Dimensions of clinical competence as conceptualized by medical school faculty

This study identified dimensions of clinical competence underlying faculty ratings of fourth-year student performance in a standardized patient examination and assessed the impact of these dimensions on faculty pass/fail decisions. Content review coupled with exploratory factor analysis was used to group 17 of 25 specific behavioral rating categories into four homogeneous clusters. Confirmatory factor analysis refined the clusters into four unidimensional scales that included 14 of the original ratings. The dimensions reflected relating to the patient, problem-solving skills, medical history skills, and physical examination skills. The factor structure was cross-validated in a separate data set. Logistic regression indicated problem solving was the only independent predictor of a student passing the exercise.