Objective Structured Clinical Examination Component Research Articles

A structured multimodal teaching approach enhancing musculoskeletal physical examination skills among undergraduate medical students

ABSTRACT Current evidence indicates that undergraduate medical students display deficits in musculoskeletal physical examination skills (MPES). While various instructional methods are recommended for teaching clinical skills, effective methods for teaching MPES have not been established. This study compared the effectiveness of a multimodal teaching approach incorporating video-based learning, interactive small-group teaching, hands-on practicing, peer-assisted learning, formative assessment, and constructive feedback with traditional bedside teaching in developing undergraduate orthopedic MPES. Participants were 151 fifth-year medical students divided into two groups. One group received multimodal teaching, and the other received traditional bedside teaching. In both groups, the participants learned how to physically examine the knee and shoulder. The primary outcome was objective structured clinical examination (OSCE) scores, while the secondary outcomes included teaching sessions’ total durations, facilitator’s demonstration time, participants’ practice time, and proportion of students with passing checklist scores and global ratings-based assessments for the two teaching approaches. The multimodal teaching group had significantly higher OSCE scores (checklist scores, global ratings, and passing rates; p = 0.02, 0.02, 0.01, respectively) than the comparison group. Individual OSCE component assessments showed significant improvements in the special musculoskeletal physical examination test. The overall duration and amount of participants’ hands-on time were significantly longer for the multimodal than for the traditional bedside teaching group (p = 0.01 and 0.01, respectively), and the facilitator’s demonstration time was significantly shorter (p = 0.01). The multimodal learner-centered teaching approach evaluated in this study was effective for teaching MPES. It appeared to maximize learner engagement through enhancing interactions and providing increased time to engage in hands-on practice. This teaching approach improved MPES levels, maximized teaching efficiency for scenarios with limited instruction time and resources, and enhanced competency of undergraduate medical students in performing special musculoskeletal physical examinations compared to traditional bedside teaching.

A Comprehensive Analysis of Graduated Residents’ and Faculty Members’ Attitudes on Iranian Radiation Oncology Board Examination: A Cross-sectional Study

Background: The Iranian radiation oncology board examination (IROBE) includes a multiple-choice question (MCQ) examination and an objective structured clinical examination (OSCE). The current mission of IROBE is to qualify the graduated residents (GRs) in terms of clinical competence. However, lack of active monitoring of its construction and administration can impair the evaluation of GR competencies. Objectives: To determine the strengths and limitations of IROBE. Methods: This cross-sectional online survey involved faculty members (FMs) and GRs as constructors and participants of the IROBE, respectively. The target time window for inclusion in the study was set between 2015 and 2019. To evaluate the strengths and limitations of IROBE, a 22-item questionnaire was distributed among FMs and a 29-item questionnaire among GRs. The Mann-Whitney U test and Pearson's chi-square test were applied to find the association between the ordinal and nominal variables, respectively. Results: The surveys were sent to 35 FMs and 107 GRs. A total of 16 (45%) FMs and 42 (39%) GRs completed the survey. Overall, the majority of FMs and GRs stated that IROBE has average to poor quality in evaluating all aspects of clinical abilities (62.5 vs. 76.1% in clinical competence, P = 0.07; 62.5 vs. 71.4% in clinical knowledge, P = 0.19; 100 vs. 92.9% in medical ethics, P = 0.21; and 93.7 vs. 95.3% in responsibility, P = 0.15). However, FMs assigned a higher score to OSCE in the assessment of clinical performance compared to GRs (P = 0.02). Most FMs and GRs declared that IROBE requires extreme to high improvement in both MCQ and OSCE components (75 vs. 59.52% and 87.5 vs. 90.47%, respectively). Conclusions: According to the participants, the present structure of IROBE has several drawbacks in both MCQ and OSCE components. Considering the highlighted strengths and limitations can help the IROBE constructors to improve its quality.

