Reliability and validity of an extended clinical examination

Area of Science:

• Medical Education
• Clinical Skills Assessment
• Psychometrics

Background:

• An extended clinical examination (ECE) was administered to 85 final-year medical students.
• The study evaluated the ECE's psychometric quality and suitability for assessing eight clinical skills.

Purpose of the Study:

• To determine the psychometric quality of the ECE.
• To assess the ECE's suitability as a measurement tool for clinical proficiency.

Main Methods:

• Generalizability studies were conducted to determine the generalizability coefficient and sources of variance.
• A D-study estimated generalizability coefficients with varying numbers of stations.

Main Results:

• The largest sources of variance were skill difficulties, general error, and skill difficulty rank ordering.
• The overall generalizability coefficient (G) was 0.74, exceeding the 0.70 lower bound.
• Extending the ECE from 8 to 14 stations yielded sufficient G coefficients for seven out of eight skills.

Conclusions:

• The ECE is a reliable clinical assessment tool.
• It allows examinees to develop a clinical reasoning path using self-obtained data.
• The ECE can be effectively used to assess separate clinical skills.