Measurement precision of spoken English proficiency scores on the USMLE step 2 clinical skills examination

Acad Med. 2009 Oct;84(10 Suppl):S83-5. doi: 10.1097/ACM.0b013e3181b37d01.


Background: Previous research has shown that ratings of English proficiency on the United States Medical Licensing Examination Clinical Skills Examination are highly reliable. However, the score distributions for native and nonnative speakers of English are sufficiently different to suggest that reliability should be investigated separately for each group.

Method: Generalizability theory was used to obtain reliability indices separately for native and nonnative speakers of English (N = 29,084). Conditional standard errors of measurement were also obtained for both groups to evaluate measurement precision for each group at specific score levels.

Results: Overall indices of reliability (phi) exceeded 0.90 for both native and nonnative speakers, and both groups were measured with nearly equal precision throughout the score distribution. However, measurement precision decreased at lower levels of proficiency for all examinees.

Conclusions: The results of this and future studies may be helpful in understanding and minimizing sources of measurement error at particular regions of the score distribution.

MeSH terms

  • Clinical Competence* / statistics & numerical data
  • Educational Measurement* / statistics & numerical data
  • Language*
  • Licensure, Medical*
  • United States