A problem-based criterion-referenced examination of clinical competence.

A model has been developed for a problem-based criterion-referenced test of clinical competence. The model, designed to increase the reliability and validity of traditional final year examinations for medical students, aims to provide a profile of student performance over a range of defined competence categories. The level of competence has been referenced to that expected of an intern. Both the content of the examination and the selection of test methods are based on patient problem blueprints which identify key areas that require testing. The content and test methods were incorporated, as appropriate, into either th;e written section or the practical section of the examination. The approach was found to be feasible and acceptable to staff and students.