THE USE OF THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE) FOR EVALUATION AND INSTRUCTION IN GRADUATE MEDICAL-EDUCATION

This study had two purposes: determining the reliability and validity of the Objective Structured Clinical Examination (OSCE) in assessing p erformance by trainees at all levels, including medical students and c hief residents; and estimating the impact of providing OSCE participan ts with immediate feedback about their performance. A comprehensive 21 0-min OSCE was administered to 53 surgical residents and 6 junior medi cal students. Faculty experts proctored all patient stations and provi ded immediate feedback to participants after the patient interaction s egments (Part A). The participants then answered questions about the p atients seen (Part B). The reliability of the OSCE was high (.91.), id entical to that of a previous resident OSCE with no feedback. The stan dard error of measurement for both parts was approximately 4%. At the 95% confidence interval, each participant's actual level of clinical p erformance (Part A) and clinical knowledge (Part B) could be estimated with an error of +/-8%. Participants showed significant differences i n clinical performance (Part A, P < 0.01) and knowledge (Part B, P < 0 .01) by level of training. Most participants (74%) rated the OSCE as a n above average or outstanding educational method. The OSCE is a valid and reliable test of residents' clinical skills. Feedback to particip ants during the OSCE was positively received and did not perturb test reliability. (C) 1996 Academic Press, Inc.