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Can Students' Scores on Preclerkship Clinical Performance Examinations Predict That They Will Fail a Senior Clinical Performance Examination?

Klamen, Debra L. MD, MHPE; Borgia, Peter T. PhD

Academic Medicine:
doi: 10.1097/ACM.0b013e31820de435
Clinical Performance

Purpose: This study was designed to determine whether preclerkship performance examinations could accurately identify medical students at risk for failing a senior clinical performance examination (CPE).

Method: This study used a retrospective case–control, multiyear design, with contingency table analyses, to examine the performance of 412 students in the classes of 2005 to 2010 at a midwestern medical school. During their second year, these students took four CPEs that each used three standardized patient (SP) cases, for a total of 12 cases. The authors correlated each student's average year 2 case score with the student's average case score on a senior (year 4) CPE. Contingency table analysis was carried out using performance on the year 2 CPEs and passing/failing the senior CPE. Similar analyses using each student's United States Medical Licensing Examination (USMLE) Step 1 scores were also performed. Sensitivity, specificity, odds ratio, and relative risk were calculated for two year 2 performance standards.

Results: Students' low performances relative to their class on the year 2 CPEs were a strong predictor that they would fail the senior CPE. Their USMLE Step 1 scores also correlated with their performance on the senior CPE, although the predictive values for these scores were considerably weaker.

Conclusions: Under the conditions of this study, preclerkship (year 2) CPEs strongly predicted medical students at risk for failing a senior CPE. This finding opens the opportunity for remediation of deficits prior to or during clerkships.

Author Information

Dr. Klamen is associate dean of education and curriculum, Southern Illinois University School of Medicine, Springfield, Illinois.

Dr. Borgia is professor, Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, Illinois.

Correspondence should be addressed to Dr. Klamen, 801 N. Rutledge Avenue, P.O. Box 19622, Springfield, IL 62794; telephone: (217) 545-7932; fax: (217) 545-0192; e-mail:

First published online February 21, 2011

© 2011 Association of American Medical Colleges