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2
Issues of Validity and Reliability
for Assessments in Medical
Education
Melissa J. Margolis, PhD, Brian E. Clauser, EdD, David B.
Swanson, PhD
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Chapter Outline
Historical Context
Kane’s View of Validity
Scoring
Example 1: A Multiple-Choice Examination
Example 2: Performance Assessment
Example 3: Workplace-Based Assessment
Generalization
Example 1: A Multiple-Choice Examination
Example 2: Performance Assessment
Example 3: Workplace-Based Assessment
Additional Thoughts on Reliability
Extrapolation
Example 1: A Multiple-Choice Examination
Example 2: Performance Assessment
Example 3: Workplace-Based Assessment
Decision/Interpretation
Example 1: A Multiple-Choice Examination
Example 2: Performance Assessment
Example 3: Workplace-Based Assessment
Consequential Validity and Program Evaluation
Conclusion
Annotated Bibliography
References
A proposition deserves some degree of trust only when it has
survived serious attempts to falsify it.
—LEE CRONBACH
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This chapter provides an overview of the concepts of validity
and reliability as they apply to assessment in medical
education. The discussion begins with a brief history of
validity theory and a description of how the
conceptualization of validity has changed over time. Michael
Kane’s approach to validity, in which the validation process
is viewed as a structured argument in support of the
intended interpretations and uses of test scores, will be the
main focus of the chapter. Kane’s approach is important
because the view that the validation process is one of
collecting evidence to construct a coherent argument in
support of the intended interpretations leads to a notable
conclusion: there is no such thing as a valid test! The score
from any given test could be used to make a variety of
decisions in different contexts and with different examinee
populations; evidence to support the validity of one type of
interpretation in one context with one population may or
may not support the validity of a different interpretation in a
different context with a different population. This point will
be discussed in greater detail later; it is introduced here
because it is central to understanding the argument that is
made throughout the chapter.
The chapter continues by presenting the components of
Kane’s validity framework and, for each one, describing
examples of the types of validity evidence that might be
collected within three different medical education
assessment contexts. The discussion of reliability will be
presented within the context of generalizability theory, and
the generalizability of scores will be considered in the
context of the overall validity argument. The intent of this
chapter is to provide the reader with a greater understanding
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