Research Methods Practice Exam

400864 Research Methods (Quantitative and Qualitative)
Final Examination Practice Set 1answers
Choose the one best answer. Items in this set have non-numerical answers.
1. What is this Research Methods unit mostly about?
A How evidence from research contributes to health care practice and policy.
Correct.
B Robot health care.

The unit is more about reflective practice than robot practice.
C Supermarket trolleys.
It’s more about the information from the supermarket – what you can put in your information trolley.
D I haven’t a clue what this 400864 unit is about. (Hint: Not the recommended answer.)
There’s still time to find out.
Other reasonable answers might be:

• Reducing uncertainty in health-care – see the first tutorial.
• “Effects” – if we’re looking for a single-word summary. Much of the unit is about different types of effect, how they
are found and measured, and how they relate to health care. However, effects are restricted to quantitative
research. Effects don’t apply to qualitative research.
2. Which of these activities is essential for evidence-based clinical practitioners to do?
A Evaluate the quality of existing research.

Correct. Evidence-based practitioners should always consider the quality of evidence. This is basic to
evidence-based practice and implied throughout this unit.
B Read systematic reviews.

Plenty of worthwhile evidence is available in reports that are not systematic reviews. Clinical guidelines are
especially useful for the busy practitioner who needs information quickly – worth remembering.
C Conduct research.
It’s unrealistic to expect most clinical practitioners to do clinical research and produce their own evidence,
and it’s unnecessary for evidence-based practitioners to do so.
D Relying only on findings from randomised controlled trials (RCTs).

Not all worthwhile research questions can be answered by RCTs. Randomised controlled trials can be
impractical or otherwise inappropriate for answering many worthwhile research questions.
For Western Sydney University Research Methods classes taught by John Bidewell Page 1
400864 Research Methods – Final Examination Practice Set 1
3. What is the purpose of the GRADE system?
A Reducing bias in randomised controlled trials.

No lecture in this unit says this about the NHMRC’s evaluation criteria.
B Improving the quality of research reports published in peer-reviewed journals.

A purpose more for the CONSORT, STARD and PRISMA statements, among the other checklists of
reporting quality for various study designs.
C Assisting development of clinical guidelines for evidence-based practice.

Correct.
D All of the above.
4. According to the GRADE system, which of the following improves the quality of a
recommendation based on evidence comparing the effect of two different treatments?
A Variability in the two treatment effects across studies.

It’s better for recommendations if results across studies are consistent rather than inconsistent.
B The two treatments are compared with a placebo, each in two different studies.
This is indirect evidence. Direct evidence is better.
C Effects from the two treatments are compared in a single study.

Correct. This is direct evidence, better than indirect.
D None of the above.
The next three questions are based on a previous exam. All three were usually answered incorrectly.
5. When deciding between two treatments, evidence-based practitioners should look for evidence
that...
A Is from every level of the NHMRC hierarchy.

There is no necessity to seek low-level evidence.
B Is only from randomised controlled trials.

Randomised controlled trials may not be available, so we may have rely on lower-level evidence. As well,
if we look only at randomised controlled trials we’ll be ignoring systematic reviews.
C Shows effect sizes and statistical significance.

Correct.
D Is from numerous studies enabling different conclusions from their results.

We should select studies according to their methodological quality, not their results.
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6. According to the NHMRC evidence hierarchy, which of these study designs could be an
intervention study with a “no-treatment” group?
A Case series.
A case series in an intervention study with only a treatment group. There’s no control or placebo condition.
B Meta-analysis.
A statistical method, not a study design.
C Study of diagnostic yield.

Not an intervention study.
D Non-randomised controlled trial.

Correct. This design tells us there’s a control condition, which could well be a no-treatment group; and it’s a
design for an intervention study.
7. Why is random allocation to treatment and control groups a preferred method of conducting
intervention studies?
A With a large enough sample, the treatment and control groups are likely to have similar
characteristics at the start of the experiment.
Correct. Random allocation should reduce or eliminate differences between the groups.
B Systematic reviews are possible only with randomised controlled trial results.
Simply untrue, and the answer doesn’t properly relate to the question.
C Random allocation protects against all internal validity threats.

See the lecture on experimental designs for a list of internal validity threats for which random allocation offers
no protection. These threats often involve problems originating after randomisation.
D Random allocation gives a representative sample, so results will generalise.

Random allocation is not a sampling method and cannot protect against sample bias.
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8. How do Level III intervention studies differ from Level II intervention studies in the NHRMC
hierarchy?
A Level III studies lack any control or placebo condition.

This is true of Level IV intervention studies but not Levels I or II.
B Level III studies lack any blinding of participants or assessors.

Blinding is not mentioned for intervention studies in the NHMRC’s (2009) Levels of Evidence, Table 3.
C Level III studies lack proper random selection or any random selection of participants
from the target population.
Random selection is not random allocation. NHMRC (2009) Levels of Evidence for intervention studies do
not mention sampling methods.
D Level III studies lack proper randomisation or any randomisation of participants to

treatment and control conditions.
Correct, from NHMRC (2009) Levels of Evidence, Table 3.
9. Which of these terms means much the same as hypothesis? Choose the closest match.
A Bias
Researchers can propose a hypothesis without entering into bias.
B Significance
Significance testing goes with hypotheses (“hypothesis testing”) but not all hypotheses involve statistics.
C Prediction
Correct. Hypotheses are predictions for results, almost always relating to quantitative research.
D Result
A hypothesis is a prediction for a result, not the actual result. Hypotheses should come before the results.
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10. The standard design for an experimental study such as a parallel clinical trial involves taking
measurements before and after treatment, and at the same times for the control group. If the
study is a randomised controlled trial, the pre-treatment measures can be considered optional.
Why is this post-treatment only measurement a valid option for a randomised trial?
A Knowing that there is only a single measurement from each group analysed, research
assistants taking the measurements will take extra care to ensure that those
measurements are valid and reliable, and thus provide sufficient information.
We can expect research assistants to take maximum care with their measurements for any study or analysis.
B Both the research assistants and the participants will not have their measurement
methods or their actual results biased from practice effects carried over from the pre-
treatment measures.
Interesting answer but it rests on the risky assumption of practice effects, and besides it’s not the real reason.
C With the randomised control trial there should be no differences or only minimal
differences between groups on outcomes before treatment. Therefore, post-test results
will not be biased by pre-test differences, and will reflect only genuine treatment effects.
Correct. For the randomised trial, the difference between post-treatment results for the treatment and control
groups can be sufficient to identify a valid treatment effect. (Here, “post-treatment” for the control group refers
to the measurements taken from the control group after the treatment group was treated.)
For the non-randomised trial, we need the complete formula from the “Experimental designs” lecture:
Effect = (Treatment group post-test minus Treatment group pre-test) minus (Control group post-test minus
Treatment group pre-test). See the “Quasi-experiment” slide.
Suppose the trial was randomised so both groups scored 1 on the pre-treatment measurement whilst the
treatment group scored 6 on the post-treatment measure and the control group scored 4. The difference
between the post-treatment scores is 2, the same as you get from the long formula that includes the
pre-treatment measure: (6-1) – (4-1) = 5 – 3 = 2.
If the study is non-randomised (e.g., a quasi-experiment) and the treatment group begins with a score of 1
and the control group begins with 2, the difference between the post-treatment measures could still be 6 -4 =
2, but the treatment group has changed by 5 whilst the control group has changed by only 2, so the treatment
effect is 3 rather than 2. We always get the correct effect from the long formula: (6-1) – (4-2) = 5-2 = 3.
D The statement is false. Differences on post-treatments measures from treatment and

control groups are never a valid indicator of a treatment effect.
The previous answer shows this statement itself to be false, and the question statement true.
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11. Suppose that randomised controlled trials and systematic reviews have consistently failed to
demonstrate the effectiveness of a treatment. Which of the following is the most reasonable
explanation for these findings?
A Randomised controlled trials are an inappropriate methodology for evaluating that

particular treatment and instead are a valid only for treatments already proven to work.
Likely a biased, self-serving explanation, more a lame excuse than a reasonable explanation. Few evidence-
based practitioners would make such a claim seriously. We shouldn’t be cherry-picking methodologies to suit
treatments so that only one result is possible. If RCTs are good only for showing that a treatment works (and
not that it doesn’t work) there is no point in doing an RCT. If we know that a treatment works, there is no
need to research its effectiveness.
B The minimum important clinical difference was set to an unrealistically small value.
Choosing small minimum important clinical differences would make it easier to show a treatment’s
effectiveness, if we want to bias the experiment that way. If we’re happy to claim trivial improvements as
important simply to promote our favourite therapies (alternative or not) we’re free to do that, but the rest of
the world may not be convinced, and the patients hardly stand to benefit. If the improvements are very small,
the results are less likely to be statistically significant, but that’s a separate issue from clinical importance.
C The treatment does not work.

