The objective structured clinical examination: a step in the direction of competency-based evaluation

Area of Science:

• Medical Education
• Competency-Based Assessment
• Pediatric Training

Background:

• The Accreditation Council for Graduate Medical Education is transitioning to competency-based medical education.
• The Objective Structured Clinical Examination (OSCE) is an outcomes-focused assessment gaining recognition.

Purpose of the Study:

• To review the existing pediatric literature on the Objective Structured Clinical Examination (OSCE).

Main Methods:

• A MEDLINE search was conducted for English-language studies on OSCE in pediatric education (1975-present).
• Studies from the US and Great Britain were reviewed, examining OSCE reliability, validity, and the use of standardized pediatric patients.

Main Results:

• Increased OSCE stations and task similarity improved reliability and validity.
• OSCE correlated with precertification exams (0.59-0.71) and clinical evaluations (0.39-0.57).
• Standardized patient experiences were positive for children and parents.

Conclusions:

• Appropriate OSCE design yields acceptable reliability and validity.
• OSCE shows significant correlations with external and internal performance measures.
• A combination of OSCE, board exams, and direct observation may form the gold standard for physician competence assessment.