A model for integrated assessment of clinical competence.

An interdisciplinary group of faculty from medicine, basic sciences, physical therapy, and education developed a performance assessment tool for evaluating clinical competence. This group was assembled following the revision to integrated systems-based curricula in the school of medicine and doctor of physical therapy program. The group was challenged to measure curricular outcomes through student assessment of clinical competence as defined through integration. The Integrated Standardized Patient Examination was developed as the assessment tool. This model utilizes standardized patients, who are trained to ask questions that require the students to integrate scientific knowledge and communicate this back to the patient. The student response is graded on a rubric and averaged with a history-taking portion of the examination. This model was administered to 140 first-year medical students who were randomly assigned to either an acute low back pain case or gastroesophageal reflux disease case. Clinical faculty scored the students in the treatment room, with additional faculty scoring in the monitor room. Interrater agreement was 87% for the low back pain case and 82% for the gastroesophageal reflux disease case. These results warrant further investigation of the Integrated Standardized Patient Examination for transfer to other health care professions, in particular physical therapy.