Clinical work sampling A new approach to the problem of in-training evaluation.
OBJECTIVE
Existing systems of in-training evaluation (ITE) have been criticized as being unreliable and invalid methods for assessing student performance during clinical education. The purpose of this study was to assess the feasibility, reliability, and validity of a clinical work sampling (CWS) approach to ITE. This approach focused on the following: (1) basing performance data on observed behaviors, (2) using multiple observers and occasions, (3) recording data at the time of performance, and (4) allowing for a feasible system to receive feedback.


METHODS
Sixty-two third-year University of Ottawa students were assessed during their 8-week internal medicine inpatient experience.


RESULTS
Four performance rating forms (Admission Rating Form, Ward Rating Form, Multidisciplinary Team Rating Form, and Patient's Rating Form) were introduced to document student performance. Voluntary participation rates were variable (12%-64%) with patients excluded from the analysis because of low response rate (12%). The mean number of evaluations per student per rotation (19) exceeded the number of evaluations needed to achieve sufficient reliability. Reliability coefficients were high for the Ward Form (.86) and the Admission Form (.73) but not for the Multidisciplinary Team (.22) Form. There was an examiner effect (rater leniency), but this was small relative to real differences between students. Correlations between the Ward Form and the Admission Form were high (.47), while those with the Multidisciplinary Team Form were lower (.37 and .26, respectively). The CWS approach ITE was considered to be content valid by expert judges.


CONCLUSIONS
The collection of ongoing performance data was reasonably feasible, reliable, and valid.
Turnbull
J
J
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
MacFadyen
J
J
Van Barneveld
C
C
Norman
G
G
D002983:Clinical Competence; D004501:Education, Medical; D004521:Educational Measurement / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D009864:Ontario; D015397:Program Evaluation; D015203:Reproducibility of Results