An Alternative Certification Examination (“ACE”) in Surgery

Abstract

Medical graduates are required to be competent in many domains of professional practice when joining the health care workforce. Current undergraduate examination methods robustly assess up to 5 of these 8 required skills. This study sought to evaluate an alternative certification examination ("ACE") in assessing all of the 8 required domains in surgical cases. A total of 143 final-year medical students were invited to participate in an "ACE" in February 2013. In total, 137 students, 95.8% of the class, agreed to participate. The "ACE" format consisted of 4 sequential patient encounters observed by 2 independent examiners. It assessed all the 8 required domains of professional practice. The examiners and the students evaluated this examination format using a Likert scale and free-text comments. The "ACE" assessed all the 8 domains. The inclusion of a patient safety measure to avoid an egregious error in the pass criteria resulted in 27 (18.9%) students failing to meet them. The correlation of grades between the independent examiners in the "ACE" was strong at a Cronbach α of 0.907 (CI: 0.766-1). The "ACE" format was reported as an acceptable examination methodology by the examiners for formative or summative assessment of surgical cases at the end of a primary medical degree. The "ACE" format is standardized, is integrative, and has excellent interrater reliability. Inclusion of a patient safety measure as pass criteria appears to increase specificity. The "ACE" shows potential as an alternative examination to the traditional long case examination and objective structured clinical examination in assessing all the 8 domains of professional practice.