Correlation of student performance on clerkship with quality of medical chart documentation in a simulation setting

BackgroundMedical chart documentation is an essential skill acquired in a clinical clerkship (CC). However, the utility of medical chart writing simulations as a component of the objective structured clinical examination (OSCE) has not been sufficiently evaluated. In this study, medical chart documentation in several clinical simulation settings was performed as part of the OSCE, and its correlation with CC performance was evaluated.MethodsWe created a clinical situation video and images involving the acquisition of informed consent, cardiopulmonary resuscitation, and diagnostic imaging in the emergency department, and assessed medical chart documentation performance by medical students as part of the OSCE. Evaluations were conducted utilizing original checklist (0–10 point). We also analyzed the correlation between medical chart documentation OSCE scores and CC performance of 120 medical students who performed their CC in 2019 as 5th year students and took the Post-CC OSCE in 2020 as 6th year students.ResultsOf the OSCE components, scores for the acquisition of informed consent and resuscitation showed significant correlations with CC performance (P<0.001 for each). In contrast, scores for diagnostic imaging showed a slightly positive, but non-significant, correlation with CC performance (P = 0.107). Overall scores for OSCE showed a significant correlation with CC performance (P<0.001).ConclusionWe conducted a correlation analysis of CC performance and the quality of medical chart documentation in a simulation setting. Our results suggest that medical chart documentation can be one possible alternative component in the OSCE.

Relationships between objective structured clinical examination, computer-based testing, and clinical clerkship performance in Japanese medical students.

It is unclear how comprehensive evaluations conducted prior to clinical clerkships (CC), such as the objective structured clinical examination (OSCE) and computer-based testing (CBT), reflect the performance of medical students in CC. Here we retrospectively analyzed correlations between OSCE and CBT scores and CC performance. Ethical approval was obtained from our institutional review board. We analyzed correlations between OSCE and CBT scores and CC performance in 94 medical students who took the OSCE and CBT in 2017 when they were 4th year students, and who participated in the basic CC in 2018 when they were 5th year students. Total scores for OSCE and CBT were significantly correlated with CC performance (P<0.001, each). More specifically, medical interview and chest examination components of the OSCE were significantly correlated with CC performance (P = 0.001, each), while the remaining five components of the OSCE were not. Our findings suggest that the OSCE and CBT play important roles in predicting CC performance in Japanese medical education context. Among OSCE components, medical interview and chest examination were suggested to be important for predicting CC performance.

The influence of different ways of training on development of practical skills in performing parenteral therapy in full-time first year nursing students

Aim: This study aimed to determine how teacher demonstrations and content affect the development of practical skills in the administration of intravenous therapy by nursing undergraduate students. Design: Prospective randomized trial. Methods: The study included 48 in their first year of nursing studies, divided into two groups. In the first phase, the group of video students (n = 22) were trained to perform practical intravenous therapy skills by demonstration, while the second group of students (n = 26) were instructed by live classroom demonstration. Both groups joined the second phase of the study after an interval of one week, when they were tested with the Objective Structured Clinical Examination (OSCE) for intravenous therapy. Results: Statistically significant differences were determined between the video student and student groups at a significance level of 0.05 (p < 0.05) for certain OSCE components. Conclusion: Pre-recorded content is not an adequate substitute for live demonstration by teachers for mastering practical skills.

Modules for the Technical Skills Section of the OSCE Component of the American Board of Anesthesiology APPLIED Examination

To assess communication and professionalism, as well as technical skills related to patient care, the American Board of Anesthesiology (ABA) has begun administering an Objective Structured Clinical Examination (OSCE) portion of the APPLIED Examination in addition to the Standard Oral Examination component. We created video modules and a curriculum for anesthesiology resident OSCE preparation for the Interpretation of Monitors and Interpretation of Echocardiography components. The modules can be used individually by trainees or included as part of an OSCE workshop led by faculty educators with seven individual stations matching the content of the actual ABA examination. These modules are recommended for all levels of anesthesiology trainees so that they can gain exposure to the format and the fast pace of the examination. Sixty-six junior and senior anesthesiology residents, fellows, and junior faculty successfully participated in these modules. Seventy-three percent of the participants agreed that after completing these modules, they now had a good understanding of the Interpretation of Monitors and Interpretation of Echocardiography technical skills stations. More than 90% of participants reported that the modules were useful, and more than 70% reported that they now felt prepared for these stations of the OSCE. Developing technical skills stations for deliberate practice and preparation for the ABA OSCE is resource intensive. Finding time and faculty to facilitate OSCE preparation is also challenging. With the video modules and scripts included in this publication, residents can practice independently or as part of larger preparation course.

