Demonstrating Medical Student Competency in Palliative Care: Development and Evaluation of a New Objective Structured...

The observed structured clinical examination (OSCE) is an important tool to assess clinical competencies; however, there are no reported palliative care OSCEs for medical student assessment.

We aimed to develop, implement, and evaluate the characteristics of a palliative care OSCE for fourth-year medical students.

We created a representative case and a checklist of 14 history items from three core palliative care competency domains. Subjects were fourth-year medical students who had completed our school's longitudinal palliative care curriculum. Measurements were students' scores compiled from the standardized patient's (SP) tally of the checklist results. We determined inter-rater reliability between the SP and a remote observer. Measurements included the difficulty and discrimination index, internal consistency reliability, factor analysis, and relationships between palliative care scores and composite seven station OSCE scores.

In the implementation year, 95 students scored an average of 74% (standard deviation [SD] = 13%) on the 14 history items. There was 95% agreement in ratings on items between the SP and the remote observer. The Cronbach's alpha was 0.53, demonstrating moderate internal consistency. The palliative care scores correlated with overall OSCE communication scores (R = 0.29, p = 0.01) and history scores (R = 0.61, p = 0.01).

A new OSCE to assess palliative care competencies was feasible to implement with high inter-rater reliability, evidence supporting validity, and moderate internal consistency. We believe this OSCE would prove useful to assess students' primary palliative care competency and to evaluate curricula in palliative care.