Correct. The RCTs and systematic reviews may be valid. If we can’t trust the results from research, how
would we ever know what works and what doesn’t?
D The sample sizes of the experiments were too large, introducing excessive randomness
and therefore swamping the systematic treatment effects that otherwise would have
proved the treatment’s effectiveness.
Gobbledygook. Total rubbish.
12. Which of these study designs has the highest NHMRC level (i.e., lowest number) of evidence?
A Retrospective cohort design for an epidemiological study.

Level III-2 for an epidemiological (i.e., aetiological) study and Level III-3 for a prognostic study. Thus, in the
NHMRC (2009) Table 3, retrospective cohort studies have different levels depending on the research
question. The main idea is that retrospective studies are considered inferior to prospective studies.
B Prospective cohort design for an epidemiological study.

Correct. Level II for an epidemiological study. The prospective cohort study offers the highest level of
evidence for a single epidemiological (i.e., aetiological) study. A cohort design for an intervention study rates
at Level III-2 but that is not an epidemiological study.
C Historical control study.

Level III-3. Historical control studies have the control group data collected before the intervention group data.
D Case series.
Level IV. Case series designs always rate as “low level” evidence. They lack a control condition.
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13. Below is a list of study aims. Which of these study aims is most likely to be achieved using an
intervention study?
A Measure the effectiveness of electrically stimulated (ES) muscle contraction plus

progressive resistance training (PRT) on quadriceps voluntary strength for spinal cord
injury patients.
Correct. A researcher deliberately setting up electrical stimulation and training (i.e., intervening) is not only
possible, but the only way these conditions will happen. An observational study is not possible.
B Examine the influence of smoking during pregnancy on child and adolescent behaviour.
Smoking would be unethical to implement as a clinical research intervention. There would be participant
compliance problems even if an ethics committee allowed it, which it wouldn’t.
C Explore the relationship between air pollution, cardiovascular mortality and

hospitalisation.
It’s impossible for researchers to systematically vary air pollution in a community setting, and it would be
unethical to do so.
D Examine childhood cancer risk associated with diagnostic radiation and ultrasounds in
unborn and infancy from 0 to 100 days of age.
In principle this study could be done using as an intervention but it would be unethical to expose unborn
children and their mothers to such hazards for non-diagnostic purposes. Answers B, C and D would all
require observational studies. Only A is both practical and ethical to do as an intervention study.
Each of these studies is summarised in the Week 1 lecture, yet the question can be answered by looking at each study’s
aims as stated here, and deciding whether an intervention study is practical and ethical.
14. Which of these design features are necessary for an experimental study in the technical rather
than the everyday sense?
A An intervention or treatment, and a no-treatment or a placebo control condition or both.

These features only are essential according to the Research terms study notes.
B Random selection of subjects and random allocation.

Random selection is desirable but not essential, and often difficult. Non-randomised experimental designs
are possible, such as the quasi-experiment.
C Collecting data in a laboratory rather than in a field setting and conducting the study
prospectively, according to a planned scientific protocol.
Not defining features of an experiment.
D All of the above are essential for a study to be classified as experimental.
In the everyday, lay sense of the word, experiment can mean any scientific study whether it has the above features or not.
Note also that the term experiment is not always used consistently, even in the technical literature. Not everyone agrees
about what an experiment is. It’s a matter of definition for a technical term. This 400864 unit offers a definition that has
widespread acceptance.
Students sometimes ask why in this unit everything can’t be said in lay terms. The answer is, we’re training you to become
professional people, not lay people. You’ll need to communicate with other professional people using the vocabulary for that
profession. On the other hand, you may need to communicate using lay terms with patients.
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15. The term control applies to all the following categories except…
A People who do not have the disease or health condition being investigated in a diagnostic
study or a cohort study or a case-control study.
In each of these study designs, a control is someone without the disease or health condition.
B Cases who test negative on a reference test.

Correct. If there’s a reference test we must be talking about a diagnostic study, where a case cannot be a
control. A case has the disease or disorder whilst the control doesn’t. A case may test negative but that
doesn’t make the person a control. In a diagnostic study we speak of someone testing negative on the index
test rather than the reference test, so this answer has two reasons for being the exception of the four.
C Cases who receive a placebo intervention in a randomised controlled trial.

The placebo group can be considered as a control condition in an intervention study. A case is a person or
thing that is sampled. This is a sampling definition of case, but there’s the also its specialised usage for
diagnostic studies, cohort studies and case control studies.
D Cases who receive no treatment in a randomised controlled trial.

Receiving no-treatment at all, not even a placebo, is a control condition. See also the explanation for C.
Case and control both have more than one meaning.

• Diagnostic and epidemiological studies:
 A case is someone with the disease or disorder.
 A control is someone without the disease or disorder.
• Intervention and most other quantitative designs except diagnostic or epidemiological:
 A case is a sampling unit, an example of one thing that is studied. A set of cases makes up a sample. If they are
people, cases might also be called subjects or participants.
 A control is a person or thing that doesn’t belong to the treatment or intervention group in a comparative study.
A control is therefore a “case” (one of the sample) that doesn’t receive the treatment or intervention.
Confusing? You bet!
16. Sharpe et al. (as cited in Taor, May 26-27, 2012) estimate that during the past 20 years, 66,000
children from the United States have been admitted to hospital because they have eaten
batteries, or inserted batteries up their nose or ears. Boys (60% of cases) were more likely to
be admitted than girls, and button batteries were the most common problem (84% of cases).
The study, as described, is best classified as…
A Screening.
B Prognostic.
C Epidemiological.
Correct.
D Aetiological.
Although causes are mentioned, the study isn’t really about why children are admitted to hospital. C is the
better answer.
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17. Which of these reporting quality statements cannot be used to evaluate the reporting quality of
a single (i.e., “primary”) research study, as published in a peer-reviewed journal?
A STARD
B CONSORT
C PRISMA
Correct. The PRISMA is for evaluating the reporting quality of systematic reviews, which always refer to
multiple studies.
D All of the above statements can be used to evaluate the reporting quality of a single
research study.
18. Which of these statements involves an inference.
A Because people who receive the treatment are cured, the treatment causes the cure.
B The patient tested positive on the diagnostic test, so the patient is a case.
C The patient is a case, so the patient must have been exposed to the hazard.
D Each of the above statements involves an inference.

Correct.
The first lecture defines an inference as a “Conclusion or belief based on observation or other available fact”. Each of the
above statements has a conclusion based on an observation. Causal inferences are only one type of inference. Not all
inferences are causal inferences. Answer A has an explicit causal inference. Answer C has an implicit causal inference.
Answer B involves an inference, though not a causal inference because no one would say that testing positive causes a
person to be a case (although they might say that being a case causes the person to test positive). Answer B is
nevertheless an inference, along with A and C.
19. The Cochrane Collaboration biases uses the term performance bias to refer to which problem
that can threaten the internal validity of a controlled intervention study?
A The outcome measurement task is too difficult for either the treatment or control group.
Definitely a threat to internal validity if this problem happens, but it’s not performance bias.
B The treatment and control group experiences do not happen as planned.

Correct, and also known as subversion of the experimental treatment regime. If participants know their group
allocation, they can alter treatments and bias measurements in ways unwanted or unknown to researchers.
C Statistical tests comparing the groups on the outcome measure are invalid.
A threat to statistical conclusion validity.
D Instrumentation.
This threat is about the results being distorted by changes to measurement methods during a study.
Performance bias refers to unplanned changes to intended treatments and control-group experiences during
an experiment, and affecting the results.
See Cochrane Bias Methods Group (2014) for more about biases and how they arise in controlled intervention studies.
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20. Aluminium accumulating in the body has been suggested as a cause of Alzheimer’s disease,
which is a type of dementia. Which of these studies would best serve as evidence that
accumulated aluminium really does cause Alzheimer’s disease?
A Studies showing that high levels of aluminium are associated (i.e., correlated) with other
suspected causes of Alzheimer’s disease.
It’s hard to see how linking aluminium and other possible causes of Alzheimer’s disease says anything about
whether aluminium by itself is a cause.
B Studies showing that people with Alzheimer’s disease have high levels of aluminium in
their body, whereas people without Alzheimer’s disease have low levels of aluminium.
This would be interesting evidence but not the best evidence from the options here. The studies in this
answer are case-control, arguing from effects back to causes, and retrospective, which is a weaker design
than prospective cohort (answer C). On the plus side, at least such studies involve a control condition, unlike
studies in answer D.
C Studies showing that people with high levels of aluminium in their body tend to develop
Alzheimer’s disease, whereas people with low levels of aluminium tend not to develop
Alzheimer’s disease.
Correct. The design is prospective, implicitly longitudinal. It’s also a cohort design, arguing forwards from
putative causes to effects. This is the strongest evidence we’ll get from this list of observational studies.
A controlled trial would give better evidence but would, of course, be impractical and unethical.
D Longitudinal studies showing that people who use aluminium cookware, eat processed
foods manufactured using aluminium equipment, or use deodorants containing aluminium
get Alzheimer’s disease later in life.
Interesting idea for a study, and such evidence could arouse suspicions about aluminium and Alzheimer’s
disease. However, no control condition is mentioned, that is, nothing about people whose lifestyles involve
low exposure to aluminium. The absence of any comparison condition weakens this design.
The studies mentioned in the answers are imaginary. If you are interested in the alleged relationship between aluminium
and Alzheimer’s disease, click here for an Alzheimer’s Australia fact sheet, which you don’t need to read for the exam. You’ll
find there’s no urgent need (so far known) to throw out your aluminium pots, pans and drink bottles, avoid factory foods
processed using aluminium equipment, nor to skip the regular roll-on and conduct your social-life entirely by computer.
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21. Health authorities become concerned that people using tablet computers on wireless networks
for long periods may be exposed to enough radiation to damage their health. Which of these
statements, if true, would illustrate confounding of the relationship between tablet computer
usage over wireless networks, and the risk of damage to health?
A People who use tablet computers for longer periods than other people also use wirelessly
networked mobile telephones for longer periods than other people.
In this scenario, use of tablet computers is positively correlated with mobile phone use.
B People who can afford tablet computers have higher incomes than those who can’t, and
wealth is known to be correlated with health.
In this scenario, use of tablet computers is positively correlated with wealth.
C People who spend more time using tablet computers get less exercise than others who
rely on mobile telephones for wireless networking.
In this scenario, use of tablet computers is negatively correlated with exercise.
D All of the above answers are correct.