Development of an Objective Structured Clinical Examination Using the American Board of Anesthesiology Content Outline for the Objective Structured Clinical Examination Component of the APPLIED Certification Examination.

The goal of this study was to use the American Board of Anesthesiology Objective Structured Clinical Examination (OSCE) content outline as a blueprint to develop and administer a 9-station mock OSCE with station-specific checklists to senior residents (n = 14). The G- and Ф-coefficient reliability estimates were 0.76 and 0.61, respectively. Residents judged the scenarios as either extremely or somewhat realistic (88%). It is feasible to develop and administer a mock OSCE with rigorous psychometric characteristics.

A novel approach to suicide prevention - Educating when it matters.

Background:Looking at the burden of suicide, there is a dire need for medical schools to incorporate suicide prevention training. Effective communication helps in early detection and management of suicidal behavior. Medical students can act as a GATEKEEPER if they receive adequate training.Methodology:This was an educational intervention study done at tertiary care teaching hospital to assess the knowledge and attitude of medical students toward depression and suicide and to impart and assess communication skills for suicide prevention in one of the four batches of students in 4th semester. Pretest was conducted to assess knowledge and attitude toward depression and suicide, followed by training using interactive lectures, demonstration of interview, and hands-on training with patients and role-plays. The posttest and objective structured clinical examination (OSCE) were administered for skill assessment. Feedback was taken regarding this intervention.Results:The mean marks of the pre- and post-test were 8.96 (8.3–9.6) and 14.58 (13.8–15.3), respectively, out of 25. The difference was statistically significant (t = 13.24, P ≤ 0.0001) which suggests improvement in knowledge. We found mixed responses in attitude statements showing limited change. Mean obtained marks on OSCE examination out of 66 was 42.7. Among various components of OSCE, students scored high on rapport building. The most useful components of trainings were role-play, OSCE, and interaction with patients as per their feedback.Conclusion:The intervention was found effective in increasing knowledge, changing attitude, and enhancing communication skills of medical students toward suicide prevention. Training of communication skills for suicide prevention in depressed person should be given to every medical student as suggested by feedback.

Revisiting 'The effect of assessments and examinations on the learning of medical students'.

Revisiting 'The effect of assessments and examinations on the learning of medical students'.

Pediatric and Adolescent Gynecology Education through Simulation (PAGES): Development and Evaluation of a Simulation Curriculum

Study ObjectiveDevelop a Pediatric and Adolescent Gynecology (PAG) curriculum, appropriate pelvic model for teaching examination skills, and an objective structured clinical examination (OSCE) for evaluation. Compare OSCE performance between residents with clinical training in PAG vs those that completed the curriculum vs those without either experience. DesignProspective cohort study. SettingObstetrics and Gynecology (Ob/Gyn) residency program in an urban academic center. ParticipantsSenior Ob/Gyn residents. InterventionsA simulation-based teaching curriculum was created to teach PAG skills. A pediatric mannequin with anatomic pre-pubertal genitalia was developed for teaching and assessment of skills. Main Outcome MeasuresPerformance on a PAG-based OSCE as assessed by 2 observers using a 40 point checklist. Results17 residents participated in the OSCE; 5 completed the curriculum, 6 completed a clinical rotation, and 6 were controls. The teaching curriculum group had the highest median composite OSCE score (75.0%) compared to the clinical group (73.1%) and control group (55.3%). There was no statistical difference between the scores of the teaching and clinical groups, but the teaching group scored statistically higher than controls (P = .0331). Scores for each OSCE component were compared. The teaching and clinical groups outperformed controls on assessment and procedures. There was no difference in scores on history taking or physical examination. ConclusionAn interactive teaching curriculum incorporating simulation and a realistic pediatric pelvic model can be used to teach PAG clinical skills. Using an OSCE to evaluate skills shows that residents completing the curriculum perform as well as those with clinical experience and better than controls.

