An evaluation of the Team Objective Structured Clinical Examination (TOSCE)

Objectives To evaluate the validity, reliability and feasibility of the TOS CE, a new means of formative assessment for medical students, from the pers pectives of examiners, simulated patients and students. Design Teams of five students rotate through five clinical stations, perfor ming one of four tasks in turn, whilst the fifth member of the team 'rests' . Setting St George's Hospital Medical School, London. Subjects Third-year medical students, their examiners and simulated patient s. Results All participants felt the TOSCE session had high validity although some students were unfamiliar with some subjects. Stations were double-mark ed and agreement rates and Cohen's Kappa ranged from 67 to 94% and 0.04-0.8 8, respectively. Analysis of the causes of disagreement led to improved mar king schedules and enhanced reliability. Conclusions The feasibility of the exercise as a formative assessment was d emonstrated by the confidence of the staff participating both as examiners and simulated patients and from the majority of students who welcomed the l earning experience.