Internal medicine clerkship directors' use of and opinions about clerkship examinations.

BACKGROUND

For years, quantifiable examinations have been a core component of assessing medical student competence during the internal medicine clerkship.

PURPOSE: To determine how internal medicine clerkship directors use and view examinations and how uses of examinations have changed.

METHODS

In 1999, the Clerkship Directors in Internal Medicine conducted a confidential survey of its 123 institutional members.

RESULTS

Survey response rate was 89% (109/123). The National Board of Medical Examiners subject examination was used by 83%, alone (49%) or in combination with a faculty developed examination or a standardized patient examination (34%). Minimum passing scores were required for the subject exam by 80%, for faculty-developed examinations by 65%, and for the standardized patient exam by 63%. Examinations contribute approximately 25% toward a student's final grade. Students with acceptable clerkship performances but who fail an exam typically retest after self-study. Students who fail a retest receive unsatisfactory grades and require additional medicine experience. Of the clerkship directors who reported using the National Board of Medical Examiners subject examination, 45 (50%) provided comments on ways to improve the examination. Comments focused on examination content, reporting results, basing the exam on a published core curriculum, and general administrative issues. Over the past decade, use of the National Board of Medical Examiners subject examination has increased (66% to 83%), use of faculty-developed examinations has declined (46% to 27%), and the use of a clerkship standardized patient examination increased sharply (2% to 27%).

CONCLUSIONS

Internal medicine clerkship directors commonly require students to pass standardized or locally developed exams and use test results to make academic decisions. The use of standardized patient examinations has increased significantly and likely reflects a broadening of competency assessment. Our results can serve as a basis for individual programmatic evaluation, for internal medicine and other clerkship directors.