Evaluation of medical student performance on objective structured clinical exams with standardized patients with and without disabilities.
OBJECTIVE
To investigate whether medical students' performance on a family medicine clerkship objective structured clinical exam (OSCE) differed when the standardized patient (SP) had a disability versus when the SP did not have a disability.


METHODS
SPs with spinal cord injury (SP-SCI), SPs with intellectual disability (SP-ID), and SPs without a disability participated separately in two OSCE scenarios that were administered by the University of South Carolina School of Medicine's Department of Family and Preventive Medicine from 2007 to 2009. OSCE scores were determined based on the number of critical actions completed by the student, and scores were analyzed to determine differences among scenarios.


RESULTS
Students scored lower in history, physical exam, lab tests, and interpersonal skills with an SP-SCI, and lower in history, physical exam, and lab tests with an SP-ID than did students interacting with SPs without a disability. The odds ratio for ordering a hemoglobin A1c in one scenario was 4.16 times higher in cases when the SP did not have a disability (95% confidence interval [CI] 1.78-9.17, P = .001). In the second scenario, the odds ratio was 3.08 times higher for ordering a urinalysis (95% CI 1.34-7.08, P = .006) and was 2.15 times higher for providing lifestyle counseling (95% CI 1.04-4.44, P = .038) in students interacting with SPs without a disability.


CONCLUSIONS
Students performed better when the SP did not have a disability. This suggests that greater emphasis should be placed on teaching appropriate care of patients with a disability.
Brown
Rachel S
RS
Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA. rachel.brown@uscmed.sc.edu
Graham
Catherine Leigh
CL
Richeson
Nancy
N
Wu
Junlong
J
McDermott
Suzanne
S
D000328:Adult; D002983:Clinical Competence; D004185:Disability Evaluation; D004521:Educational Measurement / Q000379:methods*; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008487:Medical History Taking / Q000592:standards; D016544:Patient Simulation; D010808:Physical Examination / Q000592:standards; D013119:Spinal Cord Injuries / Q000150:complications*