Is it Worth it? A Look at the Costs and Benefits of an OSCE for Second-Year Medical Students

Abstract

For the past two years, the Bowman Gray School of Medicine has used an Objective Structured Clinical Exam (OSCE) to measure the performance of 117 first- and second-year medical students at the end of introductory courses on differential and physical diagnosis. Given the surprisingly high costs of conducting the OSCE ($1300 for supplies and 527 person-hours of donated time), data about the format's perceived benefits were collected. All of the faculty involved in the examination who responded to a questionnaire (80%) reported that it was worth the time they had volunteered to evaluate students by observation and that the format should be used in the future. The majority of student examinees also reported that the OSCE format was appropriate for the course and should continue to be used.

Objective Structured Clinical Examination: The Assessment of Choice

“…20,21 An advantage of simulated patients over real patients is that of allowing different candidates to be presented with a similar challenge, thereby reducing an important source of variability. 12,22 They also have reliable availability and adaptability, which enables the reproduction of a wide range of clinical phenomena tailored to the student's level of skill. In addition, they can simulate scenarios that may be distressing for a real patient, such as bereavement or terminal illness.…”

“…However, the time efficiency of OSCE and its versatility makes the cost worthwhile. 18,22 Recruitment and training of the SP is critical to the success of the OSCE. SP could be used not only for history taking and counselling, but also for eliciting physical findings that can be simulated, including aphasia, facial paralysis, hemiparetic gait, and hyperactive deep tendon reflexes.…”

American College of Surgeons Resident Objective Structured Clinical Examination

“…[10][11][12][13][14] The most expensive component of an OSCE is the time invested by experts in developing the content. Content expertise was provided by members of the ACS task force and development costs were supported by a grant from the Agency for Healthcare Research and Quality (AHRQ); therefore, individual residency programs do not have to bear these costs.…”

ROC and Loss Function Analysis in Sequential Testing

“…Examinations using standardized patients (SP-based tests, or OSCEs) are adequate in many respects, but they are time consuming and expensive (Frye et al, 1989;Cusimano et al, 1994;Carpenter, 1995). In order to reduce the costs several authors recommended the use of sequential testing as an economic test administration procedure (Rothman et al, 1992;Colliver et al, 1992Colliver et al, , 1995Cass et al, 1997;Muijtjens et al, 2000).…”