Exam Development

Learn the process for how the NP/PA-CCKE is developed.

Blueprint Development

The blueprint for the Certified Cardiovascular Knowledge Exam for NPs and PAs (NP/PA-CCKE) was developed through a Job Task Analysis (JTA), a methodical approach designed to develop an exam blueprint, capturing the essential knowledge and skills required for competent clinical practice. This blueprint serves as the foundation of the NP/PA-CCKE exam accurately reflecting the current professional standards in cardiology care for NPs and PAs.

The JTA process builds on the American College of Cardiology’s NP/PA Clinical Competencies, emphasizing Medical Knowledge (MK) statements and Patient Care and Procedural Skills critical for providing safe and effective patient care in general cardiology. To ensure diverse and comprehensive input, ACC surveyed nearly 17,000 cardiovascular NPs and PAs across the U.S. through a detailed survey focusing on universally expected cardiovascular skills. This approach ensures a balanced representation by considering demographic variables such as geographical distribution, age, and gender of participants.

A dedicated JTA Task Force, composed of expert cardiovascular NPs and PAs, reviewed the survey outcomes, addressed any discrepancies, and refined the competencies required for safe practice across various medical domains. The process culminated in key meetings where the task force finalized the exam blueprint, later approved by the ACC Certification Governance Work Group (CGWG). This blueprint sets the standard for NP/PA-CCKE certification exam, ensuring it thoroughly assesses necessary professional competencies for cardiovascular NPs and PAs.

Given the evolving nature of medical practice, ACC continuously revises and updates its JTA process to maintain the certification relevance and alignment with the latest clinical advancements.

Exam Development Process and Question Format

The Certified Cardiovascular Knowledge Examination for NPs/PAs (CCKE NP/PA) is developed, evaluated, and approved by subject matter experts and psychometricians to ensure that it provides a fair and reliable estimate of proficiency.

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

Question Development

Prior to the exam, questions are written by cardiovascular NP and PA subject matter experts trained in effective question writing. Upon completing this training, they are officially invited to serve on the CCKE NP/PA Question Writing Committee for a minimum of two-years.

Questions for the exam are written based on the CCKE NP/PA Blueprint to reflect the latest clinical cardiovascular practices relevant to NPs and PAs. Each question writer is assigned specific topics from the blueprint. For each question, the writer first develops a "testing point" that corresponds to the assigned topics, ensuring the questions directly address essential aspects of the blueprint. Subsequently, questions are written and must be supported by up-to-date references, no older than five years.

Questions are also aligned to the 2020 ACC Clinical Competencies for Nurse Practitioners and Physician Assistants in Adult Cardiovascular Medicine document which identifies the knowledge and skills necessary for NPs and PAs practicing in cardiovascular medicine.

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.