This paper presents the ACTA system, which performs automated short-answer grading in the domain of high-stakes medical exams. The system builds upon previous work on neural similarity-based grading approaches by applying these to the medical domain and utilizing contrastive learning as a means to optimize the similarity metric. ACTA is evaluated against three strong baselines and is developed in alignment with operational needs, where low-confidence responses are flagged for human review. Learning curves are explored to understand the effects of training data on performance. The results demonstrate that ACTA leads to substantially lower number of responses being flagged for human review, while maintaining high classification accuracy.

This paper presents a corpus of 43,985 clinical patient notes (PNs) written by 35,156 examinees during the high-stakes USMLE® Step 2 Clinical Skills examination. In this exam, examinees interact with standardized patients - people trained to portray simulated scenarios called clinical cases. For each encounter, an examinee writes a PN, which is then scored by physician raters using a rubric of clinical concepts, expressions of which should be present in the PN. The corpus features PNs from 10 clinical cases, as well as the clinical concepts from the case rubrics. A subset of 2,840 PNs were annotated by 10 physician experts such that all 143 concepts from the case rubrics (e.g., shortness of breath) were mapped to 34,660 PN phrases (e.g., dyspnea, difficulty breathing). The corpus is available via a data sharing agreement with NBME and can be requested at https://www.nbme.org/services/data-sharing.

This paper brings together approaches from the fields of NLP and psychometric measurement to address the problem of predicting examinee proficiency from responses to short-answer questions (SAQs). While previous approaches train on manually labeled data to predict the human-ratings assigned to SAQ responses, the approach presented here models examinee proficiency directly and does not require manually labeled data to train on. We use data from a large medical exam where experimental SAQ items are embedded alongside 106 scored multiple-choice questions (MCQs). First, the latent trait of examinee proficiency is measured using the scored MCQs and then a model is trained on the experimental SAQ responses as input, aiming to predict proficiency as its target variable. The predicted value is then used as a “score” for the SAQ response and evaluated in terms of its contribution to the precision of proficiency estimation.