A comparison of the performance of an oral certification examination of clinical reasoning skills in emergency medicine with the performances of similar North American examinations

This study is concerned with the assessment of competence in medicine, more specifically with the assessment of clinical reasoning skills at the certification level in emergency medicine. It was our general hypothesis that many of the difficulties reported in the literature with the validity and reliability of assessments results from a lack of an adequate definition of the competence to be tested. Such a definition is important not only to determine the content of the assessment, but it also has a major impact of the choice of assessment format. We predicted that an examination based on a rigorously developed operational definition of competence, administered in a structured and objective fashion, would avoid the usual problems of validity and reliability.;A structured oral examination format was chosen as the vehicle to test this competence on a certification examination in emergency medicine. Three parallel examinations (identical structure and conceptual development, but different topics and cases) were developed and administered as real-life certification examinations. (Abstract shortened by UMI.).