The ECFMG Clinical Skills Assessment (CSA) was developed to evaluate whether graduates of international medical schools are ready to enter graduate training programs in the United States. The performance-based patient note exercise is specifically used to assess an examinee's ability to summarize, synthesize and interpret the data collected in a patient interview. The purpose of this study was to investigate whether choice of composition method (typing or writing) affected the psychometric properties of the scores. Using data for a 1-year period, the validity and reliability of typed and written notes was contrasted. Although the characteristics of individuals who chose whether or not to type were different, the statistical analyses indicated that, controlling for examinee ability, physician examiner ratings of the written summaries were not influenced by composition method. The results of this study suggest that the psychometric properties of the patient note scores are invariant with respect to composition method.