The role of performance assess,ment in outcome-based education is discussed emphasizing the relationship and interplay, between these two related paradigms. Issues of the relevancy of assessment to student learning are highlighted in the context of outcome-based education. The importance of defining assessment premises and the role of institutions in defining their educational, philosophy as it pertains to student learning and assessment is also presented. A brief description of implementation guidelines of assessment programs in outcome-based education are presented indicating the key features of such programs.

Purpose. Post-encounter written exercises (e.g., patient notes) have been included in clinical skills assessments that use standardized patients. The purpose of this study was to estimate the generalizability of the scores from these written exercises when they are rated by various trained health professionals, including physicians.Method. The patient notes from a 10 station clinical skills examination involving 10 first year emergency medicine residents were analytically scored by four rater groups: three physicians, three nurses, three fourth year medical students, three billing clerks. Generalizability analyses were used to partition the various sources of error variance and derive reliability-like coefficients for each group of raters.Results. The generalizability analyses indicated that case-to-case variability was a major source of error variance in the patient note scores. The variance attributable to the rater or to the rater by examinee interaction was negligible. This finding was consistent across the four rater groups. Generalizability coefficients in excess of 0.80 were achieved for each of the four sets of raters. Physicians did, however, produce the most dependable scores.Conclusion. There is little advantage, from a reliability perspective, in using more than one trained physician, or other health professional who is adequately trained to score the patient note. Measurement error is introduced primarily by case sampling variability. This suggests that, if required, increases in the generalizability of the patient note scores can be made through the addition of cases, and not the addition of raters.

Background: One major concern in the use of standardized patients (SPs) to assess clinical competency is whether fatigue affects the accuracy of SPs' checklist recording.Purpose: The purpose of this study was to assess how fatigue affects clinical competency.Methods: In this study, 10 SPs each interacted with as many as 21 residents in a 12-hr period. All the encounters were videotaped for subsequent review.Results: Although most SPs subjectively experienced a certain degree of fatigue, their accuracy in checklist recording did not seem to be affected. No significant differences in checklist scores were detected between morning and afternoon encounters, between the first 5 and the last 5 encounters, and throughout the day. Item agreement scores between actual test and videotaped review also did not differ significantly.Conclusion: We concluded that fatigue does not seem to systemically affect the accuracy of SPs' checklist recording. This finding is of potential importance to organizations that may test large number of candidates at national or regional testing centers.