Chronic pain has become a public health crisis in America, with subsequent high dependence on opioids. The use of nonsurgical pain management methods to treat pain is a viable alternative. Certified registered nurse anesthetists (CRNAs) have treated chronic pain patients with nonsurgical pain management methods for years, however, scope of practice and reimbursement issues over the past decade have threatened patients’ access to chronic pain care by CRNAs. As a result, the need for specialty certification in nonsurgical pain management became apparent. Assessing decision-making in healthcare professions with computerized simulation-based methods which aim to assess higher performance-based domains of competence have gained notoriety in recent years, however validity evidence is lacking. The purpose of this dissertation was to assess the validity and reliability of computer-based case simulations on the nonsurgical pain management certification examination for CRNAs who specialize in nonsurgical pain management. Computer-based case simulations, also known as clinical scenario items (CSIs), were developed by the National Board of Certification and Recertification for Nurse Anesthetists in 2013, and were tested for construct validity and internal consistency in this study. Miller’s pyramid was chosen as the theoretical framework based on its hierarchical progression of assessment methods from foundational knowledge to performance in practice. Data from a convenience sample of 32 examinees who took the nonsurgical pain management examination were utilized, and consisted of 134 multiple choice questions (MCQs) and 2 clinical scenario items (CSIs) per examinee. Exploratory factor analysis revealed two underlying factors in the assessment of knowledge using MCQs, and three factors in the assessment of decision-making using CSIs. Internal consistency reliability was low to moderate for all constructs. A weakly positive correlation between MCQ scores and CSI scores revealed a weakly modest validation that CSIs measure a higher construct of competence. Correlation between time in practice to MCQ scores and CSI scores were both nonsignificant, and demonstrated that more time in practice did not correlate with higher examination performance. This study demonstrated that competence is best evaluated by a multimodal approach, such as practice outcome data and peer attestations of competent performance.
|Advisor:||Kremer, Michael J.|
|Commitee:||Krogh, Mary Anne, Muckle, Timothy J., Schoeny, Michael, Swanson, Barbara A.|
|School Location:||United States -- Illinois|
|Source:||DAI-B 79/11(E), Dissertation Abstracts International|
|Keywords:||Assessment, Case simulations, Computer-based, Decision-making, Reliability, Validity|
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