title: Modification of an OSCE format to enhance patient continuity in a high-stakes assessment of clinical performance.
abstract: BACKGROUND
  Traditional Objective Structured Clinical Examinations (OSCEs) are psychometrically sound but have the limitation of fragmenting complex clinical cases into brief stations. We describe a pilot study of a modified OSCE that attempts to balance a typical OSCE format with a semblance of a continuous, complex, patient case.
  
  
  METHODS
  Two OSCE scenarios were developed. Each scenario involved a single standardized patient and was subdivided into three sequential 10 minute sections that assessed separate content areas and competencies. Twenty Canadian PGY-4 internal medicine trainees were assessed by trained examiner pairs during each OSCE scenario. Paired examiners rated participant performance independent of each other, on each section of each scenario using a validated global rating scale. Inter-rater reliabilities and Pearson correlations between ratings of the 3 sections of each scenario were calculated. A generalizability study was conducted. Participant and examiner satisfaction was surveyed.
  
  
  RESULTS
  There was no main effect of section or scenario. Inter-rater reliability was acceptable. The g-coefficient was 0.68; four scenarios would achieve 0.80. Moderate correlations between sections of a scenario suggest a possible halo effect. The majority of examiners and participants felt that the modified OSCE provided a sense of patient continuity.
  
  
  CONCLUSIONS
  The modified OSCE provides another approach to the assessment of clinical performance. It attempts to balance the advantages of a traditional OSCE with a sense of patient continuity.
authors: Department of Medicine, University of British Columbia, Vancouver, BC, Canada. rhatala@mac.com
authors: Rose
authors: R
authors: Hatala
authors: Sharon
authors: S
authors: Marr
authors: Cary
authors: C
authors: Cuncic
authors: C Maria
authors: CM
authors: Bacchus
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