Is the glass half full or half empty? A reexamination of the associations between assessment measures during medical school and clinical competence after graduation.

The purpose of this study was to investigate the associations between performances during medical school and in the first year of residency. It was hypothesized that the strength of such associations is a function of several variables, including similarities of the measured concepts, the formats of the assessments, the time interval between the assessments, performance levels, and specialty areas. The total sample consisted of 2,368 graduates of Jefferson Medical College between 1980 through 1990. The performance measures in medical school were grades on objective examinations in basic and clinical sciences, global ratings of clinical competence in junior core clerkships, and scores on the Part I and Part II examinations of the National Board of Medical Examiners (NBME). The postgraduate performance measures were scores on the Part III NBME examination, postgraduate competence ratings, and board certification. The ratings of postgraduate clinical competence (available for 73% of graduates) were made by residency directors at the end of the first year of residency in the areas of data-gathering and processing skills, interpersonal skills and attitudes, and socioeconomic aspects of patient care. Results supported the research hypotheses. It was found that the associations varied for different measures, at different levels of performance, and in different specialties. The authors conclude that the glass is "half full" regarding the associations between assessment measures before and after graduation from medical school.