How to develop a competency-based examination blueprint for longitudinal standardized patient clinical skills assessments
Background: Objective Structured Clinical Exams (OSCEs) with standardized patients (SPs) are commonly used in medical education to assess learners' clinical skills. However, assessments are often discrete rather than intentionally developmentally sequenced. Aims: We developed an examination blueprint to optimize assessment and feedback to learners with purposeful sequence as a series of longitudinally integrated assessments based on performance milestones. Integrated and progressive clinical skills assessments offer several benefits: assessment of skill development over time, systematic identification of learning needs, data for individualized feedback and learning plans, and baseline reference points for reassessment. Methods: Using a competency-based medical education (CBME) framework, we translated pre-determined competency milestones for medical students' patient encounters into a four-year SP-based OSCE examination blueprint. Results: Initial evaluation of cases using the blueprint revealed opportunities to target less frequently assessed competencies and to align assessments with milestones for each year. Conclusions: The examination blueprint can guide ongoing SP-based OSCE case design. Future iterations of examination blueprints can incorporate lessons learnt from evaluation data and student feedback.