Clinical competence understood through the construct validity of three clerkship assessments

This study examined the construct validity of three commonly used clerkship performance assessments, including preceptors' evaluations, objective structured clinical examination (OSCE)-type clinical performance measures, and the National Board of Medical Examiners (NBME) medicine subject examination, in order to better understand their conceptual structures and utility in the explanation of clinical competence.

A total of 686 students who took an in-patient medicine clerkship during the period 2003 to 2007 participated in the study. Exploratory and confirmatory factor analyses using structural equation modelling were adopted to examine the latent domains underlying various indicators assessed by these three measures and the pattern of indicator-domain relationships.

Factor analyses found three latent constructs, labelled Clinical Performance, Interpersonal Skills and Clinical Knowledge, underlying the observed measures. The three domains were modestly correlated with one another (inter-factor correlation coefficients ranged from 0.39 to 0.54). They also tapped a common higher-order construct, Clinical Competence, in varying degrees of magnitude (0.73, 0.74, 0.53, respectively).

The study demonstrated that although the three commonly used tools for assessing clerkship performance contributed uniquely to the understanding of clinical performance, they also attested to a shared domain of clinical competence in their assessment. The study confirmed the need for a multiple-methods approach to clinical performance assessment. Findings also revealed that clerkship preceptors need to differentiate their evaluation of students' performances, and that the OSCE did not assess a single domain of clinical competence.