An Alternative Certification Examination 'ACE': Can Post Graduate Methods Be Used to Assess Clinical Skills in Medical Under Graduates

Background: Progressing from undergraduate education to post graduate training has been punctuated by a clinical examination which has not changed significantly in decades. This study investigated the feasibility of using a validated postgraduate assessment methodology in an undergraduate setting; The Toronto Patient Assessment & Management Exam (PAME). Methods: A standardised patient-centred multifaceted healthcare pathway examination consisting of 4 separate consecutive encounters was piloted in the final year of undergraduate training. The entire final year medical class was invited to participate. The final sample of 25 was selected on a consecutive, volunteer basis. Student’s experienced 2 standardised simulated cases; 1 medical, 1 surgical. Candidates were examined by 2 independent examiners (subject experts) and were ranked on a Global Rating Scale. Passing standard was set at 3/5 - ‘barely adequate for Intern/PGY1’ but with the addition of second pass criteria of avoidance of an egregious error. Results: 23 students completed the examination. Two arrived late and were excluded. 21/23 demonstrated knowledge and skills at least at minimum expected standard. 18/23 avoided an egregious error. Subgroup analysis identified better performance in the assessment and management of the medical case and the review encounter (encounter 4) was the lowest scoring in both cases. The format was well received by students and examiners. Conclusion: The use of an alternative certification examination ‘ACE’ based on a postgraduate format ‘PAME’ in undergraduate setting appears feasible and discriminatory. Inclusion in the pass criteria of avoidance of egregious error appears to improve the specificity of the examination. The ACE format reveals potential to replace elements of prepractice (PGY1) clinical barrier assessment