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The ethics objective structured clinical examination

P A Singer1, R Cohen, A Robb

  • 1Department of Medicine, University of Toronto, Ontario, Canada.

Journal of General Internal Medicine
|January 1, 1993
PubMed
Summary
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New objective structured clinical examination (OSCE) stations effectively assess physicians' ability to handle complex clinical-ethical dilemmas, demonstrating good inter-rater agreement for evaluating medical trainees.

Area of Science:

  • Medical Education
  • Clinical Ethics
  • Assessment Methods

Background:

  • Assessing physicians' ability to navigate clinical-ethical situations is crucial for patient care.
  • Existing assessment methods may not adequately capture these complex skills.

Purpose of the Study:

  • To develop and evaluate objective structured clinical examination (OSCE) stations for assessing physician competence in clinical-ethical scenarios.
  • To determine the inter-rater agreement for these newly developed OSCE stations.

Main Methods:

  • Two ten-minute OSCE stations were created using video scenarios depicting ethical dilemmas: do-not-resuscitate (DNR) orders and withdrawal of care (re-intubation).
  • Sixty-nine foreign medical graduates participated, evaluated by two independent raters on their interactions with standardized patients in these scenarios.
Keywords:
Bioethics and Professional EthicsEmpirical ApproachToronto Hospital

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Main Results:

  • The OSCE stations demonstrated satisfactory inter-rater reliability, with coefficients of 0.79 for the DNR scenario and 0.75 for the intubation scenario.
  • Examiner scores showed high agreement, with exact agreement for 40-50% of candidates and agreement within two marks for over 94% in both stations.

Conclusions:

  • The developed ethics OSCE stations possess face and content validity.
  • These stations show promise for reliably evaluating the ethical reasoning and communication skills of medical students and residents.