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R.I.M.E. and reason: multi-station OSCE enhancement to neutralize grade inflation.

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  • 1Internal Medicine, The University of Kansas School of Medicine, Kansas City, USA.

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Summary
This summary is machine-generated.

Enhancing the Objective Structured Clinical Examination (OSCE) improved its ability to assess clinical skills objectively. This change reduced grade inflation and the reliance on the National Board of Medical Examiners-Subject Examination (NBME-SE) for final clerkship grades.

Keywords:
OSCERIMEassessmentclerkshipgrade inflationinternal medicine

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Area of Science:

  • Medical Education
  • Clinical Skills Assessment

Background:

  • Faculty evaluations were removed from summative grading, leading to grade inflation.
  • The Objective Structured Clinical Examination (OSCE) and National Board of Medical Examiners-Subject Examination (NBME-SE) were used for clerkship grading.
  • High student pass-with-distinction rates on the Internal Medicine OSCE indicated a need for enhancement.

Purpose of the Study:

  • To enhance the OSCE for more thorough objective clinical skills assessment.
  • To offset grade inflation in medical clerkships.
  • To reduce the NBME-SE's primary influence on final clerkship grades.

Main Methods:

  • Transitioned from a single-station to a three-station OSCE using the Reporter-Interpreter-Manager-Educator (RIME) framework.
  • Assessed student performance pre- and post-OSCE enhancement.
  • Collected student feedback via surveys on clinical realism and difficulty.

Main Results:

  • Post-enhancement OSCE scores showed greater dispersion and a less skewed, more normal distribution.
  • The number of students achieving pass-with-distinction decreased on the OSCE and in the clerkship.
  • This shift reduced the NBME-SE's relative weight in the overall clerkship grade.

Conclusions:

  • A structured, multi-station OSCE provides a realistic and objective measure of clinical performance.
  • OSCE enhancement can effectively address grade inflation and improve summative evaluations.
  • Student feedback indicated the enhanced OSCE was fair and clinically relevant.