A Multivariate Generalizability Analysis of History-Taking and Physical Examination Scores From the USMLE Step 2 Clinical Skills Examination

Background In clinical skills, closely related skills are often combined to form a composite score. For example, history-taking and physical examination scores are typically combined. Interestingly, there is relatively little research to support this practice. Method Multivariate generalizability theory was employed to examine the relationship between history-taking and physical examination scores from the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills examination. These two proficiencies are currently combined into a data-gathering score. Results The physical examination score is less generalizable than the score for history taking, and there is only a modest to moderate relationship between these two proficiencies. Conclusions A decision about combining physical examination and history-taking proficiencies into one composite score, as well as the weighting of these components, should be driven by the intended use of the score. The choice of weights in combining physical examination and history taking makes a substantial difference in the precision of the resulting score.