Assessment of Clinical Reasoning During a High Stakes Medical Student OSCE

Area of Science:

• Medical Education
• Clinical Skills Assessment
• Competency-Based Education

Background:

• Objective Structured Clinical Examinations (OSCEs) are standard for assessing clinical skills.
• Existing tools lack calibration for competency-based assessment in medical student OSCEs.
• There is a need for a validated tool to evaluate clinical reasoning in high-stakes OSCEs.

Purpose of the Study:

• To develop and validate a clinical reasoning assessment tool for high-stakes, summative medical student OSCEs.
• To ensure the tool is calibrated for competency-based assessment.

Main Methods:

• A minimum-competency OSCE was administered to medical students post-clerkship.
• A novel tool was developed to assess clinical reasoning within the OSCE.
• The tool's highest performance level was set to represent minimum acceptable competency.

Main Results:

• The clinical reasoning assessment tool demonstrated reliable performance.
• Scores on clinical reasoning tasks correlated with overall OSCE performance.
• Sub-scores accurately differentiated between students meeting and not meeting the minimum performance level.

Conclusions:

• The developed tool is effective and defensible for assessing medical students' clinical reasoning in OSCEs.
• Further multi-center studies are needed to establish generalizability and utility in diverse settings.