Exam Development

Learn the process for how the CCKE for physicians practicing outside the U.S. is developed.

Exam Development Process

The Certified Cardiovascular Knowledge Examination for physicians practicing outside the U.S. is developed, evaluated and approved by subject matter experts and psychometricians to ensure that each examination provides a reliable estimate of proficiency.

Question Format

The exam features clinical scenario-based multiple-choice questions. Research indicates that scores from these types of questions correlate well with superior clinical performance.

Question Development

Prior to the examination, questions are written by cardiovascular subject matter experts trained in effective question writing. The questions undergo a rigorous review process to ensure that each question is fair, clinically accurate, and culturally relevant. The questions selected for inclusion on the examination must be of good quality and meet statistical and content specifications.

Key Validation and Item Analysis

Following each exam administration, ACC conducts key validation to ensure the accuracy of questions and answers. Item analysis identifies any questions that may require adjustments due to shifts in medical practice, ensuring the exam remains current and valid. Questions flagged for discrepancies are reviewed and, if found inaccurate, are excluded from scoring.

Determination of Passing Score, Standard Setting, and Equating

The passing score is determined through a content-based standard-setting study, using the Angoff method under the guidance of a psychometrician together with a panel of subject matter experts. The results are reviewed and approved by ACC's Certification Governance Work Group.

Standard setting is a process to identify a cut-score on the scoring scale, classifying examinee results into categories such as pass or did not pass. The Angoff method is a test-centered approach that relies on the judgments of subject matter experts (SMEs) regarding examinee performance on each question.

A panel of 10 to 15 subject matter experts is assembled. The panel participates in training and discussions, guided by a psychometrician, to form a consensus on the expected performance of a borderline examinee — someone who is just at the passing threshold.

The panel assesses the performance of these borderline examinees on every question to establish the expected score of the borderline examinee, which becomes the proposed cut-score. This score is reviewed by the ACC’s Certification Governance Work Group for final approval, ensuring the passing score is both fair and valid. The cut-score reflects a comprehensive evaluation of the difficulty level of the exam based on expert evaluation and is carefully validated to maintain the integrity and accuracy of the certification process. Once an exam form is standard set, subsequent exam forms are equated to that form to obtain the cut-score on the new form. This ensures that the standard required to pass the exam remains the same from form to form.

Please note that the process of item analysis, key validation, scoring and standard setting or equating takes place after the test administration and thus the score reports may take up to two months to be released.

Reliability of This Exam

Reliability is the extent to which the CCKE accurately measures the core components of cardiovascular medicine. The reliability of the examination can be affected by the uniformity of the questions, the length of the test, as well as the quality of questions. The reliability of the CCKE will be estimated using internal consistency methods such as Cronbach's alpha once we have gathered sufficient data.