Impact of different scoring methods on the clinical skills assessment of internal medicine students

The aim of this study was to determine how different scoring methods could influence the results achieved in clinical competence assessment examinatio ns at the end of the medical school curriculum. Fifty-six final-year medica l school students were examined using a programme of multimedia computer-ba sed simulated cases (Procuste programme). For generating results, the follo wing scoring methods were applied: (1) the method used for the Internal Med icine official certification examination which includes both weighted and u nweighted items; (2) a method with only unweighted items; (3) a method whic h includes single-item analysis. Each time an absolute pass/fail cut-off st andard (greater than or equal to 60/100) and a relative pass/fail cut-off ( mean minus 1 standard deviation) were applied. Taking as a reference the fi rst method, the effect of using different scoring methods on the percentage of student failure was evaluated. Furthermore, correlation studies between the results obtained with these scoring methods and the grades reported by the examinees during the medical school curriculum were performed. It was found that the first method generated a more realistic pass/fail rate compa red with the two other methods. Furthermore this method, which has been use d for the last 10 years for administering internal medicine examinations, s howed better correlation coefficients with the curriculum scores.