The impact of communication between physician and evaluator on assessments of clinical performance.

Scores, ratings of score validity, and the precision of scores were compared for four methods of assessing clinical performance by case review that differ primarily in the communication allowed between physician and assessor. Results indicate that, at least for board-certified physicians, scores and ratings of score validity are significantly improved by increased communication.

Assessment of clinical competence on the Emergency Medicine Specialty Certification Examination: the validity of examiner ratings of simulated clinical encounters.

To evaluate the reliability and validity of examiner ratings of simulated clinical encounters (SCEs), 94 subjects representing four distinct groups in training, experience, and ability to deliver emergency medical care were administered SCEs by two examiners. Inter-rater reliabilities of performance on specific SCEs varied from 0.61 to 0.89, with an average of 0.79 for all SCEs in the library. Identified sources of examiner error in determining clinical competence included case-specific variability of candidate performance, differences in standards used by different examiners, a halo effect several different ratings were made, and random errors in determining exact rating scores. However, this research indicates that examiner ratings clearly discriminate groups with known differences in clinical competence and correlated well (0.83) with objective test scores.

Initial pelvic examination instruction: the effectiveness of three contemporary approaches.

Initial pelvic examination skills were taught to 38 second-year medical students who were assigned to one of three study groups. The cognitive posttest scores of all groups were nearly identical, but the students who had received training from professional simulated patients rated significantly better in psychomotor and interpersonal skills than did those who received simulated outpatient instruction by a gynecologist. Thirty-five per cent of the psychomotor and interpersonal ratings attained by the latter and 5 per cent of those attained by the former were marginal or inadequate. It was concluded that a program involving professional simulated patients is an effective method of teaching pelvic examination skills to beginning students.