Evaluating M.D.-level competence in internal medicine

The faculty of the Department of Medicine at the University of Hawaii John A. Burns School of Medicine defines M.D.-level competence as the capability of undertaking the first day of a primary care internship. The implementation of a clinical clerkship in internal medicine that was flexible in time required that a new evaluation program be developed to assess the progress of students toward defined end points of competence. The four measures used are an objective test of basic medical knowledge, simulations to assess intellectual skills in problem-solving, a clinical skills examination with written standards to help the evaluator make discriminations between levels of performance, and a criterion-referenced rating scale to assess professional habits and attitudes. The progress of the classes of 1979 and 1980 toward achievement of predetermined levels of mastery is presented.