Computer-based testing in family practice certification and recertification.

BACKGROUND The member boards of the American Board of Medical Specialties have agreed to expand the scope of certification to include assessment of medical knowledge, practice-based learning and improvement, patient care, interpersonal and communication skills, systems-based practice, and professionalism. Multiple-choice examinations provide limited ability to assess these dimensions. METHODS The American Board of Family Practice (ABFP) has developed a computer simulation system to facilitate more comprehensive candidate evaluation. The system consists of a knowledge base, a simulation program to create patient scenarios, an interface for presenting simulations to users, and an administrative database to track candidate performance and interactions with the system. The system uses population distributions for disease states to produce cases and evolves patients in response to candidate interventions, such as pharmacological and nonpharmacological therapies. We use Bayesian belief networks to model patient characteristics and comorbid condition interactions. RESULTS Simulations have been created for 7 disease states; ultimately simulations will be available for 25 to 30 disease states. Initial testing will take place in regional examination centers but will ultimately use the Internet for convenient access for certification and recertification candidates. CONCLUSION The ABFP will begin field-testing the system in early 2003 and will include simulations in the certification and recertification examination process in 2004.