Clinical competence certification: a critical appraisal.

Area of Science:

• Medical Education
• Internal Medicine
• Clinical Skills Assessment

Background:

• The American Board of Internal Medicine mandates clinical competence certification for residents.
• The Clinical Evaluation Exercise (CEX) is a key component of this certification process.

Purpose of the Study:

• To evaluate the effectiveness and identify areas for improvement in the Clinical Evaluation Exercise (CEX) for internal medicine residents.
• To assess the correlation between resident performance on CEX and specific clinical skills.

Main Methods:

• 120 internal medicine residents at University of Michigan Hospitals participated in CEX between 1980-1982.
• Evaluated residents' abilities in eliciting histories, performing mental status and neurologic examinations, and conducting physical examinations.
• Correlated performance with communication skills and faculty evaluations.

Main Results:

• Residents showed recurrent inadequacies in social/family history, mental status, and neurologic exams.
• Strong correlation found between complete medical history and communication skills (p < .01).
• Technical proficiency in physical exams correlated with accurate findings (p < .05) for three of four organ systems.
• Senior faculty evaluations generally did not correlate with CEX performance.

Conclusions:

• The CEX program requires significant faculty time and evaluator training for reliability.
• The validity of the CEX as a measure of clinical competence requires further investigation.
• Addressing identified weaknesses and logistical challenges is essential for national certification boards.