Clinical competence assessment in radiology: Introduction of an objective structured clinical examination in the medical school curriculum

Rationale and Objectives. Traditional oral and written examinations can be limited in predicting future clinical performance. Therefore Objective Stru ctured Clinical Examinations (OSCEs) have been introduced in other specialt ies. The au thors assessed their value in radiology. Materials and Methods. The study includes 122 Harvard medical students who undertook I-month compulsory clerkships at one of three hospitals (A, B, or C) in their 3rd and 4th year and a compulsory OSCE in their 4th year. The OSCE was constructed from five cases. Each had eight or nine standardized q uestions designed to test, within a set time, the perception of essential f indings, their interpretation, and clinical judgment (maximum possible scor e, 100). Clerkship grades were high honors (score of 3), honors (score of 2 ), satisfactory (score of 1), and fail (score of 0). Predictors of OSCE sco res-clerkship grade and affiliated hospital-were modeled as linear function s. Time elapsed between clerkship and OSCE was modeled as a nonlinear funct ion. Results. Although there was a positive relation between clerkship grade and OSCE grade, it accounted for an increase of only 5.7% in OSCE score per cl erkship grade and did not predict performance of individual students. Stude nts who trained in hospital B showed significantly higher OSCE grades. OSCE scores were highest when the examination was taken 8 months after the cler kship. Conclusion. The OSCE may be useful to uncover deficits in individuals and g roups beyond the ones detected with traditional clerkship evaluations and p rovide guidance for remediation. The improved performance after additional clinical exposure suggests that the OSCE may be well suited to test the int egration of radiologic and clinical knowledge.