The use of the objective structured clinical examination as an audit of teaching and student performance

A four year experience of the Objective Structured Clinical Examination in Child Health of 301 students in 18 separate examination diets was analysed to determine student competence in several clinical examinations including cardiovascular and central nervous system, developmental examination, history of asthma and in answering multiple choice questions relating to factual information. Using criterion reference assessment, student performance was related to individual knowledge, quality of teaching, examination design and teacher expectation. Variable levels of expectation and achievement were noted for different clinical items. Staff expectation of student performance was found to be higher than achieved in 39%, the same in 55% and in only 6% did students perform better than was anticipated. The value of using Criterion Reference Assessment System, based on a standard comprehensive examination, is discussed in relation to influencing examination design and efficiency of teaching medical students.