Correct. All of the above answers illustrate confounding of a putative cause and effect with a background
variable that’s also related to the outcome.
JB has informally heard that in the UK people are being cautioned against using wireless networked tablet computers on
their laps or close to their body because of potential risks from extended exposure to radio frequency radiation. It’s
suggested that handheld computers be placed on a tabletop to increase the separation between the device and the body.
Some important organs in the lower abdomen are prone to cancer. Tablet computers tend to be used for longer periods
closer to the body than mobile phones, which presumably increases cumulative exposure to radiation from tablet computers
compared with mobile telephones. You can be sure that this is one public health issue that will receive more research. At
present it seems no one can advise whether precautions are needed or whether the problem is just another health scare.
22. Which of these principles is not one of the criteria that Hume says we habitually use when
inferring cause and effect?
A The putative cause and its effect happen in the same place.
Hume argues for contiguity (i.e., closeness) of time and place.
B The putative causal relationship makes logical sense.

Correct. Instead, Hume argues that causal inferences are not based on logic.
C The putative cause happens just before the effect.

Hume argues exactly this for causal inferences.
D We always see the effect with the putative cause, and we never see the effect without the
putative cause.
Hume argues for constant conjunction.
Hume’s is a psychological theory, explaining how we decide whether one thing causes another. Hume says that certain
types of observations – see Causality notes – encourage us to make causal inferences, but these inferences are based on
habit rather than logical reasoning. According to Hume, the logic of how we make causal inferences is faulty, even though
our habit mostly serves us well in everyday life.
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23. According to Hume, why are causal relationships impossible to prove?
A Delayed effects are possible, with the effect happening so long after the cause that the
causal relationship goes unnoticed.
The statement is true. Of course there can be delayed effects, but that’s not what Hume said about the
difficulty of proving casual effects. Delayed effects are a problem for us if Hume’s theory describes how we
infer causality. That’s because delayed effects go against the principle of contiguity in time. Nevertheless,
answer B is what Hume said about the reliability of causal inferences. Delayed effects are perfectly possible
in real life, for example, the very delayed (and deadly) effects of asbestos.
B Our future observations may differ from our past observations.

Correct. No matter how many times we observe a supposed cause and effect relationship, these
observations don’t prove that the same relationship will always be observed. A future exception to the rule
can never be excluded. According to Hume, future causal inferences cannot be guaranteed correct.
C Science is mathematical, and mathematics says nothing about causality.

No one, least of all Hume, claims that science is purely about mathematics. Mathematics may say nothing
about causality, but that’s beside the point.
D Other events can moderate (i.e., affect) a causal relationship.

The statement is true – see Causality notes – but it’s not what Hume said about proving causal relationships.
24. Which of these observations about your dining experience at Greasy Joe’s food bar is most
consistent with David Hume’s theory of causality, and its support for the inference that dining at
Greasy Joe’s is making you sick?
A Whenever you dine at Greasy Joe’s, you immediately feel ill, even before leaving the
shop.
This scenario meets the conditions for a causal inference according to Hume’s theory.
B The only time you dined at Greasy Joe’s, you were ill for a week.
There’s no evidence of constant conjunction. The event was a one-off.
C A few days after dining at Greasy Joe’s, you began to feel queasy (i.e., not very well).
The delay between the putative cause and effect rules this scenario out. Something else could have
happened between dining at G.J.’s and your feeling ill. That other, intervening event could be the cause. The
scenario as described could also have been a one-off event.
D Sometimes you feel ill after dining at Greasy Joe’s, while on other occasions you feel OK
after dining there.
Constant conjunction doesn’t happen, so the inference is weakened. Think also “necessary connection.”
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25. It’s been said that winners aren’t quitters, and quitters aren’t winners. If both of these
statements are true, which two cells in this contingency table could have at least one
person in them?
There won’t be a question exactly like this in the exam because this question has two correct answers.
All questions in the exam have only one correct answer.
Non-quitters Quitters
Winners A Correct B
Losers (non-winners) C D Correct
26. From the previous question’s scenario and its contingency table, what can we conclude about
winning and quitting?
A Not quitting is both necessary and sufficient for winning.

From the above two statements there’s no guarantee that not quitting is enough (sufficient) for you to win.
Just because all quitters are losers and no winners are quitters doesn’t mean that all non-quitters are
winners. It’s possible not to quit and yet lose. Neither statement implies that not quitting is sufficient for
winning. People could land in cell C (i.e., losers who didn’t quit). Plenty of athletes train hard and yet lose.
B Not quitting is sufficient for winning.

Incorrect for the same reason that answer A is incorrect.
C Not quitting is necessary for winning.

Correct. Every winner is someone who hasn’t quit. To reverse the wording, quitting is sufficient for losing,
an alternative correct answer. If you quit, you lose. Cell B (i.e., winners who quit) must remain empty.
D Not quitting is neither necessary nor sufficient for winning.

Incorrect for the same reason that answer C is correct.
What could the above two questions have to do with healthcare? A lot, if we think about treatments and outcomes, and
exposure to hazards and subsequent outcomes.
• Only if the treatment is necessary and sufficient for a beneficial outcome can we expect all treated patients to
improve, and all untreated patients not to improve.
• Only if the hazard is necessary and sufficient for a bad outcome can we expect all exposed people to get the bad
outcome, and all unexposed people to avoid the bad outcome.
• Sporty people may also think about the relationship between winning and quitting.
See also the next two questions, and expect something in the exam along these lines.
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27. Mill argued that a cause is necessary and sufficient for its effect. If the treatment is
sufficient for the cure, in which of these contingency table cells will there be no (i.e., zero)
patients?
Not cured Cured
Treated A Correct B
Not treated C D
Getting the answer requires reasoning. Here is the logic:

• If the treatment is necessary, then only patients who are treated will be cured. There will be no patients who are
cured but untreated. No treatment → no cure.
• If the treatment is sufficient, then all patients who are treated will be cured. There will be no patients who are
uncured but treated, hence answer A. Treatment → cure.
• Therefore, if the treatment is necessary and sufficient, all treated patients will be in cell B and all untreated patients
will be in cell C. This would be a strong test for an effective treatment. Evidence-based practitioners would get
excited about such a result.
Mill says a causal effect involves both necessity and sufficiency. See Mill in Causality notes for more information.
28. If a treatment is sufficient for a cure, and some patients are treated whilst others are not
treated, in which of these contingency table cells must we find at least some patients?
Not cured Cured
Treated A B Correct
Not treated C D
The answer to this question follows logically from the answer to the previous question. The treated patients have to appear
somewhere in their row. There has to be a column for them.
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29. Research into the causes of cardiovascular disease has found that a diet high in saturated fats
and trans-saturated fats can raise levels of certain blood lipids and cholesterol, in turn causing
coronary arteries to clog with fatty deposits which restrict the heart’s blood supply and lead to
serious health conditions such as angina-pectoris (extreme chest pain on mild exertion) and
heart attacks. We might say that the causal relationship between diet and cardiovascular
disease is…
A Indirect.
Correct. Diet triggers a chain of events, with each one in turn eventually leading to cardiovascular disease of
the type described above. Indirect causal relationships are common in health science.
B Direct.
The relationship is not directly causal because other, causally linked events happen between diet and
cardiovascular disease. It’s the consequences of the diet, rather than the diet itself, that make people sick.
C Spurious.
There is no confounding occurring in this model of cardiovascular disease. See the second lecture for more
about spurious relationships and confounding.
D Moderator.
See Causality notes about moderator effects. Briefly, a moderator relationship occurs when a third variable
affects the strength of the causal relationship between two other variables. That’s not happening in this
model of cardiovascular disease.
See generally from Causality notes as well as the second lecture.
30. Patients whose chronic pain has recently worsened to a severe level are especially selected for
a study testing non-contact therapeutic touch (NCTT). After receiving NCTT, the patients report
an improvement in their condition – less pain. The change could have occurred because NCTT
really does relieve pain, or the change could be due to…
A Allocation bias.
The scenario doesn’t mention allocation to groups. There may have been only one group.
B Testing.
It’s hard to imagine how testing for pain would actually relieve the pain. Nothing in the above question
suggests testing could reduce pain. The question wording hints at regression to the mean because
participants were selected because of their extreme scores on pain. The second lecture says more about
“testing” as a validity threat.
C Compensatory rivalry.
Not really. Compensatory rivalry occurs when the control group tries to outdo the experimental (intervention)
group. There’s no suggestion in the above question that the study even has a control group.
D Statistical regression to the mean.

