Objective standardized clinical assessment with feedback: Adapting the objective structured clinical examination for postgraduate psychiatry training in India

Abstract

The objective structured clinical examination (OSCE) is used commonly for assessment of psychiatry trainees but has been used less for teaching. AIM AND SETTING: This study describes the adaptation of the OSCE method for training purposes in a postgraduate psychiatry training center in India and the initial findings with regard to trainee performance. The adapted method was called the objective structured clinical assessment with feedback (OSCAF). The adaptation included several steps--modifying existing OSCE patterns for language and cultural appropriateness, using supervised roleplaying instead of standardized or simulated patients and evolving an assessment method (14-item checklist) that would generate feedback. This exercise was conducted in front of a group of multidisciplinary peers and supervisors. Descriptive statistics and ANOVA were used. Analysis of the performance based on the 14-item checklist assessing common elements of any patient-related interaction in 34 different OSCAF tasks indicated the following: less-than-satisfactory (<75%) performances in the following areas--assuring confidentiality (73.5%), assessing comfort (62%), summarizing (60%), closure (62%) and checking whether the 'patient' had understood what was being communicated (42%). Based on the nature of clinical situations, performances on some specific and difficult OSCAF situations were found to be inadequate and indicated need for further training. We have been able to demonstrate OSCAF to be a convenient, cost-effective training method in psychiatry, with limited demands on resources; however, further refinements in ratings and feedback methods and studies on effectiveness may enhance its utility.