Implementing the Objective Structured Clinical Examination (OSCE) in a Geriatrics Fellowship Program - a three-year experience

Abstract

Background: The Objective Structured Clinical Examination (OSCE) appears to be an effective alternative for assessing not only medical knowledge, but also clinical skills, including effective communication and physical examination skills. Our purpose was to implement an OSCE model in a Geriatrics fellowship program and to compare the instrument with traditional essay examination. Methods: Seventy first- and second-year geriatric fellows were initially submitted to a traditional essay examination and scored from 0 to 10 by a faculty member. Subsequently, the same fellows underwent an OSCE with eight ten-minute stations, covering a wide range of essential aspects of geriatric knowledge. Each OSCE station had an examiner responsible for its evaluation according to a predefined checklist. Checklist items were classified for analysis purposes as clinical knowledge items (CKI) and communication skills items (CSI); student responses were scored 0-10. Results: While essay exams took from 30 to 45 minutes to complete, 180 to 200 minutes were required to evaluate students using the proposed OSCE method. Students scored an average of 6.2 ± 1.2 on the traditional essay examination versus 6.6±1.0 on the OSCE(p<0.001). Sub-analyses of OSCE scores indicated that average performance on CKI was lower than the average on CSI (6.4±1.1 vs.8.4±1.1; p<0.001). Students’ performance on the essay exam was similar to their performance on CKI (p=0.13). Second-year fellows performed better than first-year fellows on both the essay exam (p<0.001) and CKI (p=0.05), but not on CSI (p=0.25). Conclusion: The OSCE was successfully implemented as an educational strategy during our Geriatrics fellowship program. Combining different testing modalities may provide the best assessment of competence for various domains of knowledge, skills, and behavior comparison of first and second-year fellows’ performance on traditional essay examination and OSCE.