Designing and validating a clinical competency logbook for workplace-based assessment in undergraduate medical...

The implementation of competency-based medical education (CBME) demands robust, validated workplace-based assessment (WBA) tools. In this study, we aimed to develop and conduct an initial validation of the clinical competency logbook (CCL) as a structured instrument designed to assess the observed clinical competencies of undergraduate medical students in authentic practice settings.

A prospective validation study was conducted during the 2024-2025 academic year with 129 fourth-year medical students. The CCL was systematically constructed through literature review and expert consensus using a two-round Delphi process to establish content validity. Students were assessed using the CCL during two consecutive 4-week clinical rotations. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC) with a two-way random-effects model. Exploratory fairness analysis was conducted based on subgroup comparisons between male and female students.

The CCL exhibited strong content validity throughout its expert-driven development process. Overall test-retest reliability was moderate to good (ICC = 0.711, 95% confidence interval [0.591, 0.796]). However, the reliability varied significantly by gender subgroups: ICC = 0.507 for males and ICC = 0.346 for females, which was attributed to ceiling effects and restricted score variance in the female subgroup. The mean scores differed significantly between genders, highlighting the need for further investigations of potential rater bias or other unmeasured variables, although these findings remain strictly exploratory.

The CCL exhibited acceptable psychometric properties for formative assessment in undergraduate medical education. The strong content validity and moderate overall reliability (though highly dependent on score distribution and varying by subgroup) support its use for tracking student progress and providing structured feedback. These findings highlight the importance of contextual interpretation of reliability coefficients and suggest that caution is required for high-stakes summative decisions. In this study, we produced an evidence-informed instrument and methodological framework for developing WBA instruments in CBME programs.