Development and testing of an objective structured clinical exam (OSCE) to assess socio-cultural dimensions of patient safety competency.
BACKGROUND
Patient safety (PS) receives limited attention in health professional curricula. We developed and pilot tested four Objective Structured Clinical Examination (OSCE) stations intended to reflect socio-cultural dimensions in the Canadian Patient Safety Institute's Safety Competency Framework.


METHODS
18 third year undergraduate medical and nursing students at a Canadian University.


METHODS
OSCE cases were developed by faculty with clinical and PS expertise with assistance from expert facilitators from the Medical Council of Canada. Stations reflect domains in the Safety Competency Framework (ie, managing safety risks, culture of safety, communication). Stations were assessed by two clinical faculty members. Inter-rater reliability was examined using weighted κ values. Additional aspects of reliability and OSCE performance are reported.


RESULTS
Assessors exhibited excellent agreement (weighted κ scores ranged from 0.74 to 0.82 for the four OSCE stations). Learners' scores varied across the four stations. Nursing students scored significantly lower (p<0.05) than medical students on three stations (nursing student mean scores=1.9, 1.9 and 2.7; medical student mean scores=2.8, 2.9 and 3.5 for stations 1, 2 and 3, respectively where 1=borderline unsatisfactory, 2=borderline satisfactory and 3=competence demonstrated). 7/18 students (39%) scored below 'borderline satisfactory' on one or more stations.


CONCLUSIONS
Results show (1) four OSCE stations evaluating socio-cultural dimensions of PS achieved variation in scores and (2) performance on this OSCE can be evaluated with high reliability, suggesting a single assessor per station would be sufficient. Differences between nursing and medical student performance are interesting; however, it is unclear what factors explain these differences.
School of Health Policy & Management, York University, Toronto, Ontario, Canada.
Liane R
LR
Ginsburg
School of Nursing, Queen's University, Kingston, Ontario, Canada.
Deborah
D
Tregunno
Department of Family Medicine (Emeritus), University of Calgary, Calgary, Canada.
Peter G
PG
Norton
Medical Council of Canada, Ottawa, Ontario, Canada.
Sydney
S
Smee
Medical Council of Canada, Ottawa, Ontario, Canada.
Ingrid
I
de Vries
Faculty of Education, Queen's University, Kingston, Ontario, Canada.
Stefanie S
SS
Sebok
Department of Anesthesiology and Perioperative Medicine, School of Nursing, Queen's University, Kingston, Ontario, Canada.
Elizabeth G
EG
VanDenKerkhof
School of Nursing, Queen's University, Kingston, Ontario, Canada.
Marian
M
Luctkar-Flude
School of Nursing, Queen's University, Kingston, Ontario, Canada.
Jennifer
J
Medves
D002170:Canada; D002983:Clinical Competence; D003142:Communication; D054521:Cultural Competency; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety / Q000592:standards*; D015203:Reproducibility of Results; D012307:Risk Factors; D017751:Safety Management / Q000458:organization & administration; D013337:Students, Medical; D013338:Students, Nursing
Health professions education; Patient safety; Teamwork