Feasibility of Using Standardized Patients as Examiners in an Objective Structured Clinical Examination (OSCE) of Medical Students

Abstract

Purpose: An OSCE (Objective Structured Clinical Examination) is an assessment of medical school graduates' skills through multiple timed stations in which the graduates are assessed by one or more examiners. Due to the design of the OSCE, the demand for physician examiners is intense. The objective of this study is to confirm the feasibility of training standardized patients (SP) as OSCE examiners to alleviate the burden on physicians. Methods: Sixty SPs and 30 medical school graduates participated in a five-station OSCE at a medical center in Eastern Taiwan. Thirteen physicians participated as examiners, assessing the graduates' performance during the OSCE. All scenarios contained a content-specific checklist, with no patient note test. Every graduate was simultaneously scored by a physician examiner and an SP examiner using the same checklist. We used a paired t-test to evaluate the score difference between physician and SP examiners. Results: The SP examiners scored graduates higher than physician examiners in all scenarios except the history-taking station. Three scenarios testing patient condition explanations and physical examination revealed a statistically significant difference between SP and physician examiners. The other two scenarios, history taking and doctor-patient communication, showed no significant difference. Conclusions: Our study suggests that SPs could be trained as examiners if OSCE stations contain checklist items recommending generic concepts and not requiring medical knowledge or clinical experience of SPs. Using SPs as examiners would partially alleviate the demand for physician examiners. Further studies are needed to assess whether additional training for SP examiners can improve unbiased evaluations.