Formative assessment of the consultation performance of medical students in the setting of general practice using a modified version of the LeicesterAssessment Package

Objective To evaluate the use of a modified version of the Leicester Assess ment Package (LAP) in the formative assessment of the consultation performa nce of medical students with particular reference to validity, inter-assess or reliability, acceptability, feasibility and educational impact. Design 180 third and fourth year Leicester medical students were directly o bserved consulting with six general practice patients and independently ass essed by a pair of assessors. A total of 70 practice and 16 departmental as sessors took part. Performance scores were subjected to generalizability an alysis and students' views of the assessment were gathered by questionnaire . Results Four of the five categories of consultation performance (Interviewi ng and history taking, Patient management, Problem solving and Behaviour an d relationship with patients) were assessed in over 99% of consultations an d Physical examination was assessed in 94%. Seventy-six percent of assessor s reported that the case mix was 'satisfactory' and 20% that it was 'border line'; 85% of students believed it to have been satisfactory. Generalizabil ity analysis indicates that two independent assessors assessing the perform ance of students across six consultations would achieve a reliability of 0. 94 in making pass or fail decisions. Ninety-eight percent of students perce ived that their particular strengths and weaknesses were correctly identifi ed, 99% that they were given specific advice on how to improve their perfor mance and 98% believed that the feedback they had received would have long- term benefit. Conclusions The modified version of the LAP is valid, reliable and feasible in formative assessment of the consultation performance of medical student s. Furthermore, almost all students found the process fair and believed it was likely to lead to improvements in their consultation performance. This approach may also be applicable to regulatory assessment as it accurately i dentifies students at the pass/fail margin.