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Fresno Test

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Purpose

The Fresno Test (FT) measures medical residents’ knowledge of basic evidence-based medicine (EBM) principles including how to frame a research question, how to search for evidence to answer this question, understanding of the hierarchy of evidence, being able to interpret its magnitude, internal and external validity of the evidence, and basic statistical and methodological concepts. 

Please see the original Modified Fresno Test and Adapted Fresno Test.

Link to Instrument

Instrument Details

Acronym FT

Area of Assessment

Reasoning/Problem Solving

Assessment Type

Other

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Populations

Allied Health Care Professions

Key Descriptions

  • Utilizes the first three steps of the five-step EBM model (ask the question, acquire the evidence, and appraise the evidence)
  • Seven short answer questions that include two clinical scenarios, two questions that require a series of mathematical calculations, and three fill-in-the-blank questions
  • Total Score = 0-212; Higher scores indicate a better understanding of EBM
    ● Five grading categories (not evident, minimal and/or limited, strong, excellent), each of which is associated with a point value. 0 = not evident, 2 = limited, 4 = strong, 6 = excellent. Each criterion is scored into these categories. The sum of the points for all criteria is the score for that item.
  • Standardized grading rubric provided assigns points to all answers
  • Grading rubric was developed by the original authors and raters were identified as experts in the medical field, and experts in understanding EBM. Limited feedback on the grading rubric use exists.

Number of Items

12 questions

Equipment Required

  • Paper or electronic access to the test

Time to Administer

40 minutes

Time to grade: 9-15 minutes (Argimon-Pallàs et al., 2010)

Required Training

No Training

Instrument Reviewers

Kathy Sanders, MS, OTR/L and Andrea Vassev, MPT

Considerations

  • Please see the original Modified Fresno Test and Adapted Fresno Test.
  • The FT, AFT, and MFT are best utilized for assessing participants’ knowledge of EBM or EBP. It is important to note that they may not test an individual’s ability to successfully apply EBM or EBP in the clinical setting (Ramos et al., 2003).
  • It is essential to select the correct Fresno Test for your discipline because the case scenarios and test questions are geared toward specific disciplines. For example, an OT or PT would not be appropriate for the FT as its clinical case scenarios are specific to medical practice.
  • The FT, AFT, and MFT can be used when measuring a change in knowledge after EBP instruction or to determine areas of weakness before an instruction or practice is implemented (Argimon-Pallàs et al., 2011). It may be helpful to compare groups based on pretest upper and lower (25%) quartiles if making comparisons utilizing a pre and posttest design (McCluskey & Bishop, 2009). 
  • Consider giving the pre and posttest at least four weeks apart, to help prevent bias based on test recall (Argimon-Pallàs et al., 2011).
  • MFT raters participated in three different training sessions on three different days; 2-hour introduction on the test, scoring rubric, and standardized data collection form; 2.5 hours of practice with the scoring rubric; and 1.5 hours for questions and discussion (Tilson, 2010).
  • Information concerning rater training in the clinical setting is lacking, therefore it is unclear how long the training process would take and also what support and resources may be needed when utilizing novice raters.
  • There are two additional studies that are adaptations of the original Fresno Test, specific to pharmacy students (Coppenrath, Filosa, Akselrod, & Carey, 2017), and to pediatric bedside nurses (Laibhen-Parkes, Kimble, Melnyk, Sudia, & Codone, 2018), that are not included in this review.