Association Between National Board Dental Examination Part II Scores and Comprehensive Examinations at Harvard School of Dental Medicine

Harvard School of Dental Medicine (HSDM) uses a hybrid problem-based approach to teaching in the predoctoral program. The objective structured clinical examination (OSCE) is a formative examination designed to assess the performance of students in the problem-based learning (PBL) curriculum. At HSDM three comprehensive examinations with OSCE components are administered during the third and fourth years of clinical training. The National Board Dental Examination (NBDE) Part II is taken in the final year of the predoctoral program. This study examines the association between the NBDE Part II and the comprehensive exams held at HSDM. Predoctoral students from the HSDM classes of 2005 and 2006 were included in this study. The outcome variable of interest was the scores obtained by students in the NBDE Part II, and the main independent variable of interest was the performance of students in the comprehensive exams (honors, pass, make-up exam to pass). The Mann-Whitney U-test was used to examine the association between the grades obtained in the each of the three comprehensive exams and the NBDE Part II scores. Multivariable linear regression analysis was also used to examine the association between the NBDE Part II scores and the comprehensive exam grades. The effect of potential confounding factors including age, sex, and race/ethnicity was adjusted. The results suggest that students who performed well in the comprehensive exams performed better on the NBDE Part II, even after adjusting for confounding factors. Future studies will examine the long-term impact of PBL on postdoctoral plans and career choices.

Assessing Patient-centered Care: One Approach to Health Disparities Education

BACKGROUNDPatient-centered care has been described as one approach to cultural competency education that could reduce racial and ethnic health disparities by preparing providers to deliver care that is respectful and responsive to the preferences of each patient. In order to evaluate the effectiveness of a curriculum in teaching patient-centered care (PCC) behaviors to medical students, we drew on the work of Kleinman, Eisenberg, and Good to develop a scale that could be embedded across cases in an objective structured clinical examination (OSCE).OBJECTIVETo compare the reliability, validity, and feasibility of an embedded patient-centered care scale with the use of a single culturally challenging case in measuring students′ use of PCC behaviors as part of a comprehensive OSCE.METHODSA total of 322 students from two California medical schools participated in the OSCE as beginning seniors. Cronbach’s alpha was used to assess the internal consistency of each approach. Construct validity was addressed by establishing convergent and divergent validity using the cultural challenge case total score and OSCE component scores. Feasibility assessment considered cost and training needs for the standardized patients (SPs).RESULTSMedical students demonstrated a moderate level of patient-centered skill (mean = 63%, SD = 11%). The PCC Scale demonstrated an acceptable level of internal consistency (alpha = 0.68) over the single case scale (alpha = 0.60). Both convergent and divergent validities were established through low to moderate correlation coefficients.DISCUSSIONThe insertion of PCC items across multiple cases in a comprehensive OSCE can provide a reliable estimate of students′ use of PCC behaviors without incurring extra costs associated with implementing a special cross-cultural OSCE. This approach is particularly feasible when an OSCE is already part of the standard assessment of clinical skills. Reliability may be increased with an additional investment in SP training.

An analysis of the contribution of a patient-based component to a clinical licensure examination

The validity and reliability of high-stakes examinations such as those used by national, regional and state or provincial dental boards are under intense scrutiny by candidates, dental schools, dental educators, dental associations, and state or provincial dental boards. The authors followed the progress of 1,063 candidates from nonaccredited dental programs who began the National Dental Examining Board of Canada's (NDEB) clinical examinations between January 1996 and November 1999 through the administration of the examination's final component in December 2003 examine the utility and validity of the patient-based component of the examination process. The results showed that the first three components of the examination were effective in screening out candidates who were not adequately prepared to take the patient-based component. Only 12 (1.1 percent) of the candidates failed the maximum allowed three attempts to pass the patient-based component. The results demonstrated that the patient-based component did not contribute to the overall examination validity or decision making and did not prevent candidates from obtaining certification. Owing to this lack of utility, the associated costs and ethical concerns, NDEB eliminated the patient-based component of the examination and replaced it with the requirement to complete an accredited, qualifying/degree completion dental program followed by completion of NDEB's written and objective structured clinical examination components.