Correct. The risk of regression to the mean increases when research participants are selected especially
because of their very high or low performance on an outcome that varies naturally and randomly over time.
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31. A researcher finds that people who often drink large quantities of alcohol tend to get the types
of respiratory diseases that are associated with smoking. The researcher concludes that
alcohol must be another cause of respiratory disorders, until the researcher’s research
methods students point to additional evidence that people who drink heavily also tend to smoke
or hang about with smokers. The students argue that, in the researcher’s study, alcohol
consumption and smoking could be…
A Randomly associated with respiratory diseases.

Let’s hope that UWS Research Methods students wouldn’t say that.
B Uncorrelated.
The students would instead argue that smoking and alcohol consumption are, in fact, correlated.
C Biologically plausible.
This explanation doesn’t make a lot of sense in this scenario, but it can be important for other scenarios.
D Confounded.
Correct. Confounding is an issue for aetiological studies as well as intervention studies. Whenever two
variables are associated, their relationship with a third variable can be confused.
32. Which of these possibilities directly threatens a study’s external validity?
A Mortality.
An internal validity threat, and therefore only indirectly threatening external validity.
B Statistical conclusion validity which, if there’s a problem with it, will make the research
results invalid so the results of the study will be unlikely to generalise.
True, but statistical conclusion validity will affect interval validity before it affects external validity, so the
threat to external validity is indirect.
C The laboratory environment in which many research studies take place may not resemble
conditions in the wider world.
Correct. External validity is about whether results generalise to the intended, real-world setting and the
larger, target population. The laboratory environment may be so artificial that results don’t transfer to practical
settings where many other things are happening that influence the results.
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33. In which of these intervention study designs involving a treatment-group, a pre-test and a post-
test could placebo effects be impossible to distinguish from other effects? Assume no validity
threats other than those implied by the study descriptions below.
A Randomised trials with a control group but no placebo group.
B Randomised trials with a placebo group but no control group.
C Non-randomised trials with a control group and a placebo group.
D A and C.
Correct. Where there is no pseudo-treatment placebo group, it’s impossible to say whether a treatment effect
occurred because of the placebo effect or because the treatment really was effective. Just because the
treatment and control groups differ on the post-test doesn’t mean that the treatment works beyond any
placebo effect. That’s why answer A is reasonable. For answer B, change for treatment and placebo groups
can be compared, the difference being attributable to the placebo effect. With answer C, any effects arising
during the study, including placebo effects, could be confounded with allocation bias across the three groups.
34. What is a ratio?
A The answer we get when we divide one number by another.

Correct.
B A measurement scale in which there are equal amounts between scale values.
Not necessarily, and the question asks only about a ratio rather than a ratio scale.
C Any comparison between two different numbers.

We can compare numbers by subtraction to get the difference, which is not a ratio. We could also
(pointlessly) obtain a ratio between two numbers that are the same, and always get 1 for the answer.
D Any fractional value between zero and unity only (i.e., only between 0 and 1).
Ratios can be higher than 1. If an event is 10 times more likely than another event, that’s the ratio of one
event’s frequency to another’s.
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35. Ratios are important for healthcare practice and policy because…
A Evidence-based practitioners understand ratios more easily than they understand other
statistical measures.
Not necessarily true, and the scenarios presented during lectures suggest that this statement is not true.
B Ratios show how many people need to be treated or how many people need to be
protected from risk in order that one person benefit.
The number needed to treat and variations on that statistic are calculated from the absolute risk difference,
which is not a ratio.
C All healthcare involves at least some element of chance, which is ideally represented by
the odds ratio, as horse-racing punters readily understand.
Any answer claiming insight into the minds of racecourse tragics has to be dodgy.
D Ratios enable the comparison of outcomes among groups exposed to different

treatments or hazards.
Correct. For example, a ratio of 2¼ could mean that the risk of recovery after treatment or illness after
exposure to a risk is more than double compared with no treatment or no exposure to a risk.
36. What should an evidence-based practitioner look for when appraising the quality of a
systematic review?
A A list of databases and the search terms used to find the primary studies.
B Appraisal of the risk of bias in the primary studies.
C Evidence that the review authors themselves have published numerous primary studies.
Author prestige is a commonly applied but false indicator of research quality, whether for systematic reviews
or primary studies. It’s the quality of the information which proves the quality of the author, not the reverse.
D A and B.
Correct, from the systematic reviews lecture.
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37. In systematic reviews, what happens when there is a problem with heterogeneity?
A The primary studies are so different and diverse that it makes no theoretical or statistical
sense to combine the results in meta-analysis.
Correct.
B The individual subjects are so different and diverse that it makes no theoretical or
statistical sense to combine their results in meta-synthesis.
Meta-synthesis applies to reviews of qualitative research, so statistical arguments are irrelevant. Beyond that,
the diversity of individuals who are eligible to participate in a study presents no problem for qualitative
researchers.
C Too much diversity is evident in the pooled results from combined studies.
When heterogeneity is a problem, the pooled results conceal the diversity.
D The outcome measures are unequal across different studies.

It’s unrealistic and unnecessary to get exactly the same results across a series of studies.
38. In the context of systematic reviews, what is meant by “salami slicing”?
A Researchers dividing their results from a single study across multiple publications, giving
the false impression of more information than there really is.
Correct. The other answers are simply wrong.
B Multiple systematic reviews reporting the same studies, giving the false impression of
more information than there really is.
C Systematic reviews combining too many studies into a single meta-analysis, giving the
false impression of less information than there really is.
D None of the above definitions of salami slicing are true.
39. In systematic reviews, numerical results of multiple quantitative studies are summarised
graphically in a…
A Scatter-plot.
Used to illustrate a correlation between two continuous variables.
B Funnel plot.
Used in systematic reviews to illustrate heterogeneity among a set of studies. Because funnel plots weren’t
discussed in this unit, this answer has to be a distracter.
C Forest plot.
Correct.
D ROC curve.
Used in diagnostic studies to illustrate the relationship between the false positive rate and sensitivity, which
serves to indicate diagnostic accuracy.
Be sure to understand how to interpret a forest plot. See the example in statistics practice items, when available.
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40. Which of these statements about meta-analysis is true?
A All systematic reviews include meta-analysis.
B Meta-analysis combines data from qualitative studies to produce summaries and new
insights.
Where there are no numbers, as in qualitative research, there cannot be meta-analysis. Qualitative
researchers have developed meta-synthesis, which is altogether different from meta-analysis.
C Meta-analysis can be done with quantitative and qualitative data.

If B is wrong in the previous question (and it is wrong) then this answer must also be incorrect.
D Meta-analysis is a statistical technique.

A simple answer but correct.
41. What is one reason why degrees Celsius is considered to be an interval rather than a ratio
measure?
A The boiling point of water is 100 degrees Celsius, which is a low number for a high
temperature.
Irrelevant to the definition of an interval scale, and the claim is overly subjective.
B The temperature can drop below zero degrees Celsius, so there is still some heat in a
system at 0° Celsius.
Correct. Zero degrees Celsius doesn’t mean “no heat” or “zero temperature”. Zero on a ratio scale genuinely
means “nothing” (i.e., no quantity of what’s measured). Equal-sized units of measurement are what makes an
interval scale. Only on a ratio scale does zero have to mean “nothing”.
C On the Celsius scale, 100 degrees (the boiling point of water) is 100 times hotter than
zero degrees (the freezing point of water).
The statement is false. If the statement were true it would show that degrees Celsius is a ratio scale rather
than an interval scale.
D A degree change on the Celsius scale is the same temperature difference as a degree
change on the alternative Fahrenheit scale.
False, and irrelevant to the definition of an interval scale.
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42. Why does it make no practical sense for researchers to calculate the average postcode from a
sample of Australian residents, even though it’s statistically possible to do so?
Choose the best explanation.
A Australian postcodes are measured on a nominal scale.

