ORIGINAL REPORTS Clinical Assessment and Management Examination—Outpatient (CAMEO): Its Validity and Use in a Surgical Milestones Paradigm Adam B. Wilson, PhD, * Jennifer N. Choi, MD, * Laura J. Torbeck, PhD, * John D. Mellinger, MD, † Gary L. Dunnington, MD, * and Reed G. Williams, PhD * * Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and † Division of General Surgery, Southern Illinois University School of Medicine, Springfield, Illinois OBJECTIVES: Clinical Assessment and Management Exami- nation—Outpatient (CAMEO) is a metric for evaluating the clinical performance of surgery residents. The aim of this study was to investigate the measurement characteristics of CAMEO and propose how it might be used as an evaluation tool within the general surgery milestones project. DESIGN: A total of 117 CAMEO evaluations were gathered and used for analysis. Internal consistency reli- ability was estimated, and item characteristics were explored. A Kruskal-Wallis procedure was performed to discern how well the instrument discriminated between training levels. An exploratory factor analysis was also conducted to understand the dimensionality of the evaluation. SETTING: CAMEO evaluations were collected from 2 departments of surgery geographically located in the Mid- western United States. Combined, the participating aca- demic institutions graduate approximately 18 general surgery residents per year. PARTICIPANTS: In this retrospective data analysis, the number of evaluations per resident ranged from 1 to 7, and evaluations were collected from 2006 to 2013. For the purpose of data analysis, residents were classified as interns (postgrad- uate year 1 [PGY1]), juniors (PGY2-3), or seniors (PGY4-5). RESULTS: CAMEO scores were found to have high internal consistency (Cronbach’s α ¼ 0.96), and all items were highly correlated (Z0.86) to composite CAMEO scores. Scores discriminated between senior residents (PGY4-5) and lower level residents (PGY1-3). Per an exploratory factor analysis, CAMEO was revealed to meas- ure a single dimension of “clinical competence.” CONCLUSIONS: The findings of this research aligned with related literature and verified that CAMEO scores have desirable measurement properties, making CAMEO an attractive resource for evaluating the clinical performance of surgery residents. ( J Surg 72:33-40. J C 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: CAMEO, validity, milestones, clinic evaluation COMPETENCIES: Patient Care INTRODUCTION The Clinical Assessment and Management Examination— Outpatient (CAMEO) is an evaluation that relies on direct observation to assess the performance of resident surgeons in clinical environments. CAMEO is intended to evaluate how well residents function independently in making initial decisions about patient assessment and management and in directing a patient encounter. Per the American Board of Surgery (ABS), “Applicants to the General Surgery Qualifying Exam [are] required to obtain during residency at least two operative performance assessments and two clinical perform- ance assessments conducted by their program director or other faculty members.” 1 The 2 assessment forms recom- mended by the ABS to satisfy the clinical performance requirement are the CAMEO and mini–Clinical Evaluation Exercise (mini-CEX). This study reports on the measurement characteristics of CAMEO and makes recommendations for its use within the Next Accreditation System. Correspondence: Inquiries to Adam B. Wilson, PhD, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 543, Indianapolis, IN 46202; E-mail: wilsoadb@iupui.edu, a1wilson@comcast.net Journal of Surgical Education  & 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. 1931-7204/$30.00 http://dx.doi.org/10.1016/j.jsurg.2014.06.010 33