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This can affect the targeting of the questionnaire, meaning that the mean difficulty of the items does not effectively match the mean ability of the participants.
These included: the mean difficulty of the tests in terms of classical test theory (CTT) item facility values, the mean of the item discrimination values, and the internal consistency index Cronbach's [ 24] Alpha.
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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).
Moreover, the mean difficulty scores of tasks in the D-AI domain related to 'Mental health' were usually at the bottom of the scale.
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.
The mean difficulty score out of 10 was 3.97 for the cross-sectional approach and 3.93 for the longitudinal approach (p = 0.95).
Fig. 4 Differences of mean difficulty index across proficiency-based groups.
In the eight combinations, the difference of mean difficulty was not statistically significant (p value >.05).
The cases selected for this research, from both Cluj and USA, were from the Internal Medicine field and of mean difficulty, chosen by the academic staff from the Department of Internal Medicine in Cluj.
Mean time required; Mean number of attempts required; Mean difficulty rating.
The difference in mean perceived difficulty of 0.04 out of 10 (95% CI −0.95 to 1.01) was not statistically significant (p = 0.95).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com