Reliability of global rating scales in the assessment of clinical competence of medical students.

Undergraduate medical students of the Ben Gurion University were evaluated upon completion of their fourth- and sixth-year medical clerkships by a 17-item rating scale, a multiple choice question (MCQ) test and a patient-oriented oral examination by two academic staff members. Pearson's correlation coefficient between the fourth-and sixth-year global ratings was r = 0.44 (P less than or equal to 0.001), while that between the fourth- and sixth-year MCQ scores was r = 0.54 P less than or equal to 0.001). Pearson's coefficient between the global ratings and the MCQ scores in the sixth year was r = 0.25 (P less than or equal to 0.05). Stepwise regression analysis revealed that the ratings on the parameters 'reliability', 'knowledge', 'organization', 'diligence' and 'case presentation' were the most predictive of the overall global rating. It is concluded that the reproducibility of 'subjective' expert assessment of performance through global rating scales is comparable to that of 'objective' evaluation through written MCQ, even though these measures assess different domains of competence at different levels of simulations. It is recommended that the clinical performance of undergraduate medical students should be assessed by a combination of subjective and objective measures.