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.
Petrusa
E R
ER
Department of Medical Education, Department of Surgery, Duke University, Durham, North Carolina, USA. petru001@mc.duke.edu
Hales
J W
JW
Wake
L
L
Harward
D H
DH
Hoban
D
D
Willis
S
S
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