This article explores how traditional scores obtained from different forced-choice (FC) formats relate to their true scores and item response theory (IRT) estimates. Three FC formats are considered from a block of items, and respondents are asked to (a) pick the item that describes them most (PICK), (b) choose the two items that describe them the most and the least (MOLE), or (c) rank all the items in the order of their descriptiveness of the respondents (RANK). The multi-unidimensional pairwise-preference (MUPP) model, which is extended to more than two items per block and different FC formats, is applied to obtain the responses to each item block. Traditional and IRT (i.e., expected a posteriori) scores are computed from each data set and compared. The aim is to clarify the conditions under which simpler traditional scoring procedures for FC formats may be used in place of the more appropriate IRT estimates for the purpose of inter-individual comparisons. Six independent variables are considered: response format, number of items per block, correlation between the dimensions, item discrimination level, and sign-heterogeneity and variability of item difficulty parameters. Results show that the RANK response format outperforms the other formats for both the IRT estimates and traditional scores, although it is only slightly better than the MOLE format. The highest correlations between true and traditional scores are found when the test has a large number of blocks, dimensions assessed are independent, items have high discrimination and highly dispersed location parameters, and the test contains blocks formed by positive and negative items.
BackgroundMedical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied.MethodsWe carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies.ResultsFrom the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician’s personal level.ConclusionsThis study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents. These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0459-2) contains supplementary material, which is available to authorized users.
Forced-choice questionnaires have been proposed as a way to control some response biases associated with traditional questionnaire formats (e.g., Likert-type scales). Whereas classical scoring methods have issues of ipsativity, item response theory (IRT) methods have been claimed to accurately account for the latent trait structure of these instruments. In this article, the authors propose the multi-unidimensional pairwise preference two-parameter logistic (MUPP-2PL) model, a variant within Stark, Chernyshenko, and Drasgow's MUPP framework for items that are assumed to fit a dominance model. They also introduce a Markov Chain Monte Carlo (MCMC) procedure for estimating the model's parameters. The authors present the results of a simulation study, which shows appropriate goodness of recovery in all studied conditions. A comparison of the newly proposed model with a Brown and Maydeu's Thurstonian IRT model led us to the conclusion that both models are theoretically very similar and that the Bayesian estimation procedure of the MUPP-2PL may provide a slightly better recovery of the latent space correlations and a more reliable assessment of the latent trait estimation errors. An application of the model to a real data set shows convergence between the two estimation procedures. However, there is also evidence that the MCMC may be advantageous regarding the item parameters and the latent trait correlations.
binary data, clustering, hierarchical classes, individual differences, set-theoretical relations, three-way three-mode data,
A quasi-experimental study is reported with four measurement occasions to evaluate longer-term effects of a life-skills and HIV/AIDS school-based prevention program. Trained teachers administered the program promoting precursors of safer sex behavior to 2064 Mexican high-school students at an age before most were sexually active. The variables included in the study (knowledge about HIV/AIDS prevention, attitudes towards use of condoms, subjective norms, intentions to use condoms and life skills as decision-making skills, partner communication and individual responsibility) have been reported as precursors of protective sexual behavior. The results demonstrate the stability of training effects and a positive impact on these precursors over 1 year of follow-up.
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