Validity and reliability of a domain-referenced test of clinical competence for foreign medical graduates

The authors determined the reliability and validity of domain-referenced scores obtained from a multiple-station clinical skills examination administered at the University of Toronto to a group of foreign medical graduates in early 1990. Issues associated with the identification of essential checklist items and the setting of minimum passing scores (cutting scores) for each station and for the total test were addressed. In addition, they examined the consistency of classification of candidates and the perceived appropriateness of the number of candidates classified "competent." The findings provide evidence of the validity of standard-setting procedures based on both the performance of criterion groups and the judgment of "experts."