The myth that slow test-takers are worse students: Implications for time-limited testing.

problemTime-limited testing, a form of assessment in which participants have a fixed amount of time to complete an exam, remains a global standard across the medical education continuum from admissions through licensure and board certification. A wide-ranging literature, however, documents how speededness, the extent to which a test's time limit alters individual performance, poses a threat to both validity and equity. Specifically, some students require more time than allotted to complete an exam. When afforded more time, they perform as well as or better than those who complete it within the time constraints. While some students who need more time seek and obtain accommodations, many others-because of stigma or a lack of awareness that they have a disability-fall outside this group. Among those who seek accommodation, some are denied despite a diagnosed disability because they lack childhood documentation. MYTH: There is a lack of sufficient research evidence that people who complete academic tests rapidly are better at making appropriate clinical decisions or acting under time pressure, such as when a patient is bleeding into a surgical field. Rather, studies show experts know when to slow down to better manage a complex situation. IMPLICATIONS: Eliminating speededness on exams could be accomplished through power tests that functionally eliminate time pressure for virtually all test takers. At a practical level, this could be achieved by giving all examinees maximum accommodation, which is typically double time. Leveraging new technology and optimizing test design, including utilizing computerized adaptive testing, shortening stems, providing fewer response items and allowing remote proctoring, could partially off-set the added time and associated testing centre costs. Given the critical need to accurately and equitably assess performance on these gatekeeping exams, we recommend eliminating time limits expeditiously.