Significance of experts' overall ratings for medical student competence in relation to history-taking.

CONTEXT AND OBJECTIVE Overall ratings (ORs) of competence, given by expert physicians, are increasingly used in clinical skills assessments. Nevertheless, the influence of specific components of competence on ORs is incompletely understood. The aim here was to investigate whether ORs for medical student history-taking competence are influenced by performance relating to communication skills, completeness of questioning and asking contentdriven key questions. DESIGN AND SETTING Descriptive, quantitative study at Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. METHODS Thirty-six medical students were examined in a 15-station high-stake objective structured clinical examination (OSCE). At four stations devoted to history-taking, examiners filled out checklists covering the components investigated and independently rated students overall performance using a five-point scale from 1 (poor) to 5 (excellent). Physician ratings were aggregated for each student. Nonparametric correlations were made between ORs. RESULTS ORs presented significant correlations with checklist scores (Spearmans rs = 0.38; p = 0.02) and OSCE general results (rs = 0.52; p < 0.001). Scores for "communication skills" tended to correlate with ORs (rs = 0.31), but without reaching significance (p = 0.06). Neither the scores for "completeness" (rs = 0.26; p = 0.11) nor those for "asking key questions" (rs = 0.07; p = 0.60) correlated with ORs. CONCLUSIONS Experts overall ratings for medical student competence regarding history-taking is likely to encompass a particular dimension, since ratings were only weakly influenced by specific components of performance.