First-Year Results of the American Board of Anesthesiology’s Objective Structured Clinical Examination for Initial Certification

Abstract

In 2018, the American Board of Anesthesiology (ABA) became the first US medical specialty certifying board to incorporate an Objective Structured Clinical Examination (OSCE) into its initial certification examination system. Previously, the ABA’s staged examination system consisted of 2 written examinations (the BASIC and ADVANCED examinations) and the Standardized Oral Examination (SOE). The OSCE and the existing SOE are now 2 separate components of the APPLIED Examination. This report presents the results of the first-year OSCE administration. A total of 1410 candidates took both the OSCE and the SOE in 2018. Candidate performance approximated a normal distribution for both the OSCE and the SOE, and was not associated with the timing of the examination, including day of the week, morning versus afternoon session, and order of the OSCE and the SOE. Practice-based Learning and Improvement was the most difficult station, while Application of Ultrasonography was the least difficult. The correlation coefficient between SOE and OSCE scores was 0.35 ([95% confidence interval {CI}, 0.30–0.39]; P < .001). Scores for the written ADVANCED Examination were modestly correlated with scores for the SOE (r = 0.29 [95% CI, 0.25–0.34]; P < .001) and the OSCE (r = 0.15 [95% CI, 0.10–0.20]; P < .001). Most of the candidates who failed the SOE passed the OSCE, and most of the candidates who failed the OSCE passed the SOE. Of the 1410 candidates, 77 (5.5%) failed the OSCE, 155 (11.0%) failed the SOE, and 25 (1.8%) failed both. Thus, 207 (14.7%) failed at least 1 component of the APPLIED Examination. Adding an OSCE to a board certification examination system is feasible. Preliminary evidence indicates that the OSCE measures aspects of candidate abilities distinct from those measured by other examinations used for initial board certification.

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“…[ 17 ] Recent ABA publications that attempted to validate the introduction of the OSCE have ignored any discussion of bias. [ 18 19 ] Our results indicate that the unconscious bias training (which is provided by the ABA) may not remove the enormous suspicion held by over 90% of the residents. The futility of unconscious bias training in eliminating bias, racism, and discrimination is discussed by multiple authors.…”

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“…Research is currently seeking how best to use this examination process to assess additional clinical aptitudes including collaboration skills, leadership skills, health advocacy and professionalism (6,(10)(11)(12). In our examination proceedings, most candidates felt that paperbased cases were sufficient for the examination (as opposed to standardised patients or patient actors).…”

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“…For sample size calculation it was assumed that all within-group average scores are normally distributed [ 21 ]. Further, it was assumed that the standard deviation of the change equals approximately 1 within all three groups.…”