Why Johnnie Can't Apply Neuroscience: Testing Alternative Hypotheses Using Performance-Based Assessment

When second year medical students were less successful than expected in solving an OSCE neurologic case, a subsequent performance-based assessment was modified to permit testing of four hypotheses related to knowledge application, ability decay over time, skill performance, and case complexity. Two cohorts of second year medical students were presented with neurologic cases in the context of performance-based assessment. Although many students demonstrated that they had the requisite knowledge, few were able to access the knowledge in less structured testing formats. Students had the skills necessary to conduct a physical examination but were unable to appropriately focus the examination. Case complexity also was related to some performance domains. There was evidence of knowledge and skill decay over time. In summary, it is apparent that multiple factors influence students' performance and are important considerations in designing performance assessments to evaluate competence.