinical examination (OSCE), a multiple choice question (MCQ) paper and a modified essay question (MEQ) paper.MethodsThe two written papers were assessed for item writing flaws and taxonomic level using modified Bloom's criteria. Curriculum experts independently assessed adequacy of the examination for validity and fidelity.ResultsThe overall examination had good fidelity and validity. The results of the MEQ and MCQ were strongly and positively correlated and there was a weak negative correlation between these papers and the OSCE. The MEQ had a higher proportion of questions focussed on recall of knowledge and the questions were more structurally flawed compared with the MCQs. The MEQ re-marking process resulted in lower scores than were awarded by the original, discipline-based expert markers. The MEQ paper failed to achieve its primary purpose of assessing higher cognitive skills.ConclusionThe University of Adelaide's MBBS programme has since dropped the MEQ paper from its exit examination and is evaluating in its place the Script Concordance test.

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