Objective structured clinical assessment as an evaluation tool for medical students

Abstract

Objective structured clinical assessment as an evaluatiOn tOOl fOr medical studentsAs physicians working with students we are often requested to evaluate their knowledge, skills, attitudes, and interest in learning during their medical course. When involved in a selection process for medical residency it is very important to judge medical competency in combination with knowledge. Therefore, the ability to evaluate if the educational objectives were achieved is a major issue of any program.Validity and reliability must be considered when developing any method of assessment. We called validity of a test, the extent to which it measures what is intended to be measured and reliability the reproducibility of a set of measurements, consistency or stability of measures over time. Besides these two criteria, objectivity and practicability of the method must also be considered 1 . Any method that lacks objectivity or is very difficult to employ is not practical for assessment purposes.For many years examination tests took into consideration only knowledge. Essential cognitive components are well evaluated with written examinations either as open-ended or multiple choice questions 2 . However, they do not assess trainees´ clinical skills and attitudes.Nowadays there is a focus on competencies rather than on knowledge acquisition. Competency is defined as a complex set of behaviors built on the components of knowledge, skills and attitudes 3 . One attempt at measuring clinical competency is use of the Objective Structured Clinical Examination (OSCE).OSCE was described in 1975. Thirty-three students spent 5 minutes at each of 16 stations, either procedure stations or question and answer stations. At procedure stations, students were asked to take a history, perform a physical examination or some focused tasks. An examiner assigned points for the information obtained at each station 4 . The OSCE involves observing students in simulated encounters and often provides information about a students' communication skills as well as their abilities when collecting clinical data. There are some criticisms on use of OSCE. The timing and setting may seem artificial; the student feels inhibited by the environment. It penalizes those using shortcuts to reach the final decision. This method is very expensive and time consuming; it requires a minimum of 10 stations which students visit for over 3 to 4 hours in order to achieve a reliability of 0.85 to 0.90 5 . The cost is a real problem and a limiting factor for medical schools in developing countries.To improve the quality of clinical skills and knowledge assessment, several studies combined OSCE with other evaluation methods or compared results of OSCE with other assessment methods. Carraccio and Englander suggested that a combination of OSCE, standardized board examinations, and direct observation in the clinical setting has the potential to become the gold standard for measuring a physician's competence 6 . Another study suggested that the combination of OSCE with observation of actua...