Key Features Approach

The key features (KFs) approach is aimed at assessing applied knowledge for case-specific decisions and actions. KFs can be viewed as the difficult aspects of a case in practice or the actions most likely to cause errors that impact patient outcomes; KF developers might ask, for example, “where do interns go wrong in this situation?” These are the unique critical decisions that will best discriminate among varying levels of ability from stronger to weaker examinees. A KF test contains an adequate and representative sample of clinical problems and a scoring procedure that only rewards mastery of critical, challenging decisions or actions. The varied response formats of a KF question or examination are selected to best fit the nature of the clinical task being assessed. This chapter describes the process of developing and scoring KF cases and discusses how the KFs approach can address major threats to assessment validity.