Essential features of a criterion-based, integrated examination at Tromsø, Norway.

With data from the first integrated examinations at Stage II in the medical curriculum at Tromsø, Norway, we have found that essay-type sequential case problems may be designed according to the pattern described as 'Patient Management Problems'. In particular, a new 'standardized' morphology problem which is labour-saving and which demands from the respondents general skills of high relevance was created. We also found that the taxonomic level of this comprehensive and integrated examination could be raised by following a few simple suggestion. The reliability of the examination is shown to be above average, when pre-accepted model answers are use throughout. New criterion-sets describing clearly acceptable and clearly non-acceptable performances (established by finding the 99% safety limits of the chosen minimum passing level, taking the number of samples into account) were applied prospectively in 1978. Of 42 candidates 37 were classified as clearly passing, while three were classifed as having failed. The validity of the sets was evaluated by using them retrospectively on the 1977 data. It was shown that they were then able to pick out as failures the same four student whom the board had filed in 1977. The format has been favourably received by both students and teachers.