What is the predictive validity of clinical placement sign-off forms for medical students?
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background:
Evaluation of clinical performance is essential in all medical school programmes. Students undergo multiple clinical placements in different disciplines and settings, and typically must pass an end-of-placement supervisor sign-off evaluation to progress. However, the validity of this sign-off model remains unclear. This study aims to assess the extent to which this assessment method predicts performance in summative medical school examinations.
Methods:
We compared summative knowledge and clinical skills examination scores with end-of-placement supervisor sign-off ratings of ‘knowledge’, ‘clinical skills’ and ‘practical skills’ for medical undergraduate students, across three clinical placements at Imperial College London, UK (n=355). Statistical analysis for predictive validity was performed through Ordinary Least Squares regression.
Results:
End-of-placement supervisor ratings in hospital did not significantly predict student performance in summative knowledge tests or clinical skills assessment. ‘Knowledge’ and ‘practical skills’ ratings lacked predictive validity across all supervisors. Statistically significant predictive validity was evident for GP supervisor ratings of ‘clinical skills’ and examination scores, but the effect size was educationally insignificant (p=0.01, r2=0.02).
Conclusions:
End-of-placement supervisor ratings did not demonstrate educationally significant predictive validity towards end-of-year examinations. Multi-source feedback, embedded in-placement assessment, and additional formalised supervision time in supervisors’ work schedules could be beneficial to improve the educational value for the student and the clinical placement sign-off process. Different sign-off requirements could be considered for GP and hospital settings, with tailoring of constructs to suit the clinical environment.
Evaluation of clinical performance is essential in all medical school programmes. Students undergo multiple clinical placements in different disciplines and settings, and typically must pass an end-of-placement supervisor sign-off evaluation to progress. However, the validity of this sign-off model remains unclear. This study aims to assess the extent to which this assessment method predicts performance in summative medical school examinations.
Methods:
We compared summative knowledge and clinical skills examination scores with end-of-placement supervisor sign-off ratings of ‘knowledge’, ‘clinical skills’ and ‘practical skills’ for medical undergraduate students, across three clinical placements at Imperial College London, UK (n=355). Statistical analysis for predictive validity was performed through Ordinary Least Squares regression.
Results:
End-of-placement supervisor ratings in hospital did not significantly predict student performance in summative knowledge tests or clinical skills assessment. ‘Knowledge’ and ‘practical skills’ ratings lacked predictive validity across all supervisors. Statistically significant predictive validity was evident for GP supervisor ratings of ‘clinical skills’ and examination scores, but the effect size was educationally insignificant (p=0.01, r2=0.02).
Conclusions:
End-of-placement supervisor ratings did not demonstrate educationally significant predictive validity towards end-of-year examinations. Multi-source feedback, embedded in-placement assessment, and additional formalised supervision time in supervisors’ work schedules could be beneficial to improve the educational value for the student and the clinical placement sign-off process. Different sign-off requirements could be considered for GP and hospital settings, with tailoring of constructs to suit the clinical environment.
Date Issued
2025-06-05
Date Acceptance
2025-04-25
Citation
BMC Medical Education, 2025, 25
ISSN
1472-6920
Publisher
BMC
Journal / Book Title
BMC Medical Education
Volume
25
Copyright Statement
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s12909-025-07237-0
Subjects
Undergraduate
Medical education research
Clinical assessment
Written assessment
Curriculum infrastructure
Publication Status
Published
Article Number
840
Date Publish Online
2025-06-05