A COMPARATIVE-ANALYSIS OF THE COSTS OF ADMINISTRATION OF AN OSCE

Background. The objective structured clinical examination (OSCE) has b ecome an accepted technique for the evaluation of clinical competence in medicine. Although advances have been made in our knowledge of the psychometric aspects of the OSCE, extremely little has been written ab out feasibility and cost issues. Given the current economic imperative to control costs and the extremely scant literature on the costs of d eveloping and administering an examination in medicine, the authors fe lt it timely and relevant to explore issues related to the cost of the OSCE. Method. In 1991 - 92 and in 1992 - 93, costs and time requireme nts to implement and administer a structured oral (SO) examination and a six-station OSCE for a surgical clerkship at the University of Toro nto Faculty of Medicine were gathered by review of invoices, interview s with those involved, and perusal of diaries kept by staff. Results. To develop and administer the six-station OSCE, 327.5 hours of staff a nd faculty time were required for each rotation of surgical clerks (8. 2 hours per student). The SO examination required 110 hours of staff a nd faculty time (2.75 hours per student). Direct expenses for the OSCE amounted to U.S. $6.90 per student per station, compared with no dire ct expense for the SO examination. Conclusion. The OSCE was more time- consuming and more expensive in human and material costs than the SO e xamination. However, costs of the OSCE can be substantially reduced fr om approximately U.S. $35 to U.S. $1 per student per station if test d evelopers, standardized patients, support staff, and examiners can don ate their time. The authors compare the costs and time requirements of their OSCE with those of other OSCEs reported in the literature, and they provide guidelines to assist educators in deciding whether the co sts of an OSCE are justifiable in the educators' individual settings.