An Early Prediction of Clinical Perfprmance of Medical Students: an Integrative Approach to Evaluaticn

An Early Prediction of Clinical Performance of Medical Students: An Integrative Approach to Evaluation 4 DAN E. BENOR STEPHAN E. HOBFOLL Ben Gurion University, Beer Sheva, Israel Prediction of clinical performance of medical students in the clerkship phase was 'made possible in the earliest phase of medical education by a comprehensive and integrative evaluation instrument entitled "Integrative Examination" (INTEX). A proportional sample of the content learned throughout the year is intel4ated for measuring knowledge, attitudes and skills on various cognitive levels within the clinical context of patient problems. INTEX was found to ):)e a reliable instrument. Also its scores highly correlate with all the constituents of later clinical assessment, creating a valid multitrait-multimethod matrix. The educational implication of integrative approach to evaluation is discussed. , Early prediction of later students' performance ie-an issue of obvious importance t medical educators; indeed, it is of concern to any educator. Attempts to address this issue byMidentifying more predictive admission criteria have had but limited success (Gough, 1967; 1978; Jason, 1972; Senor & Hobfoll, 1981; Hobfoll & Senor; 1961). It may thus be assumed that identification of ,students with a high failure potential will remain the thrust of the evaluators of students' performance. It is rather obvious tha, the later this identification occurs, the more painful it is for the individual and uneconomical for the institution. The search for valid predictors of clinical performance in the pre-clinical phases have been'described across a plethora of studies, most of which agree that academic achievements in the early phases are not related to later clinical perforMance (Wingrad & Williamson, 1973; Rhoads et al., 1974). Several reasons may account for this poor predictive value. The cognitive abilities required by the pre-clinical evaluation instruments stress, more often than not, recollection of disciplinary.arranged factual knowledge, in contrast to the integrated nature of the problem-solVing tasks expected in the clinical phase (Gjerde, 1968; NeUfeld & Barrows, 1974; Elstein et al., 1978). Moreover, the applied nature of the knowledge required by the clinician is different from the theoretical and conceptual knowledge traditionally evaluated by the basic scientists (Jason, 1974; Houti & Bench, 19761. Besides these differerkes in the cognitive realm, the clinical clerk is called upon to demonstrate both psychomotor skillfulness and affective aptness. These are seldom evaluated in the pre-clinical phases. Finalltt there is an apparent shift in students' attitudes during the course of the pre-clinical studies from their initial humanistic "healer" standpoint toward a more,scientific approach, based upon the "biomediCal model" (Engel, 1977). Such'an attitude may be incongruent with the expected clinical behaviour, thus yielding poorer clinical aasessmentS of previouslr successful students and vice versa (Rhoads et al., 1974)