True, but B is the better explanation.
B Postcodes in Australia refer to categories rather than quantities. Averages are meaningful
only when describing measured amounts rather than group membership.
This is the best answer. It explains why average postcodes are not meaningful.
C Postcodes are an ordinal measure because states that are further away from New South
Wales have higher numbers than New South Wales, so averages do not apply.
Even if the geography lesson were correct (and it isn’t) postcodes are allocated arbitrarily, so the postcode
measurement scale is nominal.
D There is no postcode equal to zero.

Presumably true, but a scale need not include zero for a meaningful average to be calculated.
The next question is based on a past exam item. Students said they found the question challenging
but interesting. The question worked well for the exam but was dropped because it wasn’t relevant to
healthcare. The question below is modified to make it much harder than the exam question.
43. Which of the following is measured on an ordinal scale?

Note: All questions in the real exam have four answer options running from A to D only.
A A credit-card number.
Nominal scale. The credit card number doesn’t measure any amount. It’s only a label.
B The number of interest-free days on a credit card.

Time, as measured by a number of days (or minutes, hours or years etc.), is always ratio scaled.
C A credit card’s valid date range.

Yes! Credit-card expiry dates are expressed as months and years. Time is normally ratio scaled (i.e., zero
seconds, minutes, days etc. is no time at all) but not all months are the same length, so the intervals along
the scale are unequal, which rules out interval and ratio scaling. The measurement refers to an amount of
time so it can’t be nominal. It must therefore be ordinal.
D A credit-card interest rate.

Ratio scale. Zero interest means no interest at all. Nice card if you can get it. There’s no need to pay the bill.
E The amount owing on the credit card.

Amounts of money, as in number of dollars or other currency, are ratio-scaled. Zero dollars is no dollars.
F A credit-card spending limit.

Also expressed as a number of dollars, thus ratio, as per E above.
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44. What measurement level is this rating scale?
0 = None 1 = Low 2 = Medium 3 = High 4 = Very high
A Nominal
The scale values are in a set order and imply a quantity, so the scale is about amounts, which rules out
nominal measurement.
B Ordinal
Correct.
C Interval
We can’t be sure that the gaps between numbers refer to equal differences in what’s being measured, ruling
out interval and ratio measurement.
D Ratio
Let’s hope you weren’t taken in by the zero. It takes more than “zero = none” for a scale to be ratio. Equal
intervals are needed as well.
45. Measurement systems exist for many clinical characteristics. Click the link to the Bristol Stool
Chart, sourced from a National Health Service affiliated site in the UK. The Bristol Stool Chart
is not about bar-room furniture. The Chart is otherwise self-explanatory. After viewing the
Bristol Stool Chart, answer the question by selecting the level of measurement for this scale.
A Nominal
The scale involves more than just discrete categories. There is an ordering from Types 1 to 7 on the scale.
B Ordinal
Correct.
C Interval
We cannot say there are equal intervals on this scale. The difference between Types 1 and 2 on the Bristol
Chart are not obviously the same as from 2 to 3, or 3 to 4 etc. Therefore, the scale is not interval.
D Ratio
If the scale hasn’t equal intervals, it cannot be an interval scale and therefore cannot be a ratio scale either.
The absence of zero on the Bristol scale is another clue to its not being a ratio scale.
Page 22
46. A clinical measuring instrument keeps giving you different readings from the same person at
the same time, even though you’re consistently using the same measurement methods and
what you’re measuring couldn’t have changed. The measuring instrument has high…
A Test-retest reliability.
The instrument can’t be highly reliable if its readings keep changing when they should be constant.
B Bias.
The readings could indeed be biased, but we can’t say that for sure from the scenario.
C Random error.
Correct. If the results are different each time, when what’s measured is constant, that’s a sign of random
error. With random error, each reading can’t be predicted from the reading before it. The average reading
might be highly predictable despite random error, but the scenario doesn’t suggest that, and doesn’t need to.
D Systematic error.
Systematic error is reliable, and would tend to give the same though inaccurate results with repeated
measurement. Systematic error would not lead to different readings where the true score is constant.
47. Which of these statements is true about sample bias and sample size?
A Systematic sampling helps to reduce random sample bias.

A nonsense distracter.
B Increasing the size of a random sample helps to reduce sample bias.

Correct.
C Small samples are always more biased than large samples.

Not necessarily true, though likely to be true with random sampling. Answer B is better.
D Sample bias and sample size are unrelated.

Not true for random samples.
48. Which of these biases cannot affect the internal or external validity (or both) of a randomised
controlled trial?
A Selection bias.
B Publication bias.
Correct. Publication bias can affect systematic reviews and may prevent the results from being published, but
does not in itself affect the validity of a single study’s results, or whether the results would generalise to the
wider clinical population.
C Allocation bias.
D Attrition bias.
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49. A researcher wants to survey students doing different courses, such as health science,
medicine, nursing, natural science, commerce, arts and engineering. It’s well known that
different courses attract different proportions (percentages) of males and females. The
researcher wants to survey equal numbers of males and females from each course. An
appropriate sampling method would be…
A Simple random sampling.

This method would almost certainly reproduce the original gender imbalances in each course.
B Systematic sampling.
It’s hard to imagine how this would correct the gender imbalance within courses.
C Disproportionate stratified random sampling.

Correct. This method, properly done, would equalise gender numbers within each course.
D Proportionate stratified random sampling.

This method would preserve the gender imbalances.
50. How would you select a purposive sample of apples from a fruit shop display?
A Select only apples that suit your purpose, such as Granny Smiths for cooking.
Correct.
B Select only apples within easy reach.

More like convenience sampling.
C Use any non-probability sampling method.

Not just any non-probability sampling method.
D Find one apple you want, then select the other apples from nearby on the display.
Snowball sampling is the closest approximation to this answer.
51. Construct validity of a test refers to whether…
A The test genuinely measures what the test should measure, and nothing else.
Correct.
B Whether test is too easy or too difficult, on average.

Difficulty could affect validity, but it’s not the definition of construct validity.
C To most people, the test looks as if it measures what the test should measure.
This answer refers to face validity.
D The test includes everything relevant to what the test is intended to measure.
This answer refers to content validity.
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52. It’s difficult to design a set of exam practice questions to cover exactly the same content as the
final exam. In that case, the practice question set may have problems with…
A Face validity.
Face validity of a content-deficient test could still be fairly high.
B Internal consistency.
The unit hasn’t mentioned this topic, so it has to be a distracter, and anyway it’s wrong here.
C Content validity.
Correct.
D Discriminant validity.
A type of validity not mentioned in this unit, and an incorrect answer.
53. A student accidentally submits two identical copies of an assignment. Both copies are marked
separately by the same marker, without that marker realising that the same assignment was
being marked twice. Scores for some sections vary slightly by plus or minus amounts between
the two markings. Total scores, calculated as the sum of the section scores, are almost the
same for the two copies.
What conclusion can be drawn from this experience?
A Detection bias was low because the marker had not matched the assignments, which
further shows that blinding is an effective strategy for increasing internal validity.
This scenario is about measurement rather than controlled trials. Detection bias applies to controlled trials.
B Intra-rater reliability was high.

Correct.
C Random errors accumulate to increase the amount of bias.

Because random errors are unbiased, they tend to cancel out over multiple measurements, in this case
leading to near agreement between the two total scores. This is partly why Research Methods assignments
were scored over sections, to reduce the effect of random error on the total score. Perfect reliability is near-
impossible for judgemental measures of performance. There is a hypothetical confidence interval around all
such scores. With repeated assessment, your grade-point average will reflect your actual performance.
High performing students consistently receive good marks.
D Both final scores were invalid.

Lack of perfect agreement doesn’t prevent either of the observed scores from equalling the true score.
True scores can never be directly measured but can only be estimated. If, after reading this scenario you’re thinking of
having your assignment marked again, remember that the first mark you received could be higher than what you get next
time. Multiple-choice exam scores, where there is no judgement in marking, can also change with repeated assessment
because your own performance will vary randomly over time. The only way to remove random variation is for you to do an
infinite number of assignments and exams, and for your essays to be marked an infinite number of times. Then the positive
and negative random errors will cancel out to give a mean random error of zero. You will never finish your course, and
strictly you should repeat your HSC every year forever so you can get a true score for that test as well. If the assessment is
biased, then even doing an infinite number of assessment won’t remove the systematic error from the bias.
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54. Inter-rater reliability problems occur when two raters…
A Have different opinions about what a person’s score on a test should be.
Correct.
B Compare their results on two different tests.

