Abstract
IntroductionAssessment of medical students’ knowledge in clinical settings is complex yet essential to the learning process. Clinical clerkships use various types of written examinations to objectively test medical knowledge within a given discipline. Within emergency medicine (EM), a new national standardized exam was developed to test medical knowledge in this specialty. Evaluation of the psychometric properties of a new examination is an important issue to address during test development and use. Studies have shown that student performance on selected standardized exams will reveal students’ strengths and/or weaknesses, so that effective remedial efforts can be implemented. Our study sought to address these issues by examining the association of scores on the new EM national exam with other standardized exam scores.MethodsFrom August 2011 to April 2013, average National EM M4 examination scores of fourth-year medical students taken at the end of a required EM clerkship were compiled. We examined the correlation of the National EM M4 examination with the scores of initial attempts of the United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) examinations. Correlation coefficients and 95% confidence intervals of correlation coefficients are reported. We also examined the association between the national EM M4 examination score, final grades for the EM rotation, and USMLE Step 1 and Step 2 CK scores.Results133 students were included in the study and achieved a mean score of 79.5 SD 8.0 on the National EM M4 exam compared to a national mean of 79.7 SD 3.89. The mean USMLE Step 1 score was 226.8 SD 19.3. The mean USMLE Step 2 CK score was 238.5 SD 18.9. National EM M4 examination scores showed moderate correlation with both USMLE Step 1 (mean score=226.8; correlation coefficient=0.50; 95% CI [0.28–0.67]) and USMLE Step 2 CK (mean score=238.5; correlation coefficient=0.47; 95% CI [0.25–0.65]). Students scoring below the median on the national EM M4 exam also scored well below their colleagues on USMLE exams.ConclusionThe moderate correlation of the national EM M4 examination and USMLE Step 1 and Step 2 CK scores provides support for the utilization of the CDEM National EM M4 examination as an effective means of assessing medical knowledge for fourth-year medical students. Identification of students scoring lower on standardized exams allows for effective remedial efforts to be undertaken throughout the medical education process.
Highlights
Assessment of medical students’ knowledge in clinical settings is complex yet essential to the learning process
We examined the correlation of the National emergency medicine (EM) M4 examination with the scores of initial attempts of the United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) examinations
We examined the association between the national EM M4 examination score, final grades for the EM rotation, and USMLE Step 1 and Step 2 CK scores
Summary
Assessment of medical students’ knowledge in clinical settings is complex yet essential to the learning process. Assessment is important to provide feedback to the learner in order to guide development and acquisition of milestones necessary for independent practice; to provide information to the educational program regarding effectiveness of the pedagogies; to provide a metric for stratifying the competency of applicants; and to protect the public by ensuring all graduates have attained the requisite level of competency required to progress to the level of training.[1,2] The Liaison Committee on Medical Education (LCME), the accrediting body for education leading to the MD degree, has established guidelines for the evaluation and assessment of medical students throughout the continuum of undergraduate medical education.[3] These guidelines specify the use of formative and summative assessment methods to examine a variety of measures of knowledge, skills, behaviors, and attitudes (LCME, Functions and Structure of a Medical School).[3] Clerkships typically employ a number of assessment tools including written examinations, oral examinations, direct observation, simulation, observed structured clinical examination (OSCE), oral presentations, and written reports. While the assessment of clinical performance can be influenced by examiner subjectivity, medical knowledge assessments are often more objective in nature and are an important outcome for curricular assessment and licensure.[4]
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