Internal Medicine

Multiple Assessments

Multiple AssessmentsPurpose of the multiple assessments in medicine

We make use of a suite of assessments used to determine whether the student passes Internal Medicine or not. Each of the assessment modalities has its particular strengths, and examiners must concentrate on the areas of strength of that particular modality of assessment. These are summarised below, and the areas of strength are indicated.

Essentially we have two principal areas of assessment: clinical and classroom.

Clinical Assessment

This takes two formats, the directly-observed clinical examination, and the oral portfolio examination. Both assessments are built around patients actually seen by the student, in contrast to the classroom assessments, and allow for the assessment of the student’s ability in the authentic clinical setting.

It will be seen from the table below that the bedside clinical examination and the oral portfolio examination complement each other well. The bedside examination suffers from a small sampling number, but allows for the direct observation of the student’s comfort at the bedside, facility with history and examination, ability to detect abnormal signs and facility in interpretation of these.

The oral portfolio interview by contrast allows for the intensive interrogation of the student’s ability to reason their way through their cases, including history, examination and context, as well as to understand, plan and interpret investigations and management. We think of it as an extended open-book examination – students have had weeks in which to reflect on the cases they have seen and included in the portfolio, to seek additional information from whatever sources they choose, and to fully integrate their experience, knowledge and skills into their discussion of the case. It serves as a powerful assessment of both their competence and of the use to which they have put the opportunity for learning presented by their cases.

Classroom Assessment

Here we have two formats: the multiple choice question (MCQ) examination, and the modified essay question (MEQ) examination. It must be stressed that neither should be thought of as “theory” examinations. In fact both are essentially applied, clinical examinations, albeit taken in the classroom. Both have the following major advantages, unlike the clinical examinations:

1. Reliability – many questions are set, allowing wide coverage of the syllabus, and a good reflection of the student’s global ability

2. Objectivity – standard marking templates, effectively removing the subjective element of marking

3. Uniformity – all students are assessed on exactly the same material.


The MCQ utilises the favoured one-best-answer format and is specifically set to test the higher orders of cognitive ability, and not just factual recall. The MEQ is used to test material for which spontaneous answer generation is appropriate. Both formats are used to assess the interpretation of laboratory and imaging data, in addition to the interpretation of clinical material.

Complementarity of the assessments

The following diagram indicates how the various modes of assessment complement each other.

   Clinical  Classroom
 Domain  Bedside   Portfolio  MCQ   MEQ 
 Comfort with patients        
 Clinical reasoning        
 Interpretation of history
 and examination findings
 Planning of investigations        
 Interpretation of
 Management planning        
 Assessment of response
 to therapy
 Applied basic sciences.