Assessing the impact of examinee and standardized patient ethnicity on test scores in a large-scale clinical skills examination: gathering evidence for the consequential aspect of validity.

Purpose: The purpose of this study was to assess whether the interaction of examinee and standardized patient (SP) ethnicity has an impact on data gathering and written communication scores in a large-scale clinical skills assessment used for certification purposes.

Method: The sample that was the focus of the present investigation was selected from the population of 9,551 international medical graduates (IMGs) who completed the Educational Commission for Foreign Medical Graduates' Clinical Skills Assessment between May 1, 2002, and May 31, 2003. Analyses of covariance were undertaken separately for four cases, adjusting for initial mean differences between candidate groups and controlling for stringency levels of SPs. Over 2,800 SP-IMG encounters were analyzed, ranging from 597 (Case 2) to 915 (Case 3).

Results: None of the SP ethnicity/examinee ethnicity interactions were statistically significant.

Conclusions: Findings suggest that there is little advantage to be gained by encountering a SP of similar ethnic makeup. These results are discussed in light of past research undertaken to assess fairness issues with clinical skills examinations.