title: Cost and logistics for implementing the American College of Surgeons objective structured clinical examination.
abstract: BACKGROUND
  The American College of Surgeons has developed a reliable and valid OSCE (objective structured clinical examination) to assess the clinical skills of incoming postgraduate year 1 surgery residents, but the cost and logistics of implementation have not been described.
  
  
  METHODS
  Fixed costs included staff time, medical supplies, facility fee, standardized patient (SP) training time, and one OSCE session. Variable costs were incurred for additional OSCE sessions. Costs per resident were calculated and modeled for increasing the number of test takers.
  
  
  RESULTS
  American College of Surgeons OSCE materials and examination facilities were free. Fixed costs included training 11 SPs for 4 hours ($1,540), moulage and simulation material ($469), and administrative effort for 44 hours ($2,200). Variable cost for each session was $1,540 (SP time). Total cost for the first session was $6,649 ($664/resident), decreased to $324/resident for 3 sessions, and projected to further decline to $239/resident for 6 sessions.
  
  
  CONCLUSIONS
  The cost decreased as the number of residents tested increased. To manage costs, testing more trainees by regional collaboration is recommended.
authors.affiliation: Department of Surgery, Box 2834, Duke University Medical Center, Durham, NC, USA 27710. Electronic address: ranjan.sudan@duke.edu.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Sudan
authors.affiliation: Department of Surgery, Box 2834, Duke University Medical Center, Durham, NC, USA 27710.
authors.forename: Philip
authors.initials: P
authors.lastname: Clark
authors.affiliation: Department of Surgery, Box 2834, Duke University Medical Center, Durham, NC, USA 27710.
authors.forename: Brandon
authors.initials: B
authors.lastname: Henry
mesh_terms: D002983:Clinical Competence; D003365:Costs and Cost Analysis; D003479:Curriculum; D004521:Educational Measurement / Q000191:economics* / Q000379:methods; D013502:General Surgery / Q000191:economics / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D015397:Program Evaluation; D014481:United States
keywords: Cost; OSCE; Safety; Simulation; Standardized patients