Performance assessment is discussed as it relates to evaluation of clinical performance in medical education. Issues include the meaning of reliability and validity in performance assessment and the balance between them, including simple vs. complex behaviors; stability of performance; specific vs. generic abilities; and experts' roles in clinical…

Drawing from survey data (n=138 medical schools in the United States and Canada), a study analyzed medical schools' systems for evaluating student progress in clinical experiences. The 4-stage model used by most schools, common and unique characteristics, and 17 symptoms of system errors, signaling a need for system review, are outlined.…

Six principles of effective outcomes assessment in medical education are presented, discussed, and illustrated in assessing a preclinical course integrating basic science, social science, and clinical skills. It is argued that courses and programs for medical students and residents should use course-based assessment to ensure that medical trainees…

Interrater reliability in numerical ratings of clerkship performance (n=1,482 students) in five surgery programs was studied. Raters were classified as accurate or moderately or significantly stringent or lenient. Results indicate that increasing the proportion of accurate raters would substantially improve the precision of class rankings. (MSE)

A review of studies in which it was possible to compare results of health profession trainees' self-evaluations with assessment of performance by experts or objective tests found that self-assessment has potential but is poorly used. Effective training to improve validity and accuracy is available. (Author/MSE)

A study of a medical student clinical assessment program since 1986 at the University of Massachusetts indicates student awareness of increased faculty observation and increased feedback to students during and following clinical rotations. Results indicate a conscious faculty effort to improve students' clinical skills by improved observation and…

At Case Western University (Ohio), medical students critically analyze the quality and cost of asthma care in the community by studying patients in primary care practices. Each writes a case report, listing all medical charges and comparing them with guidelines for asthma care. Several recommendations for improved care have emerged. (MSE)

Most evaluations of technology-based instruction are poorly designed because of failure to control three common confounding variables: (1) use of different instructional methods in different treatments; (2) presentation of different content in different treatments; and (3) the novelty of new media, which tends to increase early motivation and…

A study investigated the usefulness of a small-group management process to involve physicians and nurses in analysis of patient mix, practice patterns, and care outcomes and improvement of practice strategies. Eight studies, each on one clinical topic, were undertaken at three hospitals. Significant positive changes were observed in five of them.…

Discusses the existence of three curricula in medical schools (formal, informal, and hidden) and suggests that educators and administrators investigate the hidden curriculum by examining four areas: institutional policies; evaluation practices; resource-allocation decisions; and institutional "slang." Needed reforms in accreditation standards are…

A survey of faculty (n=223) and students (n=157) in two different curriculum tracks (problem-based/student-centered primary care vs. regular) at one medical school gathered opinions on the methods and criteria of student evaluation. Differences occurred primarily in the perceptions of first- and second-year students in the problem-based…

Analysis of patient logbooks kept by 75 medical students in a family medicine clerkship provided a great deal of information about the nature of students' experience, changes taking place as the year progressed, the degree to which program objectives were being met, and differences between sites. (MSE)

Review of 11 studies of health professions curricula incorporating training in professional self-assessment found initial student disorientation and distrust to be common. However, among successful programs both noncognitive and cognitive benefits appeared. Results suggest that self-assessment training promotes more mature, collegial, productive…

A study showed that 80 percent of medical schools were collecting outcome data, but there was a lack of coherence, integrated analysis, and longitudinal study. The purpose of examining outcomes is to gain sharper focus on the achievement of institutional goals, facilitate program improvement, and assure competence of graduates. (Author/MLW)

A multistation clinical examination using standardized patients was used over 4 years to assess the interpersonal skills of 346 fourth year medical students, 51 internal medicine residents, and 71 foreign medical graduates seeking admission to graduate study. Results indicate that a reliable assessment of interpersonal skills can be achieved this…