Development and Use of Checklists for Assessment of Medical Students in Clinical Examinations on Real Patients: A preliminary study

Abstract

Background Clinical performance examinations (CPE) are important methods for assessing medical students and postgraduate medical trainees. Unfortunately, assessment (scoring) in these exams as it is practiced in most medical schools is based mainly on the general impression and level of experience of the examiner. Hence, it has the disadvantage of being non-structured, subjective, and sometimes highly
biased. The objective of this study was to develop objective structured tools (checklists), use them in the clinical examination, and to compare their scores to those given by the conventional way.
Methods Case-specific checklists were developed for some common long and short clinical examination cases. These were tried in the final undergraduate surgery exam at Alazhari University, August 2008. Scores (marks) given to the same student, using the conventional and the checklist systems were compared using the chi square and correlation statistics. Questionnaires were filled by the examiners after using the checklists.
Results Checklist and conventional scores were strongly correlated in the long case exams. A significant difference between the scores was, however, noted in the short case exams. Care should be taken in interpretation because of the small number of data. Evaluators felt that the checklist system was more objective and structured and hence fairer than the conventional method. Although checklist final scores took a bit longer time to calculate, that was not significant practically. Examiners gave valuable feedback regarding the construction and the use of checklists.

Conclusion The use of checklists in the clinical examination was more objective, more structured, and more accurate than the conventional method. The development of checklists requires hard team work and
frequent updating and use to develop experience. We propose using checklists as alternative tools of assessment with many advantages over the conventional method, and to prepare the examination culture to adopt the OSCE