The purpose of multiple choice tests of medical knowledge is to estimate as accurately as possible a candidate's level of knowledge. However, concern is sometimes expressed that multiple choice tests may also discriminate in undesirable and irrelevant ways, such as between minority ethnic groups or by sex of candidates. There is little literature…

Educational assessment concerns inference about student knowledge, skills, and accomplishments. Test theory has evolved in part to address questions of weight, coverage, and import of data. Resulting concepts and techniques can be viewed as applications of more general principles for inference in the presence of uncertainty. (SLD)

The view of learning that underlies standard test theory is inconsistent with the view rapidly emerging from cognitive and educational psychology. Learners become more competent not simply by learning more facts and skills, but by reconfiguring their knowledge; by "chunking" information to reduce memory loads; and by developing…