Analysis and technical aspects of image-related questions in the exam for Medical Internal Residence in Spain, 2022

The examination for the Medical Intern Resident (MIR) is a multiple-choice test aimed at ranking candidates for specialized medical training positions in Spain. The objective of this study is to provide an objective analysis of this test in its 2022 edition as an evaluative tool for discrimination, with a particular focus on the field of radiology and nuclear medicine. The clinical cases associated with radiology images or nuclear medicine pose greater difficulty compared to the rest of the MIR exam questions. Out of the 14 questions related to radiological or nuclear medicine images, six of them exhibit high difficulty, and only 5 out of the 14 questions demonstrate good or excellent discriminatory capacity. While the MIR exam proves to be an excellent discriminatory tool in psychometric terms, the image-related questions show a significant potential for improvement. In order for the image-associated question to exhibit appropriate discrimination, it is essential to minimize irrelevant information, ensure that it complements the clinical information provided in the text without contradicting it, represent the characteristic imaging finding of the disease, utilize the appropriate imaging modality, maintain a moderate difficulty level for the questions, and ensure that the distractors are clearly false.