title: Evaluation of unstructured medical school examinations: prospective observational study.
abstract: OBJECTIVE
  To evaluate the final examination in Ambulatory General Internal Medicine of the Medical School of the University of Basel, Switzerland regarding students' performance rated by examiners and patients, examiners' and students' self-assessment and examiners' performance concerning fairness and difficulty of the examination rated by students and patients.
  
  
  METHODS
  Prospective observational study of 144 Medical students judged by 29 pairs of examiners. Students examined 66 real untrained outpatients. Assessment by questionnaire during an unstructured final Medical School examination. Marks could be given between 1 (= very poor) to 6 (= very good). Fairness and difficulty of the examination was measured by visual analogue scale (1 to 10).
  
  
  RESULTS
  Patients judged students' performance better than examiners (5.45 +/- 0.46 vs. 5.22 +/- 0.65, p = 0.005). Examiners assessed students performance better than the students themselves (5.22 +/- 0.61 vs. 4.91 +/- 0.54, p = 0.001). Patients considered examiners as having examined fairly in 84.6%, and students rated examiners as having examined fairly on visual analogue scale (1.29 +/- 1.75). Students and examiners judged the exam to be similarly difficult (5.97 +/- 1.76 vs. 5.92 +/- 1.14, p = 0.77, r = 0.72).
  
  
  CONCLUSIONS
  An unstructured Medical examination - the long case - provides consistent results which are accepted as fair by the students, patients and examiners. Patients and examiners judge students' performance more benignly than students themselves. Examiners and examinees consider the long case as serving a meaningful purpose regarding assessment of clinical competence and doctor/patient relationship.
authors.affiliation: Medical Outpatient Department, University Hospital, Basel, Switzerland. zellera@uhbs.ch
authors.forename: Andreas
authors.initials: A
authors.lastname: Zeller
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Niklaus
authors.initials: N
authors.lastname: Gyr
authors.forename: Edouard
authors.initials: E
authors.lastname: Battegay
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008297:Male; D010817:Physician-Patient Relations; D011446:Prospective Studies; D015203:Reproducibility of Results; D012577:Schools, Medical; D013557:Switzerland