Fig. 3
From: Utility of RAND/UCLA appropriateness method in validating multiple-choice questions on ECG
Examples of questions deemed as “Appropriate” and “Revision.”. The ECG questions in the online test are organized as follows: a question text with the patient’s age, sex, and chief complaint; five choices; the ECG waveform in the middle; and five category choices at the bottom. A Example of a question deemed as “Appropriate” for both rounds 1 and 2. The category was classified as “Ischemia/infarction” in rounds 1 and 2. In round 1, the median score was high (9) with a low IQR (0); thus, the question was deemed as appropriate, as confirmed in round 2. B Example of a question considered as “Revision” after round 2. The median score was as high as 8; however, the IQR was also as high as 4; thus, it was determined as requiring discussion in round 1. The author created the question with the correct answer as effort angina. However, ST-segment elevation in II, III, and aVF was observed in the ECG. After a discussion in round 2, acute myocardial infarction could not be excluded and that the choice and ECG image required modification. ECG = electrocardiogram; IQR = interquartile range