THE EMPERORS NEW CLOTHES - THE OSCE REASSESSED

In response to increasing concerns about the prevalence of knowledge-b ased assessments of medical student competency, leaders in medical edu cation have emphasized the importance of methods that quantify student performance. As a result, the use of objective structured clinical ex aminations (OSCEs) is viewed by many as the newest and most promising technique for assessing students' abilities. In considering the implem entation of a fourth-year OSCE, faculty at the College of Human Medici ne at Michigan State University became uncomfortable with some of the technical limitations of the method (limited generalizability; weak li nkages to the curriculum; little opportunity provided for improvement in examinees' skills; and others), as well as the possible ramificatio ns of such an innovation within their school's specific curricular and organizational contexts. This essay is offered as a reflection of the challenges and possible alternatives that have emerged as the faculty have considered how best to design and implement performance-based as sessment within their institution. Rather than using the OSCE as a mil estone marker of student performance, they consider the possibility of smaller assessment events, closely tied to the curriculum and consist ent with the guiding principles of the medical school.