A major impediment to the use of the objective structured clinical examination (OSCE) is that it is a labor-intensive and costly form of assessment. The cost of an OSCE is highly dependent on the particular model used, the extent to which hidden costs are reported, and the purpose of the examination. The authors detail hypothetical costs of running a four-hour OSCE for 120 medical students at one medical school. Costs are reported for four phases of this process: development, production, administration, and post-examination reporting and analysis. Costs are reported at two ends of the spectrum: the high end, where it is assumed that little is paid for by the institution and that faculty receive honoraria for work put into the examination; and the low end, where it is assumed that the sponsoring institution defrays basic costs and that faculty do not receive honoraria for their participation. The total costs reported for a first-time examination were $104,400 and $59,460 (Canadian dollars) at the high and low ends, respectively. These translate to per-student costs of $870 and $496. The cost of running an OSCE is high. However, the OSCE is uniquely capable of assessing many fundamental clinical skills that are presently not being assessed in a rigorous way in most medical schools.
Over a threx-year period, 54 health professionals at tended three two-day workshops designed to improve diabetes patient education programs, par ticularly program manage ment and evaluation of skills. A commitment-to- change strategy was used to determine the long-term effectiveness of the workshops. Fifty-nine per cent overall of the com mitments to change were reported as attained in the six-month follow-up surveys. The evidence suggests not only that the workshops were suc cessful, but that measurable changes in participants' programs can be attained in a cost- effective manner.
The CME needs and degree of competency in managing 2 8 rheumatic disorders were assessed in a 20 percent strat@ed random sample of Illinois-based The inadequacy of training in rheumatology in both undergraduate and graduate medical education has been documented2-8 and suggests the existence of a wide variety of CME needs in rheumatology among primary care physicians. The survey reported here was undertaken to determine whether practicing physicians perceive these educational needs and whether current CME can satisfactorily meet the needs.In the literature of CME, learning needs are "identified deficiencies in medical care -a gap or discrepancy between what a physician knows or does and what he should know or dol'9 Assessment of physicians' learning needs usually is limited to the physicians' own perceptions of their needs. These perceived learning needs are not considered to be demonstrated, or "true," learning needs; i.e., needs "more objectively determined by independent assess-01987 by The
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