Abstract
BackgroundThe Objective Structured Clinical Examination (OSCE) is a commonly used tool internationally to assess clinical competency. Physical therapy (PT) licensure processes vary internationally. The OSCE is the tool used in Canada to assess clinical competency for PT graduates seeking licensure. Previous studies that examined the measurement properties of OSCEs present contradictory results.ObjectivesThe first objective was to investigate the reliability and validity of OSCEs when administered to PTs during their education or as part of a licensure process. The second objective was to conduct a structured review to report PT educational and licensing components and policies in 17 countries with well-developed PT regulation systems.MethodsAn electronic search was performed in four databases from inception to 31st March 2021 to identify relevant articles. Two reviewers performed the critical appraisal of the included studies using a validated quality assessment tool. We deployed a random effects meta-analysis on reliability and validity estimates of OSCEs and examined sources of heterogeneity with univariate meta-regressions. We searched websites of professional regulatory bodies and associations for data on educational and licencing components and policies. Educational and licensing components across countries were synthesized descriptively.ResultsA pooled estimate of Cronbach’s alpha of 0.55, (95% CI: 0.41, 0.67) was determined for OSCEs. The pooled estimate of Intraclass Correlation Coefficient (ICC) between assessors was 0.77 (95% CI: 0.70, 0.83). The pooled estimate of Pearson Correlation between multiple OSCE stations’ scores was 0.27 (95% CI: 0.15, 0.39); and between each station score and the total score was 0.71 (95% CI: 0.61, 0.79). The pooled estimates for kappa Coefficients were 0.75 (95% CI: 0.58, 0.86) and 0.84, (95% CI: 0.72, 0.91) for intra-rater and inter-rater reliability of the standardised patient respectively. From the 17 included countries, Canada (excluding Quebec) was the only country that required both a clinical and written competency exam following graduation from an accredited PT program. Two countries (USA, UAE) required a written competency exam. The remaining 14 countries did not require an additional competency examination after completion of degree requirements from an accredited program.ConclusionsWe found weak evidence that OSCE examinations items are internally consistent when used to assess PTs. Canada (excluding Quebec) is the only country out of 17 implementing a national clinical competency examination for their PT graduates to achieve licensure after completing professional degree requirements.
Highlights
In Canada, to obtain a licensure certification, physical therapists (PTs) must meet the standards of credentialing set out by the Canadian Alliance of Physiotherapy Regulators (CAPR)
We found weak evidence that Objective Structured Clinical Examination (OSCE) examinations items are internally consistent when used to assess PTs
The CAPR administers the Physiotherapy Competency Exam, a national exam which consists of two parts, written and clinical, and it is independent of university educational programs [1]
Summary
In Canada, to obtain a licensure certification, physical therapists (PTs) must meet the standards of credentialing set out by the Canadian Alliance of Physiotherapy Regulators (CAPR). The evaluation tool used for the clinical component of the competency assessment in Canada is the Objective Structured Clinical Examination (OSCE) [2]. The rationale and processes to implement OSCEs as a national licensure examination brings in additional issues and complications since the exams are administered by an independent body on a single occasion and decisions to prevent an individual from becoming a registered physical therapist are based on pass rules established by the examination regulators. Since the major role of regulators is Objective structured clinical examinations and licensure practices used in physical therapy protection of the public the extra effort to prevent incompetent professionals from entering the profession is important, and could justify the use of OSCEs if it improved protection of the public. The Objective Structured Clinical Examination (OSCE) is a commonly used tool internationally to assess clinical competency. Previous studies that examined the measurement properties of OSCEs present contradictory results
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