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Increased authenticity in practical assessment using emergency case OSCE stations

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Abstract

In case of an emergency, a fast and structured patient management is crucial for patient’s outcome. The competencies needed should be acquired and assessed during medical education. The objective structured clinical examination (OSCE) is a valid and reliable assessment format to evaluate practical skills. However, traditional OSCE stations examine isolated skills or components of a clinical algorithm and thereby lack a valid representation of clinical reality. We developed emergency case OSCE stations (ECOS), where students have to manage complete emergency situations from initial assessment to medical treatment and consideration of further procedures. Our aim was to increase the authenticity and validity in the assessment of students’ capability to cope with emergency patients. 45 students participated in a 10-station OSCE with 6 ECOS and 4 traditional OSCE stations. They were assessed using a case-specific checklist. An inter-station and post-OSCE-questionnaire was completed by each student to evaluate both ECOS and traditional OSCE. In this study, we were able to demonstrate that ECOS are feasible as time-limited OSCE stations. There was a high acceptance on both students and examiners side. They rated ECOS to be more realistic in comparison to the traditional OSCE scenarios. The reliability estimated via Crohnbach’s α for the 6 ECOS is high (0.793). ECOS offer a feasible alternative to the traditional OSCE stations with adequate reliability to assess students’ capabilities to cope with an acute emergency in a realistic encounter.

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References

  • Barman, A. (2005). Critiques on the objective structured clinical examination. Annals of the Academy of Medicine, Singapore, 34, 478–482.

    Google Scholar 

  • Battles, J. B., Wilkinson, S. L., & Lee, S. J. (2004). Using standardised patients in an objective structured clinical examination as a patient safety tool. Quality & Safety in Health Care, 13, 46–50.

    Article  Google Scholar 

  • Boursicot, K., & Roberts, T. (2005). How to set up an OSCE. The Clinical Teacher, 2, 16–20.

    Article  Google Scholar 

  • Burdick, W. P., Jouriles, N. J., D’Onofrio, G., Kass, L. E., Mahoney, J. F., & Restifo, K. M. (1998). Emergency medicine in undergraduate education. SAEM Education Commitee, Undergraduate Subcommittee, Society for Academic Emergency Medicine. Academic Emergency Medicine, 5, 1105–1110.

    Article  Google Scholar 

  • Crossley, J., Humphris, G., & Jolly, B. (2002). Assessing health professionals. Medical Education, 36, 800–804.

    Article  Google Scholar 

  • Downing, S. M. (2004). Reliability: On the reproducibility of assessment data. Medical Education, 38, 1006–1012.

    Article  Google Scholar 

  • Farrell, S. (2009). Evaluation of student performance: Clinical and professional performance. SAEM medical student educators’ handbook. Retrieved February 22, 2009, from http://www.saem.org/download/hand-4.pdf.

  • Frankfurt Institute of Emergency Medicine and Simulation Training. (2009). Retrieved June 2, 2009, from www.finest-online.org.

  • Harden, R. M., & Gleeson, F. A. (1979). Assessment of clinical competence using an objective structured clinical examination (OSCE). Medical Education, 13, 41–54.

    Google Scholar 

  • Harden, R. M., Stevenson, M., Downie, W. W., & Wilson, G. M. (1975). Assessment of clinical competence using objective structured examination. British Medical Journal, 1, 447–451.

    Article  Google Scholar 

  • Hodges, B. (2003a). Validity and the OSCE. Medical Teacher, 25, 250–254.

    Article  Google Scholar 

  • Hodges, B. (2003b). OSCE! Variations on a theme by Harden. Medical Education, 37, 1134–1140.

    Article  Google Scholar 

  • Hodges, B., Hanson, M., McNaughton, N., & Regehr, G. (2002). Creating, monitoring, and improving a psychiatry OSCE: A guide for faculty. Academic Psychiatry, 26, 134–161.

    Article  Google Scholar 

  • Hodges, B., Regehr, G., Hanson, M., & McNaughton, N. (1998). Validation of an objective structured clinical examination in psychiatry. Academic Medicine, 73, 910–912.

    Article  Google Scholar 

  • Johnson, G., & Reynard, K. (1994). Assessment of an objective structured clinical examination (OSCE) for undergraduate students in accident and emergency medicine. Journal of Accident and Emergency Medicine, 11, 223–226.

    Article  Google Scholar 

  • Lunenfeld, E., Weinreb, B., Lavi, Y., Amiel, G. E., & Friedman, M. (1991). Assessment of emergency medicine: A comparison of an experimental objective structured clinical examination with a practical examination. Medical Education, 25, 38–44.

    Article  Google Scholar 

  • Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(Suppl. 9), 63–67.

    Article  Google Scholar 

  • Newble, D. (2004). Techniques for measuring clinical competence: Objective structured clinical examinations. Medical Education, 38, 199–203.

    Article  Google Scholar 

  • Selby, C., Osman, L., Davis, M., & Lee, M. (1995). Set up and run an objective structured clinical exam. BMJ, 310, 1187–1190.

    Article  Google Scholar 

  • Streiner, D. L., & Norman, G. (2003a). Reliability. In D. L. Streiner & G. Norman (Eds.), Health measurement scales: A practical guide to their development and use (pp. 126–152). Oxford: Oxford University Press.