Allied Health Care Professions

back to Populations

Cut-Off Scores

Novice, intermediate, and expert EBM clinicians: (Ramos et al., 2003; total n = 96; novice family practice residents and faculty without formal EBM training, n = 43; self-identified experts in EBM, n = 53)

  • Each short answer question was scored on a scale of 1-6, with a total of 7  categories. The total scores were interpreted as follows:

Score

Interpretation

< 8

Not evident

8-15

Limited response

16-23

Strong response

24

Excellent response

Normative Data

Medical students and faculty without Evidence Based Medicine (EBM) training

  • 95.6 (Ramos et al., 2003, n = 43)
  • 57.6 ± 23.1 (Argimon-Pallàs et al., 2010; n = 108)

Medical students with prior EBM training (Argimon-Pallàs et al., 2010; n = 44)

  • 75.9 ± 29.2

Family medicine physicians (Argimon-Pallàs et al., 2010; n = 17)

  • 110.4 ± 11.5

Self-identified EBM Experts

  • 147.5 (Ramos et al., 2003, n = 53)
  • 149.8 ± 23.2 (Argimon-Pallàs et al., 2010; n = 17, Primary care physician researchers)

Interrater/Intrarater Reliability

Family medicine faculty: (Ramos et al., 2003; n = 19; raters are two research investigators who tested reliability with a new validation group utilizing the finalized grading rubric)

  • Excellent inter-rater reliability (ICC = 0.98)

 

Medical students with and without prior EBM training: (Argimon-Pallàs et al., 2011; n = 152; mean age = 31(8); 108 residents without EBP training and 44 with EBM training; women 76.3%; pretest and posttest after receiving EBP educational intervention; Spanish translation; raters consisted of two research investigators; case scenarios were different at pre and posttest)

  • Excellent inter-rater reliability; pre-educational intervention (ICC = 0.95)
  • Excellent inter-rater reliability; post-educational intervention (ICC = 0.85)

Internal Consistency

Medical students with and without prior EBM training: (Argimon-Pallàs et al., 2010)

 

  • Excellent internal consistency pretest (Cronbach’s alpha = 0.88)
  • Adequate internal consistency posttest (Cronbach’s alpha = 0.77)

 

Self-identified EBM experts, family  medicine students and faculty: (Ramos et al., 2003)

  • Excellent internal consistency (Cronbach’s alpha = 0.88)

Construct Validity

Medical students with and without prior EBM training: (Argimon-Pallàs et al., 2010)

  • Significant linear trend (p < 0.001) for sequentially improved mean score with level of EBP training

Content Validity

Medical students and faculty: (Argimon-Pallàs et al., 2009)

  • Cognitive debriefing utilized to maintain content validity with the English version

Face Validity

Medical students and faculty:(Argimon-Pallàs et al., 2010; medical residents, n = 5; specialists in family medicine physicians, n = 5)

  • Interviews were conducted to determine degree of understanding with each item and suggestions were made to rephrase items. The authors then analyzed this data and applied it to the pretest.

 

Medical school faculty with expertise in EBM: (Ramos et al., 2003)

  • Teachers of evidenced-based medicince reviewed the test and grading rubric. Controversial elements were removed and requested additional elements were added.

Floor/Ceiling Effects

Medical students with and without prior EBM training: (Argimon-Pallàs et al., 2010)

  • Excellent; no instances of minimal or maximal scores at pretest (range 35 to 172.2)

Responsiveness

Medical students without prior EBM training: (Argimon-Pallàs et al., 2010)

  • Large effect size = 1.77

 

Medical students with prior EBM training: (Argimon-Pallàs et al., 2010)

  • Large effect size = 1.78

Bibliography

Argimon-Pallàs, J. M., Flores-Mateo, G, et al. (2011). “Effectiveness of a short-course in improving knowledge and skills on evidence-based practice.” BMC Fam Pract 12(64): 1-7. Find it on PubMed

Argimon-Pallàs, J. M., Flores-Mateo, G, et al. (2010). “Psychometric properties of a test in evidence based practice: the Spanish version of the Fresno Test.” BMC Med Educ 10(45): 1-10. Find it on PubMed

Argimon-Pallas, J. M., Flores-Mateo G., et al. (2009). “Study protocol of psychometric properties of the Spanish translation of a competence test in evidence based practice: The Fresno Test.” BMC Health Serv Res 9(37): 1-9. Find in on PubMed

Ramos, K. D., Schafer, S., et al. (2003). “Validation of the Fresno Test of competence in evidence based medicine.” BMJ 326: 319-321. Find it on PubMed

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