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Fig. 4 Differences of mean difficulty index across proficiency-based groups.
Reassuringly, our prediction and the measured difficulty index correlated well in that our six hard questions obtained a mean difficulty index of 0.39 ± 0.10, our five medium questions of 0.53 ± 0.12, and our five easy questions of 0.71 ± 0.13 (see File S6).
The graphical comparison of the pre and post-test knowledge exams results are shown in Figures 1, 2, 3 and 4. Regarding the supplementary evidence obtained in the courses' curricular summative evaluations, the 60-item MCQ exams had an average Cronbach's alpha of 0.83, a mean difficulty index p-value of 0.66 and a mean point-biserial correlation index of 0.29.
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The means, standard deviations, mean item difficulties, indices of selectivity, and internal consistencies of the subscales of the SASKO-J are presented in Table 1.
This result is encouraging since a moderate value of the difficulty index means that the questions are not too easy nor too difficult.
In addition, both averaged difficulty indices indicate moderate values, which is an encouraging result since a moderate value of difficulty index means that the questions are not too easy nor too difficult.
For the single APSA items means, standard deviations and the difficulty index (defined as the percentage of subjects giving "never" answer) were calculated.
The mean response choice for each item (difficulty index) ranged from 2.11 to 3.60, which suggests that all items are moderately spread around the centre of the four response choices (1. Always; 2. Sometimes; 3. Rarely; 4. Not at all).
The difficulty index of the MQs ranged from 0.18 to 0.90 (mean 0.51, SD 0.2), while that of the HQs did from 0 to 0.92 (mean 0.53, SD 0.23).
Overall the means of the single items were between 0.57 and 2.52, the difficulty index (defined as percentage of subjects with "never" answer) varied between 1.42% and 58.68%.
Ideally, to ensure the quality of data in the health information system, all health workers must be able to equally identify eligible cases for indicators at the case identification stage, which means that the discrimination index of each item is not significant while its level of difficulty index is high.
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CEO of Professional Science Editing for Scientists @ prosciediting.com