Assessing the impact of modifications to the documentation component's scoring rubric and rater training on USMLE...

Documentation is a subcomponent of the Step 2 Clinical Skills Examination Integrated Clinical Encounter (ICE) component wherein licensed physicians rate examinees on their ability to communicate the findings of the patient encounter, diagnostic impression, and initial patient work-up. The main purpose of this research was to examine the impact of modifications to the scoring rubric and rater training protocol on the psychometric characteristics of the documentation scores.

Following the modifications, the variance structure of the ICE components was modeled using multivariate generalizability theory.

The results confirmed the expectations that true score variance for the documentation subcomponent would increase after adopting a modified training protocol and increased rubric specificity.

In general, results support the commonsense assumption that providing raters with detailed rubrics and comprehensive training will indeed improve measurement outcomes. Although the steps taken here were in the right direction, there remains room for improvement. Efforts are currently under way to further improve both the scoring rubrics and rater training.