PMID- 21649707
OWN - NLM
STAT- MEDLINE
DCOM- 20110915
LR  - 20120109
IS  - 1365-2923 (Electronic)
IS  - 0308-0110 (Linking)
VI  - 45
IP  - 7
DP  - 2011 Jul
TI  - A final clinical examination using a sequential design to improve 
      cost-effectiveness.
PG  - 741-7
LID - 10.1111/j.1365-2923.2010.03926.x [doi]
AB  - CONTEXT: Good examinations have a number of characteristics, including validity, 
      reliable scores, educational impact, practicability and acceptability. Scores 
      from the objective structured clinical examination (OSCE) are more reliable than 
      the single long case examination, but concerns about its validity have led to 
      modifications and the development of other models, such as the mini-clinical 
      evaluation exercise (mini-CEX) and the objective structured long examination 
      record (OSLER). These retain some of the characteristics of the long case, but 
      feature repeated encounters and more structure. Nevertheless, the practical 
      considerations and costs associated with mounting large-scale examinations remain 
      significant. The lack of metrics handicaps progress. This paper reports a system 
      whereby a sequential design concentrates limited resources where they are most 
      needed in order to maintain the reliability of scores and practicability at the 
      pass/fail interface. METHODS: We analysed data pertaining to the final 
      examination administered in 2009. In the complete final examination, candidates 
      see eight real patients (the OSLER) and encounter 12 OSCE stations. Candidates 
      whose performance is judged as entirely satisfactory after the first four 
      patients and six OSCE stations are not examined further. The others - about a 
      third of candidates - see the remaining patients and stations and are judged on 
      the complete examination. Reliability was calculated from the scores of all 
      candidates on the first part of the examination using generalisability theory and 
      practicability in terms of financial resources. The functioning of the sequential 
      system was assessed by the ability of the first part of the examination to 
      predict the final result for the cohort. RESULTS: Generalisability for the OSLER 
      was 0.63 after four patients and 0.77 after eight patients. The OSCE was less 
      reliable (0.38 after six stations and 0.55 after 12). There was only a weak 
      correlation between the OSLER and the OSCE. The first stage was highly predictive 
      of the results of the second stage. Savings facilitated by the sequential design 
      amounted to approximately GBP 30,000. CONCLUSIONS: The overall utility of 
      examinations involves compromise. The system described provides good perceived 
      validity with reasonably reliable scores; a sequential design can concentrate 
      resources where they are most needed and still allow wide sampling of tasks.
CI  - (c) Blackwell Publishing Ltd 2011.
FAU - Cookson, John
AU  - Cookson J
AD  - Hull York Medical School, Universities of York, Hull, UK. john.cookson@hyms.ac.uk
FAU - Crossley, Jim
AU  - Crossley J
FAU - Fagan, Gay
AU  - Fagan G
FAU - McKendree, Jean
AU  - McKendree J
FAU - Mohsen, Amr
AU  - Mohsen A
LA  - eng
PT  - Journal Article
PL  - England
TA  - Med Educ
JT  - Medical education
JID - 7605655
SB  - IM
CIN - Med Educ. 2011 Dec;45(12):1262. PMID: 22122429
MH  - Clinical Competence
MH  - Cost-Benefit Analysis
MH  - Education, Medical, Undergraduate/economics/*methods
MH  - Educational Measurement/economics/*methods
MH  - Feasibility Studies
MH  - Humans
MH  - Medical History Taking/standards
MH  - Patient Simulation
MH  - Physical Examination/standards
MH  - Reproducibility of Results
EDAT- 2011/06/09 06:00
MHDA- 2011/09/16 06:00
CRDT- 2011/06/09 06:00
PHST- 2011/06/09 06:00 [entrez]
PHST- 2011/06/09 06:00 [pubmed]
PHST- 2011/09/16 06:00 [medline]
AID - 10.1111/j.1365-2923.2010.03926.x [doi]
PST - ppublish
SO  - Med Educ. 2011 Jul;45(7):741-7. doi: 10.1111/j.1365-2923.2010.03926.x.