The challenge of creating new OSCE measures to capture the characteristics of expertise.

Abstract

Although expert clinicians approach interviewing in a different manner than novices, OSCE measures have not traditionally been designed to take into account levels of expertise. Creating better OSCE measures requires an understanding of how the interviewing style of experts differs objectively from novices. Fourteen clinical clerks, 14 family practice residents and 14 family physicians were videotaped during 2 15-minute standardized patient interviews. Videotapes were reviewed and every utterance coded by type including questions, empathic comments, giving information, summary statements and articulated transitions. Utterances were plotted over time and examined for characteristic patterns related to level of expertise. The mean number of utterances exceeded one every 10 s for all groups. The largest proportion was questions, ranging from 76% of utterances for clerks to 67% for experts. One third of total utterances consisted of a group of 'low frequency' types, including empathic comments, information giving and summary statements. The topic was changed often by all groups. While utterance type over time appeared to show characteristic patterns reflective of expertise, the differences were not robust. Only the pattern of use of summary statements was statistically different between groups (P < 0.05). Measures that are sensitive to the nature of expertise, including the sequence and organisation of questions, should be used to supplement OSCE checklists that simply count questions. Specifically, information giving, empathic comments and summary statements that occupy a third of expert interviews should be credited. However, while there appear to be patterns of utterances that characterise levels of expertise, in this study these patterns were subtle and not amenable to counting and classification.