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Document Type

Dissertation - University Access Only

Award Date


Degree Name

Doctor of Philosophy (PhD)

Department / School

Graduate Nursing

First Advisor

Thomas Stenvig

Second Advisor

Sandra Bunkers


Problem. Innovative items were added as scored items to the Certification Examination for Nurse Anesthetists (NCE) in 2010 and no studies to date have evaluated the psychometric impact of adding innovative items to the examination. Participants. Examination data were taken from all examinees who had graduated from an accredited nurse anesthesia program (N=1257) and items (N=992) from August 1, 2010 to January 10, 2011 to analyze ability estimates, response times, and discrimination differences with innovative items. First time, recent examinee data from August through December of 2008 (N=1071), 2009 (N=1039), and 2010 (N=994) were compared for pass rate and score distribution. Finally, an experimental pool of items (N=248) was analyzed for unidimensionality. Methodology. Candidate ability was estimated for both innovative items and multiple-choice questions (MCQs) utilizing three tests: a t-test comparison between the ability estimate means, a t-score comparison between individual candidates utilizing a pooled standard deviation, and a Pearson correlation between the ability estimates. Response times were evaluated with ANOVA and post hoc Tukey tests. A comparison of pass rates over three years was accomplished with pairwise z-tests with Bonferroni correction. Score distributions were analyzed with ANOVA. Item discrimination was analyzed with a t-test comparison of MCQs and innovative items and ANOVA analysis of discrimination in individual item types. Bifactor analysis and the Bayesian information criterion were used to analyze the unidimensionality of the innovative items. Findings. Candidates had a significantly higher ability estimate in innovative items (2.688) than in MCQs (2.580) (t=-6.819, p=0) and 84 candidates (6.7%) performed significantly differently in innovative items. The ability estimates correlated at r=.58. Items were significantly different in response times (F=5234, p=0). A significant difference was found in the pass rate comparison of 2008 to 2010 (z=3.354, p=.001). Innovative items discriminated to a higher degree than MCQs (t=-2.527, p=.012). The innovative items exhibited unidimensionality to the same degree at MCQs and the BIC confirmed the Rasch model as acceptable for scoring. Implications. The increased time required to respond to innovative items may become problematic as more items are added to the examination. The higher discrimination of the innovative items improves the NCE as a measurement tool. The BIC supports the continued use of the unidimensional model.

Library of Congress Subject Headings

Nurse anesthetists - Examinations, questions, etc
Nurse anesthetists -- Certification



Number of Pages



South Dakota State University