Inter-rater reliability refers to whether raters agree about results from the same test (done at the same time
by the same person). Bringing comparisons of two tests into the scenario only muddies the waters.
C Award some people higher scores than other people receive on the same test.
That some people score higher than others on a test is not in itself a reliability problem.
D Change their own opinions about what a person’s score on two tests should be.
This is more likely to be a test-retest reliability problem. The answer is about the single rater rather than
comparing two raters. It’s a messy distracter.
The Measurement study notes have plenty to say about types of reliability.
55. All other things being equal, which of two tests will be the more reliable?
A The harder of two tests (i.e., the average score is lower).
B The easier of two tests (i.e., the average score is higher).
C The longer of two tests (i.e., the test which has the more questions).
Now you know why multiple choice examinations have many questions. A longer test has a larger sample of
questions so the test are less prone to biases and other problems affecting reliability. Imagine the unreliability
(and resulting invalidity) of a exam with only a few questions.
D The shorter of two tests (i.e., the test which has fewer questions).
56. Which of these statements is true about diagnostic accuracy studies?
A Reference test scores accurately record whether or not controls have the disease.
If they were controls they would not have the disease.
B On a reference test, people known not to have the disease are called negatives.
Positive and negative are terms used for index tests, not reference tests.
C Index test scores may be inaccurate (i.e., invalid).

Correct, and that’s why studies of diagnostic test accuracy are done, to measure index test accuracy.
D On an index test, people known to have the disease are called cases.
Cases and controls are reference test, not index test, categories.
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57. When is a clinician most likely to use an index test?
A When patients score extremely high or low on continuous scale, so a highly sensitive and
specific reference test is not needed for diagnosing what is obvious true at first sight.
The longest answer is not always the best.
B When results on the reference test cannot be trusted as accurate despite assertions to
the contrary in published literature.
An incorrect answer designed simply to distract.
C When no reference test is available, or the reference test is too expensive to use in
everyday clinical practice.
As per the next and correct answer, index test and reference test are concepts that apply in a research
context rather than in everyday practice. In everyday practice, clinicians use tests without calling them index
or reference tests..
D When researching the accuracy of a test by comparing its results to those from a
separate test of proven or accepted high validity.
Correct. Index test and reference test are terms used in studies of diagnostic accuracy rather than in
everyday clinical practice.
58. A health screening program aims to find as many people as possible who show signs of having
the disease. These people will then receive further testing to see whether they really do have
the disease. To make the program worthwhile, the diagnostic screening procedure should be
designed to increase the number of…
A Positives.
Correct. The screening program aims to identify anyone who may have the disease. It can achieve this only
by classing people as positive. With a screening test there is tolerance for false positives because they can
be identified during further, more accurate and expensive testing (even if they get a fright before that
receiving the good news that they don’t have the disease).
B False negatives.
Definitely not. We don’t want to increase false anything. Moreover, false negatives are cases who don’t get
identified. They’ll miss the further testing, they wont’ be identified as cases and won’t received treatment.
Eventually, perhaps when it’s too late, they’ll find out they’ve got the disease.
C Controls
Testing can’t change whether a person does have the disease (case) or doesn’t have the disease (control). If
the diagnostic screening procedure could, in fact, increase the number of controls, that would make it an
effective treatment – most unexpected!
D False cases.
There’s no such thing as a false case.
In the tutorial about diagnostic accuracy, the four index tests, and especially the modified carpel compression test, returned
a lot of negative results, mostly false negatives, people who really did have carpel tunnel syndrome which was not identified
by the tests. These findings suggest that these tests would be ineffective as screening tests for carpel tunnel syndrome.
Page 27
59. Suppose a diagnostic test is totally inaccurate, giving the wrong result for every patient tested.
What could we best conclude about the results from this test?
A The test results are perfectly correlated with the patient’s disease status: case or control.
Correct! If the test is always wrong, then all cases will test negative and all controls will test positive. The
patients’ disease status is perfectly predictable from these results. Perfect prediction is perfect correlation.
We just need to reverse the test results to get the right results: Say all negatives are positive and all positives
are negative. Of course, we must know the test is always wrong before sensibly making this conversion.
Here’s another correct answer: Sensitivity, specificity, and positive and negative predictive values = zero.
B All true positives are false positives, and all true negatives are false negatives.
If the test results are always wrong, there will be no true positives and no true negatives.
C All false positives are true negatives, and all false negatives are true positives.
The logic is correct but the labelling for this answer is incorrect. All false positives are controls (true
negatives) and all false negatives are cases (true positives). Answer A is better as written.
D Test results are effectively random when compared with the patients’ true disease status.
Getting it wrong every time is systematic, not random. Even gamblers sometimes bet correctly and win.
Here’s an open-ended teaser question: If test results really were random with respect to the patients’ actual
disease status, could we predict the diagnostic accuracy results: Would sensitivity, specificity, and positive
and negative predictive values all necessarily = 50%, as we might expect from a coin-flipping exercise?
Next, if all diagnostic accuracy measures = 50%, does that always mean the test results are random?
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60. Which of these statements is true about diagnostic tests?

A curly question if ever there was one. Try to think it through. If necessary, fire up the discussion board.
A If all patients who test positive are cases, then all cases will test positive.
It’s possible to have most people or all people testing positive being cases, while having a lot of cases testing
negative. High positive predictive value (positives are cases, few false positives) doesn’t imply high sensitivity
because there could be a lot of false negatives (low sensitivity).
B If all cases test positive and all controls test negative, then all positives will be cases and
all negatives will be controls.
Correct. Such a test would have perfect sensitivity (all cases test positive) and perfect specificity (all controls
test negative). The test will also maximise the positive and negative predictive values. If all cases are testing
positive, there will be no false negatives, so all negatives must be controls. If all controls are testing negative,
there will be no false positives so all positives must be cases. If confused, draw a table using made-up
numbers and see how it works. The positive and negative predictive values will also be perfect, both 100%.
C If all cases who test positive are false positives, that means there can’t be any controls.
A case can never be a false positive. A case must either test as a true positive (good test) or be a false
negative (bad test). As for there being no controls, false positives must be controls.
D If all patients who test negative are false negatives, that means there can’t be any false
positives.
Yes there can. If all patients testing negative are false negatives, that says nothing about positives, some of
whom may be controls. The controls (perhaps all of them) could test positive without affecting how well cases
are identified. Cases and controls are separate categories with their own sets of results. So are positives and
negatives. Having all negatives false doesn’t prevent a false positive.
Some extra facts relevant to this question:
1. Sensitivity and specificity are logically independent. You can’t tell what’s happening with one just by looking at the
other. A good test will score high on both, but that’s an empirical finding and not a logical rule. Bad tests can score
low on either or both. The same applies to positive and negative predictive values.
2. For two-way tables, such as 2 x 2 tables, the row and column percentages are logically independent within a table
cell. You can’t figure out one by looking at the other in the same table cell. This principle links to diagnostic
accuracy because sensitivity, specificity, and positive and negative predictive values can be considered in terms of
row and column percentages, as the Week 7 tutorial shows.
Suppose all negatives are false and all positives are false. That means all cases are testing negative and all controls are
testing positive. Such a test is worse than useless. It’s complete rubbish, total junk, with every diagnostic decision wrong.
Let’s hope that disaster never happens in your practice, or you’ll be treating only patients who don’t need treatment, and
never treating patients who do.
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61. The best way to increase the accuracy of a diagnostic test is to choose an index test that…
A Increases the number of true positives and true negatives on the reference test.
Reference tests are assumed to be valid. There can’t be any false readings, so the number of true readings
is already maximised. We speak of positives and negatives on index tests rather than reference tests.
B Increases the sensitivity and specificity of the reference test.

We speak of the sensitivity and specificity of index tests, not reference tests.
C Has a high cut-off score, in order to screen out controls.

A high cut-off score will help screen out controls (i.e., reduce false positives) but alone it won’t increase the
index test’s accuracy. Raising the cut-off score to reduce the number of positive results, and thus false
positives, can increase the number of false negatives.

Correct.
How do we increase the accuracy of a diagnostic test? The lecture on diagnostic studies says how.
62. A researcher wishes to study how preferences in music change with age. The plan is to
compare music preferences for 15-year olds and 40-year olds. How would the researcher
conduct a prospective, longitudinal study to address this issue?
A Find a sample of 15 year olds and play them today’s pop music. Soon afterwards, play
them pop music of 40 years ago, then ask them which music they prefer.
This is a cross-sectional study examining 40-year old music rather than 40-year people.
B Find a sample of 15 year olds and play them today’s pop music. Soon afterwards, play
them pop music of 25 years ago, then ask them which music they prefer.
Another cross-sectional study, and it doesn’t examine the music preferences of 40-year olds.
C Survey a sample of 15-year olds with parents who are 40 years old. Compare the
teenagers’ music preferences with a survey of their parents’ music preferences.
Another cross-sectional design, though a better design than A and B.
D Survey a sample of 15-year olds about their music preferences, then wait 25 years and
survey the same group about music preferences again, when they have turned 40.
Correct. See the Research terms study notes, the Week 1 lecture and the Epidemiology lecture.
Page 30
The next question refers to Table 1. Each arrow refers to an individual disease case. For each case,
an arrow begins when the disease started. The length of the arrow shows the duration of the disease.
Table 1
Summer Autumn Winter Spring
63. Which season in Table 1 shows the highest prevalence of the disease?
A Summer
B Autumn
C Winter
D Spring
Correct.
64. Health authorities suspect Greasy Joe’s Food Bar as the source of an outbreak of food
poisoning. How would a case-control study identify whether eating at Greasy Joe’s could
be making people sick?
A See whether people who eat at Greasy Joe’s are more likely to get food poisoning
compared with people who eat at the nearby Golden Staph Café.
A cohort study.
B Randomly allocate healthy people to eat at Greasy Joe’s or the Golden Staph Café,
and later compare the rates of food poisoning among the two groups of diners.
An intervention study, a randomised trial.
C See whether people diagnosed with food poisoning are more likely to have eaten at
Greasy Joe’s compared to people without food poisoning.
Correct.
D Close down Greasy Joe’s.

