Use of an objective structured clinical examination [OSCE] for the assessment of physician performance in the ultrasound evaluation of trauma

Background: A reliable means of assessing physician competency in performin g ultrasound (US) is critical for training and credentialing, Objective Str uctured Clinical Examinations (OSCE) have been used successfully to assess clinical competency in other areas of surgical education hut have not been applied previously to trauma ultrasound training. The objectives of this st udy mere to assess physician performance in the focused abdominal sonograph y in trauma (FAST) examination by using a specifically designed OSCE, and t o determine whether the OSCE detects differences in two determinants of com petency (knowledge acquisition and clinical interpretation skills). Methods: Eighty-two physicians in surgery (n = 49) and emergency medicine ( n = 33) at a Level I trauma center were evaluated, All participated in a FA ST course consisting of didactic sessions on US physics, indications, and t echnique, FAST examination videos, and a hands-on session with human models . The OSCE consisted of two parts: written examination that assessed factua l knowledge, and videotape of real-time US examinations that assessed inter pretation skills, The OSCE was administered before and after the FAST cours e. Results: Significant improvements in postcourse OSCE scores were observed f or factual knowledge (52.5 +/- 2.0 vs. 87.5 +/- 1.1, p < 0.001) and interpr etation skills (27.2 +/- 1.4 vs. 62.9 +/- 1.3, p < 0.007), Scores for US in terpretation were significantly loa er than those for factual knowledge at both precourse (27.2 +/- 1.4 vs. 52.5 +/- 2.0, p < 0.001) and postcourse (6 2.9 +/- 1.3 vs. 87.5 1.1, p < 0.01), No performance differences mere observ ed between surgeons and emergency medicine physicians and no effect of trai ning level on test scores was observed, Conclusion: Knowledge acquisition and US interpretation skills can be asses sed reliably with a specifically designed OSCE, Although both skills improv ed after participation in a FAST course, US interpretation scores were cons istently lower than those for factual knowledge. This study supports the us e of the objective structured clinical examination in both the design of ul trasound teaching programs and the assessment of physician competency.