gms | German Medical Science

Introduction: Until recenty summative tests were realized mainly as written examinations or as structured practical examinations [1], [2], [3]. With respect to their relevance and validity for clinical practice workplace-based assessments [4], [5] are as well a desirable format, since they are carried out in a real clinical setting. Since the winter semester 2012/13 in the 2 week internship of general medicine at the LMU Munich structured work samples are used for marking.

Question: Is the workplace based examination in general medicine training a suitable measuring instrument for detecting clinically relevant skills?

Methods: 618 evaluation sheets from 164 interns from winter 2012/13 to winter semester 2013/14 were evaluated. The rating forms contained items for a total of 11 criteria in four relevant clinical situations (acute case, chronic case, prevention/screening and technical examination) and a global behavioral rating.

Results: The report includes the results of 611 students. The scoring exhibits a clear ceiling effect: From a maximum overall score of 32 points on average 31.48 points were reached (range 23-32, Cronbach's α=0.57). The most commonly performed technical studies were ECG (246), sonography (168) and pulmonary function test (52). Also in the technical investigation ratings on average 4.86 out of 5 points were achieved.

Discussion/Conclusion: The result suggests that the examination is seen by the general practiitioners as formative assessment rather than as a summative test. A feedback of results to the teaching doctors and a training for the grading of the observations are planned to improve the reliability of the test. The announcement of the assessment and the rating forms included in the students' logbooks point out the importance of practical skills to the students and foster the teaching of those skills by the general practitioners.