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February 1994

Evaluating Clinical SkillsGetting It Right Slowly

Arch Pediatr Adolesc Med. 1994;148(2):133-134. doi:10.1001/archpedi.1994.02170020019002

IT IS ironic that the medical profession, whose progress in recent decades so closely parallels the development of precise and meaningful biological measurements, continues to lag in its ability to assess some cherished qualities of its very own graduates. As suggested by Osler's lament in 1885, the profession has long searched, seemingly fruitlessly, for a method that would allow clinical skills to be assessed in a fair and accurate way.

In US medical schools today, the ability of students to deal directly with patients is typically assessed in a formal or informal clinical oral examination in which the vagaries of student performance, case difficulty, and rater stringency are so enmeshed as to make a valid outcome seem technically impossible.2 In 1963, based on this critique, the clinical oral format of assessment was dropped from the clinical competence component (part III) of the National Board of Medical Examiners Certification Examination.