Journal of General Internal Medicine

, Volume 9, Issue 3, pp 140–145 | Cite as

Do ratings on the american board of internal medicine resident evaluation form detect differences in clinical competence?

  • Richard J. Haber
  • Andrew L. Avins
Original Articles


Objective: To determine whether raters using the American Board of Internal Medicine (ABIM) Resident Evaluation Form can detect differences among residents in clinical competence.

Design: Cross-sectional study.

Setting: Inpatient general medicine service in a university-affiliated public hospital.

Participants: University-based internal medicine (UCIM) residents (ABIM certifying examination pass rate, 91%; mean score, 95th percentile), community hospital-based internal medicine (CHIM) residents (ABIM examination pass rate, 68%; mean score, 42nd percentile), and residents from three university-based non-internal medicine (UC non-IM) programs all assigned to the same inpatient general medicine service over a three-year period. Four hundred eighty-nine evaluations of 110 postgraduate-year-one residents were analyzed.

Measurements and main results: Mean ratings for the UCIM residents were significantly higher than those for the CHIM or UC non-IM residents (analysis of variance [ANOVA], p<0.05). Variance was smallest for the UCIM residents (F test, p<0.01), and only the UCIM residents’ mean scores were in the “superior” range (7–9) in all evaluated categories. The mean ratings for the CHIM residents while at the university-affiliated hospital were not significantly different from the ratings of the same residents at their home hospital. The ratings for the CHIM residents at either site were significantly lower than those for the UCIM residents in all categories (ANOVA, p<0.05). Factor analysis revealed a single factor accounting for 76% of the variance among the ratings with all dimensions loading high on that factor (0.75–0.95), providing evidence for a “halo” effect. Mean interrater agreement over all variables was 0.87, indicating good consistency among raters.

Conclusions: Ratings on the ABIM Resident Evaluation Form detect global differences among residents in clinical competence in the expected direction based on type of training program and performance on the ABIM certification examination, but fail to differentiate among the nine evaluated dimensions of clinical care. This rating method may be valid for assessing overall clinical performance, but is less useful for providing feedback in specific areas to individual residents.