    Google Scholar 

  • Streiner, D. L., & Norman, G. (2003b). Selecting the items. In D. L. Streiner & G. Norman (Eds.), Health measurement scales: A practical guide to their development and use (pp. 61–79). Oxford: Oxford University Press.

    Google Scholar 

  • Stufflebeam, D. L. (2000). The checklists development checklist. Western Michigan University Evaluation Center. Retrieved February 22, 2009, from http://www.wmich.edu/evalctr/checklists/cdc.htm.

  • van der Vleuten, C. (1996). The assessment of professional competence: Developments, research and practical implications. Advances in Health Sciences Education, 1, 41–67.

    Article  Google Scholar 

  • van der Vleuten, C. (2000). Validity of final examinations in undergraduate medical training. BMJ, 321, 1217–1219.

    Article  Google Scholar 

  • van der Vleuten, C. P., & Schuwirth, L. W. (2005). Assessing professional competence: From methods to programmes. Medical Education, 39, 309–317.

    Article  Google Scholar 

  • van der Vleuten, C., & Swanson, D. (1990). Assessment of clinical skills with standardized patients: State of the art. Teaching and Learning in Medicine, 2, 58–76.

    Article  Google Scholar 

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Acknowledgments

M. R. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy for the data analysis. None of the authors had potential conflicts of interest. We would like to thank the clinicians, paramedics and course instructors who contributed to the construction and evaluation of scenarios and marking schemes. Our special thanks go to the students, examiners, standardized patients and assistants who took part in this study.

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany

    Miriam Ruesseler, Ingo Marzi & Felix Walcher

  2. Med Con Team, CEO, Reutlingen, Germany

    Michael Weinlich

  3. Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Johann Wolfgang Goethe-University, Frankfurt, Germany

    Christian Byhahn

  4. Department of Anaesthesiology and Critical Care Medicine, Carl Gustav Carus Technical University, Dresden, Germany

    Michael P. Müller

  5. Medical Hospital, University of Heidelberg, Heidelberg, Germany

    Jana Jünger

Authors
  1. Miriam Ruesseler
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  2. Michael Weinlich
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  3. Christian Byhahn
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  4. Michael P. Müller
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  5. Jana Jünger
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  6. Ingo Marzi
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  7. Felix Walcher
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Corresponding author

Correspondence to Miriam Ruesseler.

Appendix

Appendix

Stem

You are the emergency physician on standby service together with your paramedic.

You are called to an office, where a 54 year old male complains of chest pain.

Simulated patient’s role

Name:

Frederik Wolter

Age:

54 (date of birth: September 16, 1954)

Sex:

Male

Weight:

Normal weight

Appearance:

Business style (suit, shirt, tie)

Profession:

Financial Manager

Actual complaints

Main complaints:

Chest pain (retrosternal), tightness in the chest

Chronology:

Sudden onset 20 min ago

Intensity:

8 on a scale of 10

Attendant symptoms:

Sweaty, radiation to the left arm no correlation to respiration

Patient’s history

Smoking:

Heavy smoker for 14 years, approx. 2–3 pack per day

Alcohol:

Regularly 1–2 beer while watching TV

Blood pressure:

“My blood pressure is increased according to my GP!”

“I don’t know how high it normally is!”

“My GP prescribed me some stuff, but what should I take it for. Tablets will not remove the stress in my job.”

Cholesterol:

“My GP says its increased.”

Blood sugar:

Until now not known

Heart:

Chest pain at physical strain e.g. climbing stairs

“So I take the elevator!”

Medication:

“My GP prescribed me some stuff, but what should I take it for. Tablets will not remove the stress in my job.”

Stress:

Ongoing stress due to a major project he is responsible for

Social:

Married, 2 children

Family:

Father died from a heart attack aged 51

Mother had a stroke in 2004 in nursing home since then

Siblings none

Scenario

First sentence (Answer of the reason for the emergency call)

  • “I have got very bad chest pain!”

Question: Since when/What happened?

  • “I had a heavy argument with one of my colleagues about 20 min ago!”

Attitude

  • Agitated, anxious, do not hyperventilate, despaired, burned out

Comments during scenario (esp. when examinee is at a loss)

  • “What is wrong with me?”

  • “Can I go on with my project? You must know it has to be ready in 3 days!”

  • “I should have listened to my GP!”

This data will only be mentioned when examinee asks them directly

  • Onset of symptoms

  • Localisation and radiation of symptoms

  • Past medical history

  • Previous episodes of chest pain

  • Family history

  • Smoking and alcohol

Setting

Office with two desks, each one with computer and several telephones and cell phones. Desks cramped with ring binders and papers. Phones are ringing all the time. Filled ashtray and coffee cups on the desk.

Several fully labeled white boards beside the desks.

Checklist

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Ruesseler, M., Weinlich, M., Byhahn, C. et al. Increased authenticity in practical assessment using emergency case OSCE stations. Adv in Health Sci Educ 15, 81–95 (2010). https://doi.org/10.1007/s10459-009-9173-3

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  • DOI: https://doi.org/10.1007/s10459-009-9173-3

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