PERFORMANCE-BASED ASSESSMENT OF CLINICAL ETHICS USING AN OBJECTIVE STRUCTURED CLINICAL EXAMINATION

Purpose. To further examine the objective structured clinical examinat ion (OSCE) as a performance based assessment method for clinical ethic s. Method. In the spring of 1993, a volunteer sample of 88 final-year medical students from all five Ontario medical schools took a four-sta tion OSCE that used standardized patients and involved decisions to fo rego life-sustaining treatment. Performance was scored on a checklist of behaviors unique to each case. Data were analyzed for reliability u sing intraclass correlation coefficients and the Spearman-Brown prophe cy formula. Results. Reliability of the test was only .28 as a result of a low average inter-station correlation of .07. To achieve a test r eliability of .8, 41 stations (almost seven hours of testing time) wou ld be required. Conclusion. Because of its low test reliability, the O SCE is not a feasible stand-alone method for summative evaluation of c linical ethics. This performance-based evaluation method should be com bined with other, more reliable evaluation methods. The OSCE has promi se for formative evaluation.