Investigating the Use of Simulated Patient Ratings in Objective Structured Clinical Examinations to Enhance Undergraduate Medical Assessments in Riyadh, Saudi Arabia.

Abstract

Objective structured clinical examinations (OSCE) are the gold standard of clinical assessment, and are used to conduct undergraduate family medicine clinical assessment at King Faisal Specialist Hospital and Research Centre (KFSHRC). Some studies have suggested that simulated patient (SP) ratings could provide a better measure of empathy and communication skills than physician scores. The objective of this study is to further explore the effectiveness of simulated patient (SP) ratings inundergraduate OSCE assessments. The research employed a mixed-method approach. Three OSCE assessments for final-year students were selected. Both physicians and SPsevaluated each student, providing global ratings across four domains. The quantitative aspect involved comparing physician and SP scores and assessing correlation. The qualitative aspect involved interviewing SPs to establish what student behaviours led to higher or lower scores. Moderate correlation was found between physician ratings and SP ratings (r=0.53, p<0.01). Internal consistency of the SP ratings was lower than physician scores. SPs considered themselves to be patient advocates and were keen to give formative feedback. The ability of the trainee to truly listen was a major concern. Scoring for SPs was relatively holistic in nature. The results demonstrate that SP scores have slightly weaker reliability but are still relevant and offer a completely different perspective, enriching the assessment data. Assessment should take patientor SP perspectives into account, and not rely solely on the expert physician. Changing the assessment methods will lead to necessary changes in student approach to the OSCE and improve authenticity and validity.