In-Training Performance Assessment in family practice.

The In-Training Performance Assessment (ITPA) is an evaluation instrument derived from 174 basic objectives in family medicine. The instrument was applied to two consecutive classes of fourth-year medical undergraduates during the family medicine clerkship. Comparisons were made of two scoring systems: one measuring mastery of the objectives using the criterion of performance expected of a fully qualified family physician, the other using traditional categories of "poor", "satisfactory", "good", and "outstanding". The mastery evaluation model made it more difficult to achieve the objectives but had no effect on the discriminatory ability of the objectives when compared with the traditional evaluation method. The mastery model showed "management" to have the greatest differential between medical students and qualified family physicians. The evaluating supervisor was most influenced by the student's assessment in "problem-solving" using the traditional method, and by "management" using the mastery model. Management skills accounted for 89 percent of the variance of the overall competence assessments.