The Objective Structured Clinical Examination. The New Gold Standard for Evaluating Postgraduate Clinical Performance

Department of Surgery, University of Kentucky Chandler Medical Center, Lexington, USA.
Annals of Surgery (Impact Factor: 8.33). 01/1996; 222(6):735-42. DOI: 10.1097/00000658-199512000-00007
Source: PubMed


The authors determine the reliability, validity, and usefulness of the Objective Structured Clinical Examination (OSCE) in the evaluation of surgical residents.
Interest is increasing in using the OSCE as a measurement of clinical competence and as a certification tool. However, concerns exist about the reliability, feasibility, and cost of the OSCE. Experience with the OSCE in postgraduate training programs is limited.
A comprehensive 38-station OSCE was administered to 56 surgical residents. Residents were grouped into three levels of training; interns, junior residents, and senior residents. The reliability of the examination was assessed by coefficient alpha; its validity, by the construct of experience. Differences between training levels and in performance on the various OSCE problems were determined by a three-way analysis of variance with two repeated measures and the Student-Newman-Keuls post hoc test. Pearson correlations were used to determine the relationship between OSCE and American Board of Surgery In-Training Examination (ABSITE) scores.
The reliability of the OSCE was very high (0.91). Performance varied significantly according to level of training (postgraduate year; p < 0.0001). Senior residents performed best, and interns performed worst. The OSCE problems differed significantly in difficulty (p , 0.0001). Overall scores were poor. Important and specific performance deficits were identified at all levels of training. The ABSITE clinical scores, unlike the basic science scores, correlated modestly with the OSCE scores when level of training was held constant.
The OSCE is a highly reliable and valid clinical examination that provides unique information about the performance of individual residents and the quality of postgraduate training programs.

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Available from: William E. Strodel, Jun 13, 2014
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    • "(Barman, 2005; Caraccio, 2000; Merrick, 2000; Auewarakul, 2005). Its reliability is determined mainly by the number of stations, with more stations increasing the reliability (Barman, 2005; Sloan 1995; Joorabchi, 1991). "

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    • "Because SPAs are simulated doctor– patient consultations in which an actor is trained to play the role of a patient in a standardized way, they are useful in evaluating interpersonal communication skills in a specific domain. Using interitem and split-half reliability methods, the SPA has proved to be a reliable assessment tool and has demonstrated discriminant validity (Sloan et al., 1995). Using SPAs will enable us to observe each participant demonstrate communication skills in a specific situation of a predetermined and standardized duration. "
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    • "Lewis (2007) identified a lack of clinical knowledge and skills amongst health professionals as one of the leading causes of potentially avoidable mortality in the UK. The use of OSCEs is acknowledged as effective assessment tool and is seen as the gold standard for evaluating clinical performance (Sloan et al., 1995). According to Murray et al. (2008) though there is limited empirical evidence to support its effectiveness on clinical practice, simulation is seen to have the potential to teach and promote safe practice in an increasingly litigious culture. "
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    ABSTRACT: This paper reports on a qualitative descriptive study that explored student midwives' experiences of the Objective Structured Clinical Examination assessment process for obstetric emergencies within a university setting. The development of fundamental clinical skills is an important component in preparing students to meet the responsibilities of a midwife. There is an international concern that the transfer of midwifery education into universities may impact on the development of midwifery clinical skills. Objective Structured Clinical Examinations (OSCEs) have the potential to promote integration and consolidation of skills prior to clinical placement. Twenty six students (n=36) from two midwifery programmes (BSc and Higher Diploma) participated in four focus groups and Burnard's (2006) framework was used for data analysis. Three main themes emerged following analysis: preparation for the OSCE assessment, the OSCE process and learning through simulating practice. Preparation for the OSCE's which included lectures, demonstrations, and practice of OSCE's facilitated by lecturers and by the students themselves, was considered central to the process. Learning via OSCEs was perceived to be more effective in comparison to other forms of assessment and prepared students for clinical practice. Positive aspects of the process and areas for improvement were identified. Using OSCE's increased the depth of learning for the students with the steps taken in preparation for the OSCE's proving to be a valuable learning tool. This study adds to the evidence on the use of OSCE's in midwifery education.
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