Effect of Position-Within-Sequence on Case Performance in a Multiple-Stations Examination Using Standardized-Patient Cases

Several recent studies of multiple-stations examinations of clinical competence have found a "sequence effect," which refers to an observed improvement in performance across a sequence of examination cases, so that performance on stations encountered later in the sequence is significantly superior to that on stations encountered earlier. The present study was conducted to assess the possibility of a sequence effect in the multiple-stations performance-based examination given to senior medical students at Southern Illinois University School of Medicine. Unlike the previous studies, the present study assessed the sequence effect at the level of the individual case, the level at which the effect creates a serious problem for score interpretation. Analyses were performed on scores obtained from checklists completed by standardized patients and on scores to written questions following the patient encounter for each standardized-patient case for the classes of 1989 and 1990. In general, the results showed no improvement in case scores across successive cases in the examination. There was no evidence for a sequence effect on student examination performance.