Not the correct answer, but perhaps a good idea.
Page 31
65. Which of the following has a meaning identical to the term paradigm?
A Methodology.
A plausible distracter, but incorrect. A methodology is an approach to doing research, and is based on a
paradigm rather than being a paradigm itself.
B Ontology.
C Epistemology.

Correct. Compare the definition of a paradigm (from the Qualitative lecture) with the other answers to see the
difference.
66. Which of these statements is true?
A The critical paradigm challenges beliefs and assumptions which are so widely held that
they are rarely, if ever, questioned.
Correct. According to the critical paradigm, most of us live in a state of false consciousness.
B The subjective paradigm argues that objective reality is socially constructed.

There is no recognised “subjective paradigm”.
C Logical positivism argues that a statement is meaningful only if it is true.

Not quite. Logical positivism argues that meaningful statements must be verifiable, which is not to say that
they are true, rather that they can tested for truth. See also the next question.
D All of the above statements are true.
67. Someone claims that if you travel back in time and kill your great grandfather before he had
any children, you will instantly disappear because without your great grandfather alive to have
children, you could not exist. How would a logical positivist most likely evaluate this claim?
A The claim is false because if you exist then you cannot have killed your great grandfather
before he had children, and it’s easily confirmed that you exist.
B The claim is false because time travel is impossible using current technology.
C The claim is true because it’s logically impossible for any child to be born if an alleged
ancestor had no children.
D The claim is meaningless because it cannot be shown empirically to be true.

Correct. If the claim cannot be verified, for a logical positivist the claim has no meaning.
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68. A 37-year old female acquaintance of JB’s has undergone “past life regression”, a New Age
personal exploration technique with no scientific basis. From her experience with this pseudo-
therapy, our subject claims that, in one of her former existences she lived miserably as a
housewife ruled by an oppressive husband in 16th century England. How might a critical
theorist respond to her claim?
A If her past life as an oppressed housewife centuries ago is how she genuinely
experiences herself now, we should accept that interpretation as valid for her.
A phenomenologist may say that.
B Her interpretation reflects her being socially conditioned to accept the past and present
injustice of females’ domestic subordination.
Correct. A critical theorist may say that.
C Her experience is a treatment effect of the therapy.

Neither an interpretative paradigm theorist, a critical theorist, nor a positivist would say that.
D The woman’s claim is meaningless because it can never be shown empirically to be true.
A logical positivist would almost certainly say that. See also the previous question, which is similar.
69. In which of these research methodologies is the researcher expected to begin with a
completely open mind, uninfluenced by preconceived ideas?
A Post-modernism.
Not a social research methodology as such.
B Heideggerian phenomenology.
A plausible distracter if we confuse Heiddegger’s with Husserl’s phenomenology.
C Symbolic interactionism.
We’ve not discussed symbolic interactionism at all in this unit, so this answer has to be a distracter.
D Grounded theory.
Correct.
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70. A basic assertion of evidence-based practice is that properly interpreted observation and
measurement of the external world can yield trustworthy, reliable knowledge.
To which branch of philosophy does such a claim belong?
A Relativism
A relativist would argue that knowledge depends at least as much on a person’s perspective on the evidence
as it does on the evidence itself.
B Epistemology
Correct. The above evidence-based practice assertion above works as a theory of knowledge, so it qualifies
as an epistemology.
See the Qualitative Research lecture for the difference between epistemology and ontology.
C Ontology
The evidence-based practice assertion above is not about existence. Ontology refers to what it is to “be”.
D Pluralism
Argues that no particular doctrine is dominant over others. This would apply to one’s theory of knowledge, so
a pluralist would not promote the evidence-based practice assertion in this question over competing views.
71. According to phenomenological theories described in the Qualitative Research lecture, popular
song and dance entertainer, Beyoncé, could be any or all of the following except…
A An intentional object, whenever someone thinks about her.

Very likely Beyoncé is an intentional object most of the time, because a lot of people think about her.
B A being in itself.
Correct. Unlike a stone, which is a being in itself (consistent with J. P. Sartre’s phenomenology), Beyoncé is
a being for itself: conscious, possessing free will, and thus able to choose and create her own life project.
C A being for itself.
D A being for others.

A being for her family, her friends, her tour group and her many fans. These people are “others”.
72. Which of these data collection methods is least associated with qualitative research?
A Participant observation.
B Focus groups.
C Unstructured interviews.
D Structured interviews.
Correct.
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73. What is mixed methods research?
A Quantitative research that uses numerical and text-based qualitative data.

If it’s purely quantitative research, it’s not mixed methods regardless of the form of the data.
B Research that combines qualitative and quantitative methodologies.

Correct.
C Research that combines observation with intervention strategies.

Not the accepted definition.
74. Which of these approaches to research is most easily applied to quality assurance?
A Systematic review.
Nothing in the quality assurance slides suggests that quality assurance officers will conduct a systematic
reviews to collect empirical information.
B Exploratory.
With quality assurance you have a fair idea of what you want to achieve. You’re testing whether it’s been
achieved, so the approach is more confirmatory than exploratory.
C Action.
Correct.
D A and B.
Not all quality assurance is action research, and not all action research is quality assurance. The point here is that action
research and quality assurance can be similar. Action research is readily applied to quality assurance in local settings, done
by practitioners who care about their work, and know something about research methods and evidence-based practice.
Page 35
75. Your therapist colleagues attend to 10% more patients in a day than you do, but because
you’re an evidence-based practitioner, your patients show the same improvement after half the
number of consultations that your colleagues’ patients require.
Compared with your colleagues, your work is…
A More efficient and more effective.

If your patients showed better improvement than those of your colleagues, this answer would be correct.
B Equally effective and more efficient.

Correct. If you can get the same results (equal effectiveness) in half the number of consultations, you’re more
than making up for the 10% extra patients that your colleagues see in a day, so you’re more efficient.
C Equally effective and equally efficient.
D More effective and equally efficient.
Do not confuse efficiency with effectiveness. You can be very effective without being efficient: slow
and costly but accurate. The job is done well (effective), but it takes too much time and effort to do it
(inefficient).
76. Which of the following is an empirical, comparative method for assessing healthcare quality?
A Optimality
B Legitimacy
C Benchmarking
Correct. Benchmarking compares actual results against defined “best practice” standards. The other answers
are measures of quality rather than methods of assessing it.
D Efficacy
77. Which of these organisations is the principal funding source for health research in Australia?
A ARC
The Australian Research Council funds some health research, but it isn’t the main funding body.
B NHMRC
Correct, the National Health and Medical Research Council.
C CSIRO
Not the Commonwealth Scientific and Industrial Research Organisation.
D WHO
Not the World Health Organization.
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78. An undergraduate student wishing to start a career in research is best advised to…
A Enrol in a PhD course immediately after graduating with a Bachelor’s degree.
B Complete a post-graduate qualification in statistics.
C Complete any post-graduate qualification, then seek industry experience in research.
D Get an Honours degree, enrol in a research higher degree and seek part-time or casual
employment as a research assistant.
Correct.
Incidentally, this information may change because there’s a move among some universities to phase out
Honours degrees. Instead, the student graduating with a Bachelor degree would go straight to a
postgraduate research degree, either Masters by research or PhD. You don’t have to know this for the exam.
79. According to each of the privacy acts covering New South Wales (i.e., Privacy, PPIP and HRIP)
when is information about an individual considered personal?
A When the information about the person is true, but not when the information is false.
B When the information is in written form, but not as spoken or wireless communication.
C When a person’s identity could reasonably be identified from the information.

Correct.
D When the information includes information about a person’s physical or mental health.
Specifically, only according to the HRIP Act.
80. According to the Privacy Act (1988), which of the following is classed as sensitive information?
A A person’s credit history.

Financial affairs aren’t listed as sensitive in the lecture slide on sensitive information.
B How a person votes in a parliamentary election.

Correct. Political opinions are considered sensitive.
C Information about people identified on Facebook pages.

