Use of an objective structured clinical examination to determine clinical competence

To describe the performance of second-year internal medicine residents on an objective structured clinical examination (OSCE) and to analyze the role of the OSCE in the evaluation of clinical competence.

In 1993-94, 51 second-year residents in an internal medicine training program at the Mayo Clinic participated in an OSCE. The OSCE was administered in four sessions, with 12 or 13 students in each session. The OSCE was composed of nine physical diagnosis stations, with two or three test-interpretation stations per session. Student's t-test and one-way analysis of variance were used to compare scores on the basis of the residents' gender, medical school training (international medical graduates versus those trained in the United States and Canada), and OSCE session. In addition, the residents' scores were correlated with scores on the American Board of Internal Medicine's in-training exam (ITE) and with the training program's clinical rotation scores (CRSs).

The residents' scores were significantly higher for test interpretation stations than for physical diagnosis stations (p < .0001). There was no significant difference in average scores based on gender, medical school training, or OSCE session. The OSCE scores correlated with the ITE scores (r = .30) and the CRSs (r = .40).

The OSCE's moderate correlation with the ITE and CRS suggests that the OSCE, which consists largely of physical diagnosis stations, may test a component of clinical skills not evaluated by the other measures. Thus, the OSCE is an important addition to the assessment of clinical competence.