Methodological factors in studying medical graduates: a review of six internship performance studies

This "state of the art" article examines six internship performance studies of medical school graduates that use rating scales as the vehicle for data collection. The methodological decisions investigators faced in designing the studies are described and the range of options used is illustrated. The content and format of rating forms employed are compared. No methodological standards currently exist for internship performance studies. We call for greater attention to methodological issues in study design, including examination of potential sources of bias. How structural aspects of the internship performance study design may influence the results obtained needs careful study.