Purpose Systematic differences among raters' approaches to student assessment may result in leniency or stringency of assessment scores. This study examines the generalizability of medical student workplace-based competency assessments including the impact of rater-adjusted scores for leniency and stringency. Methods Data were collected from summative clerkship assessments completed for 204 students during 2017-2018 the clerkship at a single institution. Generalizability theory was used to explore variance attributed to different facets (rater, learner, item, and competency domain) through three unbalanced random-effects models by clerkship including applying assessor stringency-leniency adjustments. Results In the original assessments, only 4-8 of the variance was attributed to the student with the remainder being rater variance and error. Aggregating items to create a composite score increased variability attributable to the student (5-13 of variance). Applying a stringency-leniency ('hawk-dove') correction substantially increased the variance attributed to the student (14.8-17.8) and reliability. Controlling for assessor leniency/stringency reduced measurement error, decreasing the number of assessments required for generalizability from 16-50 to 11-14. Conclusions Similar to prior research, most of the variance in competency assessment scores was attributable to raters, with only a small proportion attributed to the student. Making stringency-leniency corrections using rater-adjusted scores improved the psychometric characteristics of assessment scores.
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