FURTHER EXPERIENCE IN DEVELOPMENT OF AN OBJECTIVE STRUCTURED CLINICALEXAMINATION FOR PHYSICAL MEDICINE AND REHABILITATION RESIDENTS

Since the last report, two additional objective structured clinical ex aminations (PGY-2, PGY-3, and PGY-4, as well as incoming PGY-2) have b een administered. As a result, our curriculum has been modified to str engthen physical examination skills, including specific workshops. Int errater reliability of evaluators has been tested for the first time t o verify reliability, and refinements have been made in the standardiz ed checklist grading system. The interrater grading of history-taking had good reliability (0.73-0.96), as did neurological and spine physic al examination (0.84-0.88). The interrater grading reliability of smal l and large joint examination was more problematic (0.46-0.62) because of examiners' inability to have full visibility, evaluator's fatigue, and confusing evaluation scoring descriptions. We now use a two-point grading scale (correct or incorrect) for history but continue a three -point scale (correct, partially correct, or incorrect) for physical e xamination. The examination schedule is being modified to add more enc ounters, give time for trainee feedback, and further refinement of gra ding expectations for a more efficient and reliable scoring system.