title: Virtual alternative to the oral examination for emergency medicine residents.
abstract: BACKGROUND
  The oral examination is a traditional method for assessing the developing physician's medical knowledge, clinical reasoning and interpersonal skills. The typical oral examination is a face-to-face encounter in which examiners quiz examinees on how they would confront a patient case. The advantage of the oral exam is that the examiner can adapt questions to the examinee's response. The disadvantage is the potential for examiner bias and intimidation. Computer-based virtual simulation technology has been widely used in the gaming industry. We wondered whether virtual simulation could serve as a practical format for delivery of an oral examination. For this project, we compared the attitudes and performance of emergency medicine (EM) residents who took our traditional oral exam to those who took the exam using virtual simulation.
  
  
  METHODS
  EM residents (n=35) were randomized to a traditional oral examination format (n=17) or a simulated virtual examination format (n=18) conducted within an immersive learning environment, Second Life (SL). Proctors scored residents using the American Board of Emergency Medicine oral examination assessment instruments, which included execution of critical actions and ratings on eight competency categories (1-8 scale). Study participants were also surveyed about their oral examination experience.
  
  
  RESULTS
  We observed no differences between virtual and traditional groups on critical action scores or scores on eight competency categories. However, we noted moderate effect sizes favoring the Second Life group on the clinical competence score. Examinees from both groups thought that their assessment was realistic, fair, objective, and efficient. Examinees from the virtual group reported a preference for the virtual format and felt that the format was less intimidating.
  
  
  CONCLUSIONS
  The virtual simulated oral examination was shown to be a feasible alternative to the traditional oral examination format for assessing EM residents. Virtual environments for oral examinations should continue to be explored, particularly since they offer an inexpensive, more comfortable, yet equally rigorous alternative.
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
authors.forename: Jillian
authors.initials: J
authors.lastname: McGrath
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kman
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Obstetrics & Gynecology, Columbus, Ohio.
authors.forename: Douglas
authors.initials: D
authors.lastname: Danforth
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
authors.forename: David P
authors.initials: DP
authors.lastname: Bahner
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
authors.forename: Sorabh
authors.initials: S
authors.lastname: Khandelwal
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Martin
authors.affiliation: The Ohio State University College of Medicine, Office of Evaluation, Curriculum Research and Development, Columbus, Ohio.
authors.forename: Rollin
authors.initials: R
authors.lastname: Nagel
authors.affiliation: The Ohio State University College of Medicine, Office of Evaluation, Curriculum Research and Development, Columbus, Ohio.
authors.forename: Nicole
authors.initials: N
authors.lastname: Verbeck
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
authors.forename: David P
authors.initials: DP
authors.lastname: Way
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
authors.forename: Richard
authors.initials: R
authors.lastname: Nelson
mesh_terms: D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D011446:Prospective Studies; D012570:School Admission Criteria; D014584:User-Computer Interface
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