Licensure boards are responsible for assessing a candidate's ability to provide competent health care. In recent years there has been significant change in how licensure agencies assess a candidate's competence. In the past, only a small percentage of licensure test items began with a case vignette. One of the newer licensure changes has been a dramatic increase in the number of test items beginning with a case vignette.
Currently, approximately 80% of all licensure test items begin with a case vignette. These case-vignette-based test items represent a formidable licensure challenge in that they represent what is often referred to as a 'second-order' question. A second order question is one that actually asks two questions. The first (hidden/indirect) question within such a test item is one that requires the examinee to correctly identify/infer the condition represented by the case vignette (the illness present) portrayed within the item stem. Only after the examinee has made the correct inference (e.g., identified the disease represented by the case vignette), can the examinee use that inference as the prelude/basis for correctly selecting the response that is actually the objective of the test item.
Now that the vast majority of all licensure board test items (and in-training examinations) begin with a case vignette, in order to correctly respond to a physiology, biochemistry, anatomy, pharmacology, etc. oriented question, the student must first diagnose the disease represented by the case vignette. Thus, rudimentary competence in DDX is becoming increasingly recognized as critical in any examination heavily laden with second-order questions (such as licensure boards).
KBIT provides the kind of instruction, practice and feedback needed to correctly diagnose the disease/disorder represented by the case vignette component of second-order test items. Preliminary findings now suggest that improvements in DDX lead to improved licensure board performance.