title: Utilisation, Reliability and Validity of Clinical Evaluation Exercise in Otolaryngology Training.
abstract: OBJECTIVE
  To investigate the utilisation, reliability and validity of clinical evaluation exercise (CEX) in otolaryngology training.
  
  
  METHODS
  Retrospective database analysis.
  
  
  METHODS
  Online assessment database.
  
  
  METHODS
  We analysed all CEXs submitted by north London core (CT) and speciality trainees (ST) in otolaryngology from 2010 to 2013.
  
  
  METHODS
  Internal consistency of the 7 CEX items rated as either O: outstanding, S: satisfactory or D: development required. Overall performance rating (pS) of 1-4 assessed against completion of training level. Receiver operating characteristic was used to describe CEX sensitivity and specificity. Overall score (cS), pS and the number of 'D'-rated items were used to investigate construct validity.
  
  
  RESULTS
  One thousand one hundred and sixty CEXs from 45 trainees were included. CEX showed good internal consistency (Cronbach's alpha= 0.85). CEX was highly sensitive (99%), yet not specific (6%). cS and pS for ST was higher than CT (99.1% ± 0.4 versus 96.6% ± 0.8 and 3.06 ± 0.05 versus 1.92 ± 0.04, respectively P < 0.001). pS showed a significant stepwise increase from CT1 to ST6 (P < 0.001). In contrast, cS only showed improvement up to ST4 (P = 0.025). The most frequently utilised item 'management and follow-up planning' was found to be the best predictor of cS and pS (rs  = +0.69 and +0.21, respectively).
  
  
  CONCLUSIONS
  CEX is reliable in assessing early years otolaryngology trainees in clinical examination, but not at higher level. It has the potential to be used in a summative capacity in selecting trainees for ST positions. This would also encourage trainees to master all domains of otolaryngology clinical examination by end of CT.
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.|Department of Otolaryngology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Awad
authors.affiliation: School of Medicine, Imperial College, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Hayden
authors.affiliation: School of Medicine, Imperial College, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Muthuswamy
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.|Department of Otolaryngology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: N S
authors.initials: NS
authors.lastname: Tolley
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D008131:London; D010036:Otolaryngology / Q000193:education* / Q000592:standards; D010808:Physical Examination; D015203:Reproducibility of Results; D012189:Retrospective Studies