Functional and dysfunctional characteristics of the prevailing model of clinical evaluation systems in North American medical schools.

To ensure that graduates are ready to move on to residency, medical schools need systems to monitor students' progress through clinical experiences. Clinical rotations occur in geographically separated settings in a variety of disciplines that use evaluators of varying levels of experience. That this complexity lends itself to error has been documented by the Association of American Medical Colleges' ongoing Clinical Evaluation Project, begun in 1979. This paper draws from that work and a 1987-1988 survey of 77% of the U.S. and Canadian deans for student affairs. This information is subjected to an analysis that emphasizes both common and unique characteristics of evaluation systems that are based on the four-stage model employed by most medical schools. Seventeen symptoms that can be signs of system errors are identified. It is recommended that schools having these symptoms review their clinical evaluation systems to ensure effective and efficient monitoring of clinical students.