title: Performance-based assessment of clinical ethics using an objective structured clinical examination.
abstract: OBJECTIVE
  To further examine the objective structured clinical examination (OSCE) as a performance-based assessment method for clinical ethics.
  
  
  METHODS
  In the spring of 1993, a volunteer sample of 88 final-year medical students from all five Ontario medical schools took a four-station OSCE that used standardized patients and involved decisions to forego life-sustaining treatment. Performance was scored on a checklist of behaviors unique to each case. Data were analyzed for reliability using intraclass correlation coefficients and the Spearman-Brown prophecy formula.
  
  
  RESULTS
  Reliability of the test was only .28 as a result of a low average inter-station correlation of .07. To achieve a test reliability of .8, 41 stations (almost seven hours of testing time) would be required.
  
  
  CONCLUSIONS
  Because of its low test reliability, the OSCE is not a feasible stand-alone method for summative evaluation of clinical ethics. This performance-based evaluation method should be combined with other, more reliable evaluation methods. The OSCE has promise for formative evaluation.
authors.affiliation: Department of Medicine, University of Toronto Faculty of Medicine, Ontario, Canada. peter.singer@utoronto.ca
authors.forename: P A
authors.initials: PA
authors.lastname: Singer
authors.forename: A
authors.initials: A
authors.lastname: Robb
authors.forename: R
authors.initials: R
authors.lastname: Cohen
authors.forename: G
authors.initials: G
authors.lastname: Norman
authors.forename: J
authors.initials: J
authors.lastname: Turnbull
mesh_terms: D004521:Educational Measurement; D004992:Ethics, Medical / Q000193:education*; D006801:Humans; D011361:Professional Competence; D011594:Psychometrics; D015203:Reproducibility of Results; D013337:Students, Medical / Q000523:psychology*