Creating a reliable and valid blueprint for the internal medicine clerkship evaluation

The objective of this study was to design an examination blueprint for the Internal Medicine clerkship rotation that is congruent with both the learning objectives and delivered learning experiences and reflects the perceived importance of clinical presentations from both the students' and clinicians' perspectives. In this cross-sectional study 11 specialists in General Internal Medicine (GIM) and 11 clinical clerks at the University of Calgary were asked to score each of the 47 clinical presentations in the Internal Medicine clerkship rotation for 'impact' and 'frequency'. These attributes were used to provide an estimate of the relative importance of each clinical presentation. Statistical tests used were the Pearson's correlation coefficient and the Kappa statistic. Multi-attribute utility theory was applied to assess the best way of combining the variables of 'impact' and 'frequency'. The correlation between clerks and GIM specialists was 0.85 for the impact score and 0.86 for the frequency score (p < 0.001 for both). Corresponding Kappa values were 0.71 and 0.82, respectively (p < 0.001 for both). Combining impact and frequency as a multiplicative function produced a distribution that was positively skewed towards common, high impact presentations such as chest pain. We have created an examination blueprint that provides a realistic and objective measure of the relative importance of clinical presentations. Such a blueprint provides both face validity and content validity to the evaluation process.