Prediction accuracy and financial savings of four screening tests for a sequential test of clinical performance

Sequential testing of clinical performance is an effective strategy to reduce cost of testing.

To evaluate prediction accuracy and financial savings of 4 screening tests of clinical performance.

Screening tests were created from a 13-case examination taken by 434 medical students at 4 schools. Regression analysis determined prediction accuracy for 2 test outcomes. Financial savings were computed from published estimates.

Zero false passes were obtained with the "Total Number of Cases Passed" screening test, but it saved only 27%. Sixty-two percent savings with 5% false passes occurred with the "Classification" screening test. The "Scale" and "Mini Test" screening tests would have excused 79% and 67% examinees with 5% and 1% false passes, respectively.

Prediction accuracy varies with screening test and outcome measure. Sequential testing of clinical performance can save 40% to 60% with low false pass rates. However, programs need to consider loss of information for curriculum and individual feedback relative to financial savings.