THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION - THE NEW GOLD STANDARDFOR EVALUATING POSTGRADUATE CLINICAL-PERFORMANCE

Objective The authors determine the reliability, validity, and usefuln ess of the Objective Structured Clinical Examination (OSCE) in the eva luation of surgical residents. Summary Background Data Interest is inc reasing in using the OSCE as a measurement of clinical competence and as a certification tool, However, concerns exist about the reliability , feasibility, and cost of the OSCE. Experience with the OSCE in postg raduate training programs is limited. Methods A comprehensive 38-stati on OSCE was administered to 56 surgical residents. Residents were grou ped into three levels of training: interns, junior residents, and seni or residents. The reliability of the examination was assessed by coeff icient alpha; its validity, by the construct of experience. Difference s between training levels and in performance on the various OSCE probl ems were determined by a three-way analysis of variance with two repea ted measures and the Student Newman-Keuls post hoc lest. Pearson corre lations were used to determine the relationship between OSCE and Ameri can Board of Surgery In-Training Examination (ABSITE) scores. Results The reliability of the OSCE was very high (0.91). Performance varied s ignificantly according to level of training (postgraduate year; p < 0. 0001). Senior residents performed best, and interns performed worst. T he OSCE problems differed significantly in difficulty (p < 0.0001). Ov erall scores were poor. Important and specific performance deficits we re identified at all levels of training. The ABSITE clinical scores, u nlike the basic science scores, correlated modestly with the OSCE scor es when level of training was held constant. Conclusion The OSCE is a highly reliable and valid clinical examination that provides unique in formation about the performance of individual residents and the qualit y of postgraduate training programs.