E-Mail karger@karger.com Interventional Pulmonology Respiration 2014;88:67–73 DOI: 10.1159/000362884 Development and Validation of a Theoretical Test in Endosonography for Pulmonary Diseases Mona M. Savran a Paul Frost Clementsen b Jouke T. Annema c Valentina Minddal b Klaus R. Larsen d Yoon Soo Park e Lars Konge a a Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, and b Department of Pulmonology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; c Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; d Department of Pulmonology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; e Department of Medical Education, University of Illinois Chicago, Chicago, Ill., USA tion of 0.47 and a mean item difficulty of 0.63. The internal consistency reliability was calculated at 0.91. The 3 groups performed significantly differently (ANOVA: p < 0.001), and post hoc tests were significant. The experts performed sig- nificantly more consistently than the novices (p = 0.037) and the intermediates (p < 0.001). Conclusions: This study pro- vides a theoretical test in endosonography consisting of multiple-choice questions. Validity evidence was gathered, and the test demonstrated content and construct validity. © 2014 S. Karger AG, Basel Introduction Accurate staging of non-small cell lung cancer is piv- otal in determining therapeutic strategies, and the evalu- ation of mediastinal lymph nodes through tissue verifica- tion is a key component [1, 2]. Staging can be performed in a minimally invasive manner via endosonography in- cluding endobronchial ultrasonography (EBUS) and esophageal ultrasonography (EUS) with real-time aspira- tion of the lymph nodes [3–5]. Unlike surgical staging Key Words Theoretical test · Validity testing · Endobronchial ultrasonography · Esophageal ultrasonography Abstract Background: Theoretical testing provides the necessary foundation to perform technical skills. Additionally, testing improves the retention of knowledge. Objectives: The aims of this study were to develop a multiple-choice test in endo- sonography for pulmonary diseases and to gather validity evidence for this test. Methods: Initially, 78 questions were constructed after informal conversational interviews with 4 international experts in endosonography. The clarity and content validity of the questions were tested using a Delphi- like approach. Construct validity was explored by adminis- tering the test to 3 groups with different levels of endo- sonography experience: 27 medical students, 18 respiratory physicians with limited endosonography experience, and 14 experts in endosonography. Results: Two Delphi iterations reduced the test to 52 questions. After item analysis, the final test consisted of 46 questions with a mean item discrimina- Received: January 6, 2014 Accepted after revision: April 4, 2014 Published online: May 21, 2014 Lars Konge Centre for Clinical Education University of Copenhagen and the Capital Region of Denmark Blegdamsvej 9, DK–2100 Copenhagen Ø (Denmark) E-Mail lkonge  @  yahoo.dk © 2014 S. Karger AG, Basel 0025–7931/14/0881–0067$39.50/0 www.karger.com/res