title: Reliability and validity of an extended clinical examination.
abstract: BACKGROUND
  An extended clinical examination (ECE) was administered to 85 final year medical students at the Radboud University Medical Centre in the Netherlands. The aim of the study was to determine the psychometric quality and the suitability of the ECE as a measurement tool to assess the clinical proficiency of eight separate clinical skills.
  
  
  METHODS
  Generalizability studies were conducted to determine the generalizability coefficient and the sources of variance of the ECE. An additional D-study was performed to estimate the generalizability coefficients with altering numbers of stations.
  
  
  RESULTS
  The largest sources of variance were found in skill difficulties (36.18%), the general error term (26.76%) and in the rank ordering of skill difficulties across the stations (21.89%). The generalizability coefficient of the entire ECE was above the 0.70 lower bound (G = 0.74). D studies showed that the separate skills could yield sufficient G coefficients in seven out of eight skills, if the ECE was lengthened from 8 to 14 stations.
  
  
  CONCLUSIONS
  The ECE proved to be a reliable clinical assessment that enables examinees to compose a clinical reasoning path through self-obtained data. The ECE can also be used as an assessment tool for separate clinical skills.
authors: a Radboud University Medical Centre , The Netherlands .
authors: G A M
authors: GA
authors: Bouwmans
authors: b Radboud University Nijmegen , The Netherlands.
authors: E
authors: E
authors: Denessen
authors: a Radboud University Medical Centre , The Netherlands .
authors: A M
authors: AM
authors: Hettinga
authors: b Radboud University Nijmegen , The Netherlands.
authors: C
authors: C
authors: Michels
authors: a Radboud University Medical Centre , The Netherlands .
authors: C T
authors: CT
authors: Postma
mesh_terms: D000046:Academic Medical Centers; D002983:Clinical Competence / Q000592:standards*; D003937:Diagnosis, Differential; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement / Q000379:methods* / Q000592:standards*; D006801:Humans; D008487:Medical History Taking / Q000592:standards; D009426:Netherlands; D010808:Physical Examination / Q000592:standards; D011594:Psychometrics; D015203:Reproducibility of Results; D013337:Students, Medical