How we developed and piloted an electronic key features examination for the internal medicine clerkship based on a US national curriculum

Abstract

Background: Key features examinations (KFEs) have been used to assess clinical decision making in medical education, yet there are no reports of an online KFE-based on a national curriculum for the internal medicine clerkship.

What we did: The authors developed and pilot tested an electronic KFE based on the US Clerkship Directors in Internal Medicine core curriculum. Teams, with expert oversight and peer review, developed key features (KFs) and cases.

Evaluation: The exam was pilot tested at eight medical schools with 162 third and fourth year medical students, of whom 96 (59.3%) responded to a survey. While most students reported that the exam was more difficult than a multiple choice question exam, 61 (83.3%) students agreed that it reflected problems seen in clinical practice and 51 (69.9%) students reported that it more accurately assessed the ability to make clinical decisions.

Conclusions: The development of an electronic KFs exam is a time-intensive process. A team approach offers built-in peer review and accountability. Students, although not familiar with this format in the US, recognized it as authentically assessing clinical decision-making for problems commonly seen in the clerkship.

Acknowledgments

The authors would like to acknowledge the contribution of Dr. Georges Bordage who was an invaluable resource and consultant for the key features development group (KFDG); Amy Holthauser, MD, for her leadership of the KFDG; and Debra Stottlemyer, MD, and Janet Jokela, MD, who were also members of the KFDG.

Declaration of interest: Kirk A. Bronander, MD, FACP, is an associate editor for SIMPLE virtual patient cases; Valerie J. Lang, MD, is an editor-in-chief of SIMPLE virtual patient cases; L. James Nixon, MD, MHPE, is an editor-in-chief of SIMPLE virtual patient cases; Heather E. Harrell, MD, FACP – no declarations of interest; Regina Kovach, MD, is an associate editor for SIMPLE virtual patient cases; Susan Hingle, MD, FACP – no declarations of interest; and Norman Berman, MD, is executive medical director at MedU, publisher of SIMPLE virtual cases.

Supplementary material available online.