A Look Behind the Curtain: Development of the CASC™ Exam

By Andrew S. Weiss, CASC, Administrator, The Kennedy Surgery Center at Cherry Hill (NJ) and Martha R. Colen, RN, CASC, Administrator, Virginia Beach (VA) Ambulatory Surgery Center

Ever wonder how the CERTIFIED ADMINSTRATOR SURGERY CENTER™ (CASC™) exam is developed and administered? The process is more scientific than you may think.

It begins with the CASC™ Job Analysis Task Force ascertaining the body of knowledge that the candidate is expected to understand to be an ASC administrator. This is done by surveying ASC administrators to determine what job duties they hold and are expected to have proficiency in. The CASC™ Job Analysis Committee reviews the results, which become the content outline that is the framework for the CASC™ exam. The process is repeated at a minimum every five years to ensure that the exam is still current.

Since the exams inception in 2001, the five major content areas are:

  1. Delivery of Patient Care
  2. Quality Management
  3. Human Resources
  4. Financial, and
  5. Regulatory and Legal Issues

When the Job Analysis Task Force completes the task of developing the content outline, CASC’s™ Item Writing Committee gets to work developing questions to test the candidates knowledge. The committee’s goal is to develop questions, or items as they are called, that are unbiased and applicable nationally. Each item on the examination is linked to the content outline and also categorized according to the level of complexity or the cognitive level that a candidate would likely use to respond.

Items are then written requiring the following type of response:

  • Recall: The ability to recall or recognize specific information.
  • Application: The ability to comprehend, relate or apply knowledge to new or changing situations.
  • Analysis: The ability to analyze and synthesize information, determine solutions and/or to evaluate the usefulness of a solution.

The Item Writing Committee is tasked to review all 200 items on the CASC™ exam plus “pool” items that are used to replace items that might become obsolete or unusable for other reasons. Members of the committee take the entire exam at least four times.

The Board of Ambulatory Surgery Certification (BASC) engages PSI Services, a professional testing agency, to assist in the development, administration, scoring, score reporting and analysis of the CASC™ examination. PSI Services is a research and development firm that conducts professional competency assessment research and provides examination services for several credentialing programs.

PSI Services provides BASC with a facilitator who holds a doctorate in psychometrics. Psychometricians are psychologists with additional training in measurement of skills and knowledge. The methods used by this psychometrician to measure the test help ensure reliability and validity.

Danny Breidenbach is a psychometrician who works with the CASC™ item writing committee. Breidenbach is fond of quoting one of his professors regarding the field, saying “Nobody says they are going to be a psychometrician when they grow up.” He became interested in the field because, as a former math teacher, he was intrigued about how applying the field would enable measurement to support a claim for competencies in a certification program like CASC™.

As a facilitator, his job is not to develop content but to ensure that the items written and chosen by the committee are formatted properly and consistent with the parameters of the exam. “Most organizations aren’t aware of the amount of work necessary to develop an exam like CASC™,” says Breidenbach.

The end result is an examination that tests candidates on their body of knowledge that is generally accepted by their peers as necessary to perform the job of an ASC administrator. By passing the exam, CASC™ certificants demonstrate their competency in their field and earned a credential that has relevancy and recognition of this accomplishment.


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