Validity and use of written simulation tests of clinical performance

The outcome of a simulated clinical problem (drug-induced agranulocytosis) was compared with the outcome of similar cases in real medical service. The total performance of 100 sixth-year medical students at the end of their clerkship in internal medicine resulted in a mortality of 10 per cent in the simulation exercise. This mortality rate is the same as that which occured in the medical service during a four-year period. The total performance of the students was at about the same level at the end of the first clinical term and at the beginning of the clerkship in internal medicine (sixth term) but significantly better at the end of the latter.