Objective Structured Clinical Examination as an assessment ...

1 Objective Structured Clinical Examination as anassessment method for undergraduate medical studentsAisha M Al-Osail1, Mona H Al-Shiekh2, Abir H Al-Said1, Emad M Al-Osail1*, Mohannad A Al-Ghamdi1*,Abdulaziz M Al-hawas1*, Abdullah S Al-bahussain1*, Ahmed A Al-dajani1*1 Department of Internal Medicine, University of Dammam, Khobar, Saudi of Physiology, University of Dammam, Khobar, Saudi to: M. Aisha Al-Osail, E-mail: October 31, 2014. Accepted November 13, :One of the most important objectives for University of Dammam is to send competent graduated physiciansinto the society, which cannot be accomplished without assessments of the Clinical skills of the students. The ObjectiveStructured Clinical Examination (OSCE) was recently implemented to improve the quality, reliability, validity, universitystandards, and international rankings, and to decrease time consumption by the :To study OSCE as an assessment method for undergraduate medical and Methods:A pilot study was conducted over one semester.

2 A total of 92 examinees took the OSCE andwritten exams in three groups. The OSCE comprised 20 Clinical stations, which included noting histories, physicalexaminations, communication skills, and data interpretation. The written exam contained 80 multiple-choice :Cronbacha s by group were , , and Correlations for all stations ranged from to , whichindicated good stability and internal consistency. The reliability of the written exam was found to be The validity of theOSCE was assessed using Pearson correlations, which was found to be :The OSCE is the gold standard for student assessment and is more reliable and valid than the traditional styleof WORDS: Objective Structured Clinical Examination , assessment , Clinical skill, Cronbach, reliability, validityIntroductionThe Objective Structured Clinical Examination (OSCE) isconsidered the standard method for medical student assess-ment for both preclinical and Clinical courses internationally,especially in high-rank universities of the United States,Canada, the United Kingdom, and Australia.

3 It has alsobecome part of United States Medical Licensing Examination (USMLE),[1 3]Medical Council of Canada Evaluating Exam-ination (MCCEE),[4]and Professional and Linguistic Assess-ments Board (PLAB) Examination .[5]In 1979, Harden and Gleeson[6]implemented thefirstOSCE. Many changes were made in its design and structureto make it more efficient and reliable for evaluating the skills ofthe examinee.[7]It is the best way to assess multiple anddifferent Clinical skills that can show the students knowledge,history taking, physical Examination , communication skills,investigation interpretation, and management in professionaland fair method.[8]The OSCE needs a lot of preparation fromstudents because they must read about most of the systemsto clear the exam, and they will be examined by a numberof faculty members, EXAMINED by same faculty members,which will decrease the discrepency and they will have similarstations and case had many disadvantages, which aresummarized as follows[9,10]:1.

4 Time consuming (it will take 45 60 min for interviewingand examining real patients).2. No direct observation for the students by Absence of reliability index for Difference in patients distribution among examinee (somewill have easy cases and others difficult).5. Difference in patients cooperation with this article onlineWebsite: Response Code:DOI: *Medical studentsInternational Journal of Medical Science and Public Health|2015|Vol 4|Issue 2192 Research Article6. Differences of scoring among the Discussion focused on few systems because of Discussion of investigation and management might beskipped because of time Possibility of psychological and grading effects due toinjustice in the scoring of students.

5 [11 14]10. Discrepancy in exam scores in comparison to clinicalexam scores of some OSCE had many advantages in comparison to long/short cases and written exam or the written essay. The mostimportant points are as follows:1. It takes less time for assessment of multiple It standardizes patients/cases for all It is a reliable exam.[15 17]4. It is a valid test.[3,18]5. It is considered as a fair exam.[6,19,20]Many tools exist that are used to measure the reliabilityof the OSCE, such as Cronbachathat mainly evaluates stability. It can reveal the differences in students perfor-mance at each station and afford a global rating, whichevaluates the overall performance and if the checklist used isappropriate for the skill level of the students.

6 The R2coefficient is used to measure the proportional change in thedependent variable (the checklist score) by changes in theindependent variable (the global grade); this is a marker ofinternal consistency.[21 26]Thefinal method for establishingthe validity of the exam is the comparison of the OSCE scoreswith written exam scores using Pearson correlation.[27]In Saudi Arabia, King Saud University and King AbdulazizUniversity were thefirst Saudi universities to published theirexperiences about using the OSCE in thefield of surgery,which was reported in detail by Al-Naami[28]at King SaudUniversity (for students in theirfinal year). This reportconcentrated on reliability and validity. The use of the OSCEin family medicine at King Saud University was reported byRaheel and Naeem[29]; the undergraduate perceptions of theexams were positive.

7 For thefield of dermatology, it wasconcluded that the OSCE was a gold standard exam, butagain, there were no details about internal medicine.[28,29]In 2014, the Internal Medicine Department at University ofDammam decided to shift from the old-style long/short casesexams to the OSCE style after becoming aware of the moreobvious disadvantages of the former exam style. Theseincluded the lack of establishing the reliability and validity ofthe exam, especially with the increasing number of medicalstudents accepted and many students entering a residency orfellowship program in the United States, Canada, the UnitedKingdom, or Australia, where the OSCE is part of the licen-sing requirements ( , the USMLE, MCCEE, and PLAB).

8 In addition, the OSCE will assist in the goals of sendingcompetent physicians into the community and evaluating thequality and contents of aims of this study were the following: To evaluate the reliability and validity of the OSCE. To assess if different reliability results affect the validity ofthe exam. To develop a standard for all examinees. To ensure the competency of and MethodsParticipantsThis pilot study was conducted during one semester(February to May) with 92 medical students, who took theexam in three groups (March, April, and May 2014). At the endof the semester, the students took the written exam, whichcomprise 80 multiple-choice lectures for the faculty were held about theOSCE; stations, the importance of the rubric for the checklist,and global ratings were explained.

9 Meticulous and lenientconsultants were excluded. An introductory orientation aboutthe OSCE was given for each student group on thefirst day ofthe blueprint was established for each exam, and therewere no repeated stations in the exam. The OSCE examhad 20 Clinical stations and covered history taking, physicalexaminations, communication skills, and data station took 7 min to complete. Students were divided ingroups as shown in Table 1. The blueprint for each groupcovered all the systems in internal medicine, including commu-nication skills, cardiology, the respiratory system, gastroenter-ology, endocrinology, hematology/oncology, nephrology,Table 1:Reliability measures for thefifth-year OSCEDay/yearGenderStudents/dayStabilitya Internal consistencybp-ValueInternal consistencycFirst groupFemale29 (61%)Second groupFemale21 (80%)Third groupMale42 (85%)aCronbachabSpearman rank correlationcR2coefficient determinantsInternational Journal of Medical Science and Public Health|2015|Vol 4|Issue 2193Al-Osailet al.

10 : OSCE and students assessmentinfectious disease, rheumatology, and general medicine, whichare shown in Table 2. The exams were conducted for over3 days for all the three groups for 5 7 highest total score was 100%; the OSCE examaccounted for 50%, a continuous assessment for 10%, andthe written exam for 40%. All 92 students took the Clinical andwritten exam; after each exam, the coordinator of the coursemet with faculty and students to assess and correct anyproblems with the OSCE to ensure better reliability in ConsiderationsThe study was approved by the Institutional ReviewBoard of the University of Dammam (approval number:IRB-2014-01-317). Informed consent was obtained from AnalysisThe exam reliability was assessed using Cronbacha,the global rating (our rating was clear pass, borderline, andclear fail), and the coefficient of determination, R2.