Performance-based assessment of clinical ethics using an objective structured clinical examination

Area of Science:

• Medical Education
• Clinical Ethics Assessment
• Performance-Based Assessment

Background:

• The objective structured clinical examination (OSCE) is a performance-based assessment tool.
• Evaluating clinical ethics is crucial for medical professionals.
• Previous studies have explored OSCE's utility in various medical domains.

Purpose of the Study:

• To evaluate the objective structured clinical examination (OSCE) as a performance-based assessment for clinical ethics.
• To determine the reliability and feasibility of using OSCE for summative evaluation in clinical ethics.

Main Methods:

• A four-station OSCE was administered to 88 final-year medical students.
• Standardized patients were used, focusing on decisions regarding life-sustaining treatment.
• Performance was scored using case-specific checklists, with reliability analyzed via intraclass correlation coefficients and the Spearman-Brown prophecy formula.

Main Results:

• The OSCE demonstrated low test reliability (0.28) due to poor inter-station correlation (0.07).
• Achieving a reliability of 0.8 would necessitate 41 stations, equating to nearly seven hours of testing.
• These findings indicate significant limitations in the current OSCE format for comprehensive ethics assessment.

Conclusions:

• The objective structured clinical examination (OSCE) is not a feasible standalone method for the summative evaluation of clinical ethics.
• Combining OSCE with other reliable assessment methods is recommended for a more robust evaluation.
• The OSCE shows potential for formative evaluation purposes in clinical ethics education.