Internal medicine house officers' performance as assessed by experts and standardized patients

Three chronically ill patients were trained to evaluate the performance of 31 second-year internal medicine house officers based upon: a checklist for the medical data elicited during the medical interview; the process of the interview (that is, the house officer's interviewing style); and the physical examination technique. Four standardized rating scales were completed by the patients for the evaluations. Expert evaluations of the same house officers were conducted by a trained evaluator who reviewed videotapes of the interview and a faculty member who reviewed the adequacy of the medical history write-ups. Results of the study indicate a high correlation between the patients' and the experts' evaluations of the adequacy of the medical history data collected; less agreement was found in evaluations of the adequacy of the psychosocial data collected. These findings suggest that, if carefully selected and trained, patients with chronic medical conditions can provide reliable and standardized evaluations of house officers' performance at a level consistent with but less expensive than faculty members' evaluations.