Purpose. To develop a pattern-recognition examination (called PAT) for
use in assessing surgical clerkship students. Method. The PAT was dev
eloped in 1992 - 93 by the surgery faculty at the Wright State Univers
ity School of Medicine. The top 30 diagnoses of patients seen by clerk
ship students in 1991-92 were identified, and possible presenting comp
laints were selected for each diagnosis. Then for each complaint facul
ty selected 18 common or catastrophic diagnoses, and a distinctive pat
ient description was written for each diagnosis. An examination of 200
items was compiled covering 20 presenting complaints, each with a set
of ten patient descriptions and 18 diagnoses from which to choose the
most likely diagnosis. Scoring was by the percentage of correct respo
nses. The PAT was given to 77 students during the 1992-93 clerkship al
ong with other forms of evaluation. The PAT was also administered to 1
8 surgical residents. Results. The students' mean score on the PAT was
65%, SD, 12.7. Split-half reliability was high (Spearman-Brown r = .9
1). The students' PAT performances correlated strongly with other cued
-response testing formats, e.g., r(s) = .79, PAT versus the surgery su
bject examination of the National Board of Medical Examiners. Moderate
correlations with essay scores (r = .49) and preceptors' ratings (r =
.49) were found. The residents' PAT performances were significantly h
igher for senior than junior residents (82% versus 63%, p = .004). Con
clusion. Utilizing this examination format, it is possible to locally
develop a reliable examination that is grounded in the actual clinical
problems seen by clerkship students and that assesses more than factu
al recall.