Simulated Patients vs. Standardized Patients in Objective Structured Clinical Examinations

To describe the use of patient-actors as educators in a senior-level pharmacy practice course, and to contrast the value and application of "standardized patient" and "simulated patient" educational methodologies. The objective structured clinical examination (OSCE) of the licensing examination were utilized during and at the end of the course along with external assessment to determine the impact of this educational methodology. Interviews with a randomly selected cohort of 14 students were undertaken 3 years after graduation and licensure to evaluate long-term impact of this course. Overall, students responded positively to the shift from "standardized" patients to "simulated" patients, recognizing their value in teaching clinical and pharmaceutical care skills. Concerns were expressed regarding objectivity in assessment and individual grading. Over 98% of students successfully passed the OSCE component of the licensing examination. Long-term follow-up suggests students valued this approach to education and that it provided them with a foundation for better understanding of the psychosocial needs of patients in practice. Simulated-patient educators can play an important role in the pharmacy curriculum, and can complement practitioner-educators in providing students with a real-world context for understanding complex patient care needs.

Concurrent Validity of Written and OSCE Components of the Canadian Dental Certification Examinations

The purpose of this study was to assess the concurrent validity of the National Dental Examining Board of Canada (NDEB) Written Examination and Objective Structured Clinical Examination (OSCE) by correlating students' scores with their performance in the final year of the D.D.S./D.M.D. program. The subjects of this study were the 2,317 students at nine Canadian dental schools who completed both NDEB examinations between 1995 and 2000. The findings indicate positive correlations (r = 0.43 and r = 0.46, p < .001, for the written and OSCE examinations respectively) between students' examination scores and final year results. Year-to-year and school-to-school variations were minimal. These findings supported the concurrent validity of both NDEB examinations.

Cancer Pain Management Skills Among Medical Students: The Development of a Cancer Pain Objective Structured Clinical Examination

Recent surveys suggest that most physicians have inadequate knowledge to assess and manage cancer pain; however, the important domain of clinical performance has not yet been clearly evaluated. The Objective Structured Clinical Examination (OSCE) has become a widely- used and accepted method to evaluate the clinical abilities of medical students. The purpose of this study was to develop and test a Cancer Pain OSCE for medical students evaluating their clinical competence in the area of cancer pain management. A four-component Cancer Pain OSCE was developed and presented to 34 third-year medical students during a sixteen-week combined medicine/surgery clerkship. The content of the objective criteria for each component of the OSCE was developed by a multidisciplinary group of pain experts. The OSCE was designed to assess the students' cancer pain management skills of pain history-taking, focused physical examination, analgesic management of cancer pain, and communication of opioid analgesia myths. Actual cancer survivors were used in the five-minute individual stations. The students were asked to complete a cancer pain history, physical examination, manage cancer pain using analgesics, and communicate with a family member regarding opioid myths. Clinical performance was evaluated using pre-defined checklists. Results showed the student's average performance for the history component was the highest of all four components of the examination. Out of 34 points possible on this clinical skills item, students on average (SD) scored 24.5 (5.2), or 72%. For the short-answer analgesic management component of the Cancer Pain OSCE, the overall score was 32%. Most students managed cancer pain with opioids, however, very few prescribed regular opioid use, and the use of adjuvant analgesics was uncommon. Student performance on the focused cancer pain physical examination was, in general, poor. On average students scored 61% on the musculoskeletal system, but only 31% on both the neurological and lymphathic examination. The overall percent score for the cancer pain OSCE was 48%. We conclude that the Cancer Pain OSCE is a useful performance-based tool to test individual skills in the essential components of cancer pain assessment and management. Of the four components of the Cancer Pain OSCE, medical students performed best on the cancer pain history and performed poorly on the cancer pain physical examination. Information gained from this study will provide a foundation on which future small-group medical student structured teaching will be based.

How discriminatory is the objective structured clinical examination (OSCE) in the assessment of clinical competence of medical students?

