Does quantity ensure quality? Standardized OSCE-stations for outcome-oriented evaluation of practical skills at different medical faculties

Background: Practical skills are often assessed using Objective Structured Clinical Skill Exams (OSCE). Nevertheless, in Germany, interchange and agreement between different medical faculties or a general agreement on the minimum standard for passing is lacking.

Methods: We developed standardized OSCE-stations for assessing structured clinical examination of knee and shoulder joint with identical checklists and evaluation standards. These were implemented into the OSCE-course at five different medical faculties. Learning objectives for passing the stations were agreed beforehand. At each faculty, one reference examiner scored independently of the local examiner. Outcome of the students at the standardized station was compared between faculties and correlated to their total outcome at the OSCE, to their results at the Part One of the National Medical Licensing Examination as a reference test during medical studies and to their previous amount of lessons in examining joints.

Results: Comparing the results of the reference examiner, outcome at the station differed significantly between some of the participating medical faculties. Depending on the faculty, mean total results at the knee-examination-station differed from 64.4% to 77.9% and at the shoulder-examination-station from 62.6% to 79.2%. Differences were seen in knowledge-based items and also in competencies like communication and professional manner. There was a weak correlation between outcome at the joint-examination-OSCE-station and Part One of the National Medical Licensing Examination, and a modest correlation between outcome at the joint-examination-station and total OSCE-result. Correlation to the previous amount of lessons in examining joint was also weak.

Conclusion: Although addressing approved learning objectives, different outcomes were achieved when testing a clinical skill at different medical faculties with a standardized OSCE-station. Results can be used as a tool for evaluating lessons, training and curricula at the different sites. Nevertheless, this study shows the importance of information exchange and agreement upon certain benchmarks and evaluation standards when assessing practical skills.