Item pre-knowledge true prevalence in clinical anatomy - application of gated item response theory model

Background: Computer and paper examinations in our days are constructed from an item pool which is regularly updated. Given the way that exams are created, one of the major concerns is the security of the items that are being used in order to ensure a good estimation of abilities. The aim of this study is to measure the prevalence of item pre-knowledge in our medical school.

Methods: The Deterministic, Gated Item Response Theory Model (DGM) was applied to estimate the prevalence of students who have had item pre-knowledge from six multiple choice examinations of the Clinical Anatomy course at the Faculty of Medicine of University of Porto. Each examination consisted of 100 items with an average of 200 students and 20% repeated items per examination. The estimation of the sensitivity and specificity was based on a simulation study. The sensitivity and specificity estimates, and apparent prevalence were used to estimate true prevalence of cheating students in the examinations under study.

Results: The specificity in the DGM for different simulation scenarios was between 68 and 98%, while the sensitivity ranged from 60 to 91%. The apparent prevalence was between 0.0 and 3.4%, while the true prevalence ranged from 1.2 to 3.7%.

Conclusions: The true prevalence was much lower compared to the students self-reported copying of responses from other students; however, it is important to keep monitoring the pre-knowledge prevalence in order to enforce measures in case an increase occurs.