This study investigated the feasibility of implementing the same 10 cases in an objective structural clinical examination (OSCE) to evaluate medical students' clinical skills following the medicine clerkship at four geographically dispersed medical schools. Results indicated that a clinically equivalent, standardized test of clinical performance could be developed at multiple schools. Generalizability of student scores ranged from.26 to.50. Overall performance averaged 63%, with case scores ranging from 74% for a history of recurrent urinary tract infections to 52% for a fever and cough. Significant differences were found among schools for individual cases, but performance from any one school was not consistently highest. Clinical skills scores ranged from 72% for physical examination technique to 58% for initial management, with varying significant differences among schools, suggesting inconsistent clinical training within and among schools. Performance was not higher for students examined later in the third year. Participant reactions were generally favorable. Results support the feasibility of implementing standardized OSCEs that would provide important data on the performance of graduates and on the adequacy of clinical education from different medical schools.
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