Key words

clinical competence educational measurement evaluation studies internal medicine internship and residency ABIM Resident Evaluation Form 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    The American Board of Internal Medicine. Guide to Evaluation of Residents in Internal Medicine 1988–1989. Portland, OR: Office of the President, American Board of Internal Medicine, 1988.Google Scholar
  2. 2.
    Thompson WG, Lipkin M Jr, Gilbert DA, Guzzo RA, Roberson L. Evaluating evaluation: assessment of the American Board of Internal Medicine Resident Evaluation Form. J Gen Intern Med. 1990;5:214–7.PubMedGoogle Scholar
  3. 3.
    Benson JA Jr, Blank LL, Norcini JJ Jr. Examining the ABIM’s evaluation form [letter], J Gen Intern Med. 1990;5:535–6.PubMedGoogle Scholar
  4. 4.
    Program Director’s Report A. American Board of Internal Medicine, 1986–1991. In:Google Scholar
  5. 5.
    Snedecor G, Cochran W. Statistical Methods. 8th ed. Ames, IA: Iowa State University Press, 1989.Google Scholar
  6. 6.
    Sokal RR, Rohlf FJ. Biometry, 2nd ed. New York: W. H. Freeman, 1981;242–62.Google Scholar
  7. 7.
    Stevens J. Applied Multivariate Statistics for the Social Sciences. Hillsdale, NJ: Lawrence Erlbaum, 1986.Google Scholar
  8. 8.
    James LR, Demaree RG, Wolf G. Estimating within-group interrater reliability with and without response bias. J Appl Psychol. 1984;69:85–98.CrossRefGoogle Scholar
  9. 9.
    Neufeld VR An introduction to measurement properties. In: Neufeld VR, Normal GR (eds). Assessing Clinical Competence. Springer Series on Medical Education, vol. 7. New York: Springer Publishing, 1985;7:39–50.Google Scholar
  10. 10.
    Benson JA Jr. Certification and recertification: one approach to professional accountability. Ann Intern Med. 1991;114:238–42.PubMedGoogle Scholar
  11. 11.
    Noricini JJ Jr, Webster GD, Grosso LJ, Blank LL, Benson JA Jr. Ratings of residents’ clinical competence and performance on certification examination. J Med Educ. 1987;62:457–62.Google Scholar
  12. 12.
    Ramsey PG, Carline JD, Inui TS, Larson EB, LoGerfo JP, Wenrich MD. Predictive validity of certification by the American Board of Internal Medicine. Ann Intern Med. 1989;110:719–26.PubMedGoogle Scholar
  13. 13.
    Streiner DL. Global rating scales. In: Neufeld VR, Norman GR (eds). Assessing Clinical Competence. Springer Series on Medical Education, vol. 7. New York: Springer Publishing, 1985;7:119–41.Google Scholar
  14. 14.
    Hess JW. A comparison of methods for evaluating medical student skill in relating to patients. J Med Educ. 1969;44:934–8.PubMedGoogle Scholar
  15. 15.
    Stillman P, Swanson D, Regan MB, et al. Assessment of clinical skills of residents utilizing standardized patients. A follow-up study and recommendations for application. Ann Intern Med. 1991;114:393–401.PubMedGoogle Scholar
  16. 16.
    Geertsma RH, Chapman JF. The evaluation of medical students. J Med Educ. 1967;42:938–48.PubMedGoogle Scholar
  17. 17.
    Gough HG, Hall WB, Harris RE. Evaluation of performance in medical training. J Med Educ. 1964;39:679–92.PubMedGoogle Scholar
  18. 18.
    Landy FJ, Farr JL. Performance rating. Psychol Bull. 1980;87:72–107.CrossRefGoogle Scholar
  19. 19.
    Levine HG, McGuire CH. Rating habitual performance in graduate medical education. J Med Educ. 1971;46:306–11.PubMedGoogle Scholar
  20. 20.
    Printen KJ, Chappell W, Whitney DR. Clinical performance evaluation of junior medical students. J Med Educ. 1973;48:343–8.PubMedGoogle Scholar
  21. 21.
    Dowaliby FJ, Andrew BJ. Relationships between clinical competence ratings and examination performance. J Med Educ. 1976;51:181–88.PubMedGoogle Scholar
  22. 22.
    Brumback GB, Howell MA. Rating the clinical effectiveness of employed physicians. J Appl Psychol. 1972;56:241–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Gluskinos U, Brennan TF. Selection and evaluation procedure for operating room personnel. J Appl Psychol. 1971;55:165–69.PubMedCrossRefGoogle Scholar
  24. 24.
    Cranton PA, Dauphinee WD, McQueen MM, Smith LP. The reliability and validity of in-training evaluation reports in obstetrics and gynecology. Proceedings, 23rd Annual Conference on Research in Medical Education. Washington, DC: Association of American Medical Colleges, 1984;59–64.Google Scholar
  25. 25.
    Kegel-Flom P. Predicting supervisor, peer, and self ratings of intern performance. J Med Educ. 1975;50:812–5.PubMedGoogle Scholar
  26. 26.
    Pierleoni RG, Dudding BA, Clark GM. An analysis of pediatric clerkship performance in a multicomponent evaluation system. Proceedings, 17th Annual Conference on Research in Medical Education. Washington, DC: Association of American Medical Colleges, 1978;31–6.Google Scholar
  27. 27.
    Borman WC. Effects of instructions to avoid halo error on reliability and validity of performance evaluation ratings. J Appl Psychol. 1975;60:556–60.CrossRefGoogle Scholar
  28. 28.
    Borman WC, Dunnette MD. Behavior-based versus trait-oriented performance ratings: an empirical study. J Appl Psychol. 1975;60:561–5.CrossRefGoogle Scholar
  29. 29.
    Noel GL, Herbers JE Jr, Caplow MP, Cooper GS, Pangaro LN, Harvey J. How well do internal medicine faculty members evaluate the clinical skills of residents? Ann Intern Med. 1992;117:757–65.PubMedGoogle Scholar
  30. 30.
    Kroboth FJ, Hanusa BH, Parker S, et al. The inter-rater reliability and internal consistency of a clinical evaluation exercise. J Gen Intern Med. 1992;7:174–9.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 1994

Authors and Affiliations

  • Richard J. Haber
    • 1
  • Andrew L. Avins
    • 1
    • 2
  1. 1.the Division of General Internal Medicine, San Francisco General Hospital, Department of MedicineUniversity of CaliforniaSan Francisco
  2. 2.the Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan Francisco

Personalised recommendations