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Performance-Based Assessment

A Brief History

Dr. Robert Kretzschmar was a pioneer in the use of trained patients to teach interviewing and examination skills in the University of Iowa's Department of Obstetrics and Gynecology starting in the late 1960s.  In 1999, the directive came from the accreditation board and deans of the Carver College of Medicine to incorporate clinical skills assessment into the medical curriculum.  Subsequently, the UI developed its Performance-Based Assessment (PBA) program.  In September, 2002, the UI held its first PBA exam.  Since 2004, a Performance-Based Assessment is a component of the United States Medical Licensing Exam (USMLE), Step II CS.  The graduating 2011 and 2012 classes of  the University of Iowa Carver College of Medicine achieved a 100% pass rate for medical students taking the USMLE Step II CS.

What is the PBA Program?

The PBA program assesses the clinical and communication skills of physician assistant and medical students at the Carver College of Medicine. By having students interact with Standardized Patients (SPs) in 15-minute encounters, medical faculty are able to assess medical students according to the objectives set forth by the college and its clerkships. This form of authentic assessment supports the College's objective that all our students will graduate with demonstrated competency in the areas needed by physicians starting residency training. The program also provides faculty with a means of assessing the areas of strength and weakness in the medical school curriculum.

Our SPs are not true patients, but rather, they simulate a patient case that may have been seen in the clinics or on the wards in the hospital. Previous research with practicing physicians, as well as with students, shows that the performance a learner or physician demonstrates in this setting is highly correlated with actual performance in a real clinical setting. There are several real advantages of using 'standardized'' patients for this type of assessment. First, it is the matter of standardization. Essentially, each learner can be assessed with the same patient and problem.

Additionally, simulation addresses the problem of patient availability. Through the use of actors, specific clinical situations can be simulated for an assessment. Thus, if a faculty member wants to assess the competency of students faced with a patient with abdominal pain, the PBA program can create such a case. In that way, all students can have that experience without having to wait for such a patient to check into the hospital. Finally, a broad range of skills can be given focus during an assessment. Cases can be tuned to specifically focus on interpersonal relationships ("bedside manner''), patient education, or professionalism.