A prospective collection and analysis of examination marks for three consecutive academic years was undertaken to determine the correlation between the objective structured clinical examination (OSCE) and various other components of medical students' examination, and also to examine how discriminatory the OSCE examination is in the assessment of clinical competence. Out of 388 students, 96·3% passed the examination at the first attempt. Of those who passed, 15·5% had merit while 1·0% had a distinction. When the OSCE component was excluded from the analysis, 11·6% and 2·8% had merits and distinctions, respectively, but when the clinical examination was excluded, there were 17·8% and 6·2% merits and distinctions, respectively. Correlations between the various components of the examination were significant except for that between the clinical examination and the project. Although the OSCE and clinical components of examinations for clinical students are complementary, the OSCE component awards more merit and distinction categories. Although there were statistically significant correlations between the various components of the examination, only 11% of the variability in clinical examination scores could be explained by the performance in OSCE suggesting that the different components are testing different aspects of the student's clinical competence. Completely replacing clinicals with an OSCE may not necessarily be the best way of assessing medical students' clinical competence.

Defining the content for the objective structured clinical examination component of the professional and linguistic assessments board examination: development of a blueprint.

We describe the steps taken to develop an appropriate list of 'clinical problems' used to define the content of the objective structured clinical examination (OSCE) component of the Professional and Linguistic Assessments Board (PLAB) examination. A blueprint and list of 255 clinical problems was compiled by reviewing PLAB questions, published curricula of the UK Royal Colleges and other sources such as the General Medical Council's own guidelines. This list was sent to a random sample of 251 successful PLAB candidates who were asked to rate the clinical problems using a scale of 'seen frequently/seldom/never' and to 120 members of the accident and emergency (A&E) specialists' association who were asked to identify 'important' tasks. The list was further validated using activity data obtained for consecutive A&E attendances (934) and admissions (6130) at three hospitals. After two mailings, 131/251 (52%) former PLAB candidates and 89/120 (74%) A&E specialists replied. All of the 255 clinical problems were seen by some former candidates and were felt to be important by some A&E specialists. Of the 255 problems, 40 were neither rated as important nor as seen frequently/seldom by over 50% of respondents. The 255 clinical problems covered a mean 94% consecutive A&E attendances and 97.6% reasons for hospital admission. The correlation between clinical problems that were frequently encountered and those felt to be important was rho=0.38 (P<0.01). The clinical problems appear to be appropriate for defining the content of the PLAB OSCE. We suggest that our problem list is useful in that all the problems are seen by some senior house officers, are felt to be important by some A&E specialists and cover greater than or equal to 94% of the conditions for which patients both attend and are admitted from casualty. The correlation between clinical task importance and the frequency that they were seen was only moderate, partly reflecting the relative seriousness of some uncommon medical conditions, which should not be missed on clinical assessment. The content of the OSCE component of the PLAB examination is being reviewed in the light of the findings of this study. The limitations of the study are discussed.

Learning effect of reusing stations in an objective structured clinical examination

This article reports the effect of administering identical stations to different classes over a 12‐year period within the objective structured clinical examination component of a comprehensive examination of competence given to final‐year medical students at the University of Adelaide. Analyses of variance on 16 stations used twice and on 6 of these stations used more than twice showed evidence of statistically significant increments of about 5% to 7% per repeat administration. The most marked effect was on a CPR station used a total of five times; scores rose from an initial 45% to about 80% over 10 years. The educational implications of these findings for examining in medicine are discussed.

Psychometric characteristics of the objective structured clinical examination

The objective structured clinical examination (OSCE) is increasingly being used as a method of clinical assessment yet its measurement characteristics have not been well documented. Evidence is accumulating that many OSCEs may be too short to achieve reliable results. This paper reports detailed psychometric analyses of OSCEs which were administered as part of a well-established final-year examination. Generalizability theory guided investigation of test reliability. At the present test length the OSCE components showed low reliabilities relative to written components. Satisfactory reliabilities could potentially be achieved if test length was increased to approximately 6 hours, a time which would create significant logistic problems for most medical schools. Several strategies for dealing with this practical problem have been explored. Firstly, it was shown that more careful selection of stations based on their psychometric characteristics can significantly improve reliability. Secondly, where rater availability is a limiting factor to increasing test length, more can be gained by using one rater per station and having more stations than using two raters per station. Finally, OSCE scores can, with advantage, be combined with other test scores which are obtained by using less resource-intensive methods. By adopting such strategies, a reliable assessment of clinical competence could be obtained in about 4 hours of testing time which was equally divided between an OSCE constructed of practical and clinical stations and a written test.