Isn’t this just private information? See previous question, answer C.
D Business secrets.
Privacy in business is not covered by the relevant acts.
Page 37
81. Which of these statements about privacy and its relevant legislation is true?
A The Privacy Act (1988), the PPIP Act (1998) and the HRIP Act (2002) share the same
definition of personal information.
Correct.
B Under the Privacy Act and the HRIP Act, sensitive and health-related information share
the same definition.
Lecture notes on privacy will show this answer to be false.
C Under the PPIP and HRIP Acts, only information recorded and stored as words or
numbers is considered personal.
Under these acts, information in any format about a person who can be identified with that information is
considered personal. That can include including non-textual information such as an image.
D All privacy legislation in Australia is state rather than Federal legislation.

The Privacy Act (1988) is Federal legislation.
82. The Western Sydney University Human Research Ethics Committee becomes concerned that
a project’s data management is insecure, so that personal information collected during the
project may be available to unauthorised persons. Any Committee member could express this
concern, but which of the regular members of the Committee is most likely to raise this
objection?
A The information technology specialist.

Not required on an ethics committee.
B The student representative.

Student representatives are not required on ethics committees. Not all ethics committees serve educational
institutions.
C The intuitionist moral philosopher.

There’s a better answer.
D The lawyer.
Correct. The lawyer especially could be concerned about whether the institution is fulfilling its obligations
under the privacy acts because, if not, there could be a risk of legal action. The risk of damage to the
institution’s public standing (i.e., loss of reputation) if private information were made public is another serious
consideration.
Page 38
83. Which of these research team members is most likely to be included on the author list for a
published article?
A The industry partner who funded the project.

Sometimes industry partners are included as authors. In this example, the research assistant who actually
did the writing should be considered a stronger candidate for authorship. The industry partner would certainly
get an acknowledgement, which is different to authorship.
B The research assistant who did the main literature search and drafted the article’s
literature review.
Correct. Generally, it’s the people who write the article that get to be authors; at least that’s how it should be.
If the research assistant is writing parts of the article, they should be an author even though research
assistance is not a senior position.
C The statistician who analysed the data and forwarded a report of the results to the
principal researcher.
Data analysis alone is not enough to qualify a person for authorship of a report that others wrote.
D The project manager who maintained the project’s financial accounts.

Not an author.
84. Which of these meta-ethical positions is most compatible with the normative ethical prescription
of “Do no harm”?
A Intuitionism
It’s hard to match intuitionism with any particular ethical rule without universal agreement concerning that
rule. Empirically, not everyone agrees with “Do no harm”. The evening news should convince you of that.
B Deontology
Arguably this is the answer. It could also be said that doing no harm is about preventing bad consequences.
If there’s no harm done then people will be happier, which is utilitarian thinking. However, Mill’s utilitarianism
is specifically about promoting happiness. The “do no harm” principle isn’t just about happiness. As with most
philosophical arguments, it’s not cut and dried. I have tested the idea of “do no harm” being utilitarian with a
Research Methods class. Most of the class voted it as deontological, which doesn’t resolve the controversy,
but the class vote probably captures the dominant position in this debate.
C Utilitarianism
A teleological theory. If deontology is a better answer then teleology, deontology is also a better answer than
utilitarianism.
D Emotivism
There are better answers.
Page 39
85. Which of these statements is most consistent with a teleological meta-ethical perspective?
A An action is morally good if everybody does it.

None of the theories we look at says this. If everyone steals, does that make stealing good?
B The morality of an action should be evaluated according to its consequences.

Correct.
C We should act in the same way as we expect everyone else to behave.

This is the categorical imperative, the basis for deontology.
D If an action has no purpose then it can neither be morally good nor morally bad.
Teleology is about purpose, but it doesn’t make this claim.
86. What is the main reason why Stanley Milgram’s early 1960s studies of obedience to authority
may be considered unethical?
A Participants were placed at risk of psychological harm.

This would be the main reason, and the best answer. It’s apparent from the lecture that participants were
subjected to psychological stress and perceived duress.
The experiments where real electric shocks were given to a puppy involved no deception, yet a
contemporary ethics committee would be unlikely to approve such a study, again because of psychological
risk to participants, and they would consider the puppy.
B The results were invalid.

The validity of Milgram’s results is controversial, but controversy over findings alone doesn’t make a study
unethical. The results may or may not be valid. The experiments were arguably informative, whether they
inform us about how people behave under authority, or whether they inform us about poor quality research.
C The study involved deception.

A reasonable answer because deception did occur. Answer A is arguably better, but only just. Deception is
not necessarily unethical. Ethics committees will considered deception justifiable under limited
circumstances. The committee will look at whether the likely benefits from the research justify deceiving
people and whether the set-up humiliates participants, which may well have happened in the Milgram
studies. The first answer (A) is the more fundamental and so preferred for this example question.
Because this question has two answers with a reasonable claim to being correct, it’s a better question for a
learning task (i.e., this practice set) rather than an assessment task. In the final exam, answers will be clear-
cut, if you understand the material. Notice how answers to morality questions aren’t always black and white.
D Participants were paid to participate.

The lecture doesn’t say that participants were paid. Paying participants isn’t necessarily unethical, especially
when the payments are token amounts that won’t encourage people to do what they wouldn’t normally do.
Page 40
87. When planning the Stanford Prison Experiment, Philip Zimbardo did not intend to conduct
unethical research. He later acknowledged that the study was unethical. What general
conclusion might we draw from this episode?
A Research should be subjected to ethical review after it has been conducted.

Isn’t it too late to stop a study after it has already finished. As it happens, researchers are required to submit
progress reports to ethics committees, but you don’t need to know that to answer the question.
B Zimbardo was a hypocrite, stating one ethical position while acting from another during
the Stanford Prison studies.
Zimbardo changed his opinion after the studies were conducted, according to the question wording, so he
wasn’t adopting two contrary positions at the same time.
C Zimbardo did not understand research methods, because the Stanford Prison studies
were observational rather than experimental.
The studies may not have been a controlled experiment, but they weren’t purely observational either because
there was an intervention.
D Right motives can lead to wrong actions.

A risk with research and clinical practice is our becoming so enthusiastic with the mission that we fail to see
the harm we could be doing. A real risk is where treatments inflict pain or discomfort.
Old saying: “The road to hell is paved with good intentions.”
For the final exam you aren’t expected to know minor details of the unethical studies discussed in the final lecture. More
important is an understanding of the ethical issues they raise and how they apply to clinical practice.
Page 41

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400864 Research Methods (Quantitative and Qualitative)

Final Examination Practice Set 1answers

1. What is this Research Methods unit mostly about?

B Robot health care.

Other reasonable answers might be:

2. Which of these activities is essential for evidence-based clinical practitioners to do?

A Evaluate the quality of existing research.

B Read systematic reviews.

D Relying only on findings from randomised controlled trials (RCTs).

3. What is the purpose of the GRADE system?

A Reducing bias in randomised controlled trials.

B Improving the quality of research reports published in peer-reviewed journals.

C Assisting development of clinical guidelines for evidence-based practice.

D All of the above.

A Variability in the two treatment effects across studies.

C Effects from the two treatments are compared in a single study.

D None of the above.

A Is from every level of the NHMRC hierarchy.

B Is only from randomised controlled trials.

C Shows effect sizes and statistical significance.

D Is from numerous studies enabling different conclusions from their results.

C Study of diagnostic yield.

D Non-randomised controlled trial.

C Random allocation protects against all internal validity threats.

D Random allocation gives a representative sample, so results will generalise.

A Level III studies lack any control or placebo condition.

B Level III studies lack any blinding of participants or assessors.

D Level III studies lack proper randomisation or any randomisation of participants to

D The statement is false. Differences on post-treatments measures from treatment and

A Randomised controlled trials are an inappropriate methodology for evaluating that

C The treatment does not work.

A Retrospective cohort design for an epidemiological study.

B Prospective cohort design for an epidemiological study.

C Historical control study.

A Measure the effectiveness of electrically stimulated (ES) muscle contraction plus

C Explore the relationship between air pollution, cardiovascular mortality and

A An intervention or treatment, and a no-treatment or a placebo control condition or both.

B Random selection of subjects and random allocation.

D All of the above are essential for a study to be classified as experimental.

B Cases who test negative on a reference test.

C Cases who receive a placebo intervention in a randomised controlled trial.

D Cases who receive no treatment in a randomised controlled trial.

Case and control both have more than one meaning.

18. Which of these statements involves an inference.

D Each of the above statements involves an inference.

B The treatment and control group experiences do not happen as planned.

D All of the above answers are correct.

B The putative causal relationship makes logical sense.

C The putative cause happens just before the effect.

23. According to Hume, why are causal relationships impossible to prove?

B Our future observations may differ from our past observations.

C Science is mathematical, and mathematics says nothing about causality.

D Other events can moderate (i.e., affect) a causal relationship.

Losers (non-winners) C D Correct

A Not quitting is both necessary and sufficient for winning.

B Not quitting is sufficient for winning.

C Not quitting is necessary for winning.

D Not quitting is neither necessary nor sufficient for winning.

Not cured Cured

Getting the answer requires reasoning. Here is the logic:

Not cured Cured

See generally from Causality notes as well as the second lecture.