Global Ratings of Student Performance in a Standardized Patient Examination: Is the Whole More than the Sum of the Parts?

Standardized patient examinations (SPE) are widely used in medical education to assess skills that cannot be measured with written examinations. Trained actors termed standardized patients (SPs) are used to simulate patients with specific medical problems. SPs typically use behaviorally specific checklists and rating scales to evaluate examinees. This study explored the use of faculty and SP global ratings of students' clinical and interpersonal skills in an SPE. The reliability of global ratings was found to on par with more specific behaviorally anchored ratings. Global ratings were also found to be predictive of written tests of clinical knowledge and ratings of actual clinical performance after controlling for behaviorally anchored ratings. Faculty global ratings were more reliable and more predictive of other performance than SP global ratings. These results suggest global ratings by faculty observers and possibly SPs can provide unique and useful information in these performance-based examinations.