Ágoston Kecskés

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January 6, 2012

Blog Entry #4: MKSAP

Today we discussed the advantages and disadvantages of the Medical Knowledge Self-Assessment Program (MKSAP).[1] Specifically, we reviewed the 1998 version of the MKSAP.

Most of the advantages of the MKSAP are relatively obvious: it is quite comprehensive, it covers all of the major subspecialty areas of internal medicine, and it facilitates independent learning. I was pleasantly surprised to see the inclusion of an annotated bibliography of the key journal articles referenced in the MKSAP text. Such a resource can be invaluable in familiarizing oneself quickly with some of the landmark studies that guide practice in the various internal medicine subspecialties.

The disadvantages of the MKSAP are more subtle. The MKSAP suffers from all of the drawbacks of a multiple choice question format. For example, self-assessors are asked to select the “best” answer from four choices. While simple, this format belies the underlying complexity of the questions. For instance, one cannot choose an answer that is not presented as one of the four choices. In the same way, many of the questions are leading and do not provide self-assessors an opportunity to answer more realistic, open-ended questions. One also cannot choose more than one answer. This is a particularly frustrating limitation in a scenario given that self-assessors may be accustomed to ordering a battery of tests instead of one test at a time and given that self-assessors have also been taught for years to make decisions based on the whole clinical picture versus a single piece of evidence. It is also worth mentioning that the MKSAP can be prohibitively expensive for many trainees. The MKSAP also makes for a cumbersome point-of-care resource.

Happily, some of the disadvantages of the MKSAP could be readily remedied. For example, the drawback of having equal weighting assigned to unequally important questions could be remedied with a simple weighting system. Alternately, the most basic and important questions could be considered separately in the marking scheme to represent a “core” body of knowledge that self-assessors would have to be familiar with to achieve minimum competency. In addition, the MKSAP could “force” learning by not allowing self-assessors to move on after answering questions without confirming the principles underlying both the correct and incorrect answers. This is particularly true of the newer electronic versions of the MKSAP.

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[1] American College of Physicians, “MKSAP 14 Online - American College of Physicians,” Medical Knowledge Self-Assessment Program, http://mksap15.acponline.org/; accessed January 7, 2012