Prediction accuracy and financial savings of four screening tests for a sequential test of clinical performance.
BACKGROUND
Sequential testing of clinical performance is an effective strategy to reduce cost of testing.


OBJECTIVE
To evaluate prediction accuracy and financial savings of 4 screening tests of clinical performance.


METHODS
Screening tests were created from a 13-case examination taken by 434 medical students at 4 schools. Regression analysis determined prediction accuracy for 2 test outcomes. Financial savings were computed from published estimates.


RESULTS
Zero false passes were obtained with the "Total Number of Cases Passed" screening test, but it saved only 27%. Sixty-two percent savings with 5% false passes occurred with the "Classification" screening test. The "Scale" and "Mini Test" screening tests would have excused 79% and 67% examinees with 5% and 1% false passes, respectively.


CONCLUSIONS
Prediction accuracy varies with screening test and outcome measure. Sequential testing of clinical performance can save 40% to 60% with low false pass rates. However, programs need to consider loss of information for curriculum and individual feedback relative to financial savings.
Department of Medical Education, Department of Surgery, Duke University, Durham, North Carolina, USA. petru001@mc.duke.edu
E R
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Petrusa
J W
JW
Hales
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L
Wake
D H
DH
Harward
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D
Hoban
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S
Willis
D002983:Clinical Competence / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D017145:Models, Educational; D009657:North Carolina; D011237:Predictive Value of Tests; D012044:Regression Analysis