| The development of performance-based testing to better assess clinical competence is a priority in the field of medical education. The purpose of this study was to develop and implement a performance-based examination of the clinical competence of fourth year medical students enrolled in an ambulatory care rotation using standardized patients. Standardized patients are persons trained to simulate a patient seeking medical intervention for an illness in a standardized, reproducible way. After each encounter with a medical student, the standardized patient evaluates the encounter using checklists. In this manner, groups of students can be evaluated in a standardized fashion using the same patients.;Seven cases and corresponding checklists were written and standardized patients (SPs) were recruited and trained for each case. Forty-five senior medical students enrolled in a required ambulatory care rotation were evaluated by the SPs in the areas of Communication Skills, History Taking, and Physical Examination over eight 2;Content validity was substantiated by clinical experts who examined each case; however, examination of differences in group performance did not provide compelling evidence for validity. Total scores and scores for each sub-set showed a wide range for each case. No significant correlation was found between CCE scores and scores on a standardized written examination. The generalizability coefficient was.57 and the dependability coefficient.39. Inter-rater concordance was fair to good (59% to 83%) with a mean of 72%. Areas identified for improvement of the methodology included deleting ambiguous items from the checklists and providing additional patient training. Suggestions for future research and application of the methodology were discussed. |
