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Progress testing: is there a role for the OSCE?

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Objective structured clinical examinations (OSCEs) effectively assess medical resident progress. Performance-based assessments like OSCEs demonstrate high reliability and differentiate learners by training level, supporting their use in competency-based medical education.

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Area of Science:

  • Medical Education
  • Assessment and Evaluation

Background:

  • The shift to competency-based medical education necessitates frequent formative assessments.
  • Written progress tests are common, but the role of performance-based assessments like OSCEs is unclear.

Purpose of the Study:

  • To describe the use of OSCEs for assessing learners at different training stages.
  • To outline a score reporting structure for OSCEs.
  • To provide evidence for the psychometric properties of various rating tools used in OSCEs.

Main Methods:

  • A 10-station OSCE was administered to 69 internal medicine residents (postgraduate years 1-4).
  • Assessments used a checklist (CL), global rating scale (GRS), and training level rating scale (TLRS).
  • Reliability (Cronbach's alpha), performance differences by training year (ANOVA), and score correlations were analyzed.

Main Results:

  • The TLRS showed higher inter-station reliability (0.88) than CL (0.84) and GRS (0.79).
  • Significant performance differences by training year were observed across all rating instruments (p < 0.001).
  • Scores from CL, GRS, and TLRS were highly correlated (r = 0.90-0.94, p < 0.001).

Conclusions:

  • OSCE scores demonstrated high reliability and validly differentiated resident performance by training level.
  • This supports the use of OSCEs as progress markers in competency-based medical education.
  • Future research will examine individual OSCE progress over time.