A systematic review and meta-analysis of measurement properties of objective structured clinical examinations used in physical therapy licensure and a structured review of licensure practices in countries with well-developed regulation systems

Abstract

Background The Objective Structured Clinical Examination (OSCE) is a commonly used tool internationally to assess clinical competency. Physical therapy (PT) licensure processes vary internationally. The OSCE is the tool used in Canada to assess clinical competency for PT graduates seeking licensure. Previous studies that examined the measurement properties of OSCEs present contradictory results. Objectives The first objective was to investigate the reliability and validity of OSCEs when administered to PTs during their education or as part of a licensure process. The second objective was to conduct a structured review to report PT educational and licensing components and policies in 17 countries with well-developed PT regulation systems. Methods An electronic search was performed in four databases from inception to 31st March 2021 to identify relevant articles. Two reviewers performed the critical appraisal of the included studies using a validated quality assessment tool. We deployed a random effects meta-analysis on reliability and validity estimates of OSCEs and examined sources of heterogeneity with univariate meta-regressions. We searched websites of professional regulatory bodies and associations for data on educational and licencing components and policies. Educational and licensing components across countries were synthesized descriptively. Results A pooled estimate of Cronbach’s alpha of 0.55, (95% CI: 0.41, 0.67) was determined for OSCEs. The pooled estimate of Intraclass Correlation Coefficient (ICC) between assessors was 0.77 (95% CI: 0.70, 0.83). The pooled estimate of Pearson Correlation between multiple OSCE stations’ scores was 0.27 (95% CI: 0.15, 0.39); and between each station score and the total score was 0.71 (95% CI: 0.61, 0.79). The pooled estimates for kappa Coefficients were 0.75 (95% CI: 0.58, 0.86) and 0.84, (95% CI: 0.72, 0.91) for intra-rater and inter-rater reliability of the standardised patient respectively. From the 17 included countries, Canada (excluding Quebec) was the only country that required both a clinical and written competency exam following graduation from an accredited PT program. Two countries (USA, UAE) required a written competency exam. The remaining 14 countries did not require an additional competency examination after completion of degree requirements from an accredited program. Conclusions We found weak evidence that OSCE examinations items are internally consistent when used to assess PTs. Canada (excluding Quebec) is the only country out of 17 implementing a national clinical competency examination for their PT graduates to achieve licensure after completing professional degree requirements.

Autonomic stress response of physiotherapy student in the different scenarios of an objective structured clinical examination

“…The no reduction in the anxiogenic response could be explained because students had no experience in this type of clinical evaluation which is a novel, incontrollable and unpredictable environment for them. In contrast with other OSCE in physiotherapy in the world, in our study students face a higher number of stations and taps in every aspect of practice ( musculoskeletal, respiratory, neuromuscular and obstetrics) (Bobos et al, 2021). This lack of habituation response was also evaluated in other challenging education contexts as nursing students during an OSCE, pharmacy students in real Although this sympathetic modulation is maintained, the HRV analysed showed a different autonomic stress response depending on the nature of the scenario.…”

Autonomic stress response of physiotherapy student in the different scenarios of an objective structured clinical examination

“…The no reduction in the anxiogenic response could be explained because students had no experience in this type of clinical evaluation which is a novel, incontrollable and unpredictable environment for them. In contrast with other OSCE in physiotherapy in the world, in our study students face a higher number of stations and taps in every aspect of practice ( musculoskeletal, respiratory, neuromuscular and obstetrics) (Bobos et al, 2021). This lack of habituation response was also evaluated in other challenging education contexts as nursing students during an OSCE, pharmacy students in real chemistry laboratory practices and physiotherapy students in the defence of their nal degree Although this sympathetic modulation is maintained, the HRV analysed showed a different autonomic stress response depending on the nature of the scenario.…”

Autonomic stress response of physiotherapy student in the different scenarios of an objective structured clinical examination

“…There have not been new stations added or modified scenarios. Moreover, in contrast with other OSCE in physiotherapy in the world, in our study students face a higher number of stations and taps in every aspect of practice (musculoskeletal, respiratory, neuromuscular and obstetrics) [34]. This lack of habituation response was also evaluated in other challenging education contexts as nursing students during an OSCE, pharmacy students in real chemistry laboratory practices and physiotherapy students in the defence of their final degree dissertation [15,16,35].…”