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      Clinical skills assessment: limitations to the introduction of an "OSCE" (Objective Structured Clinical Examination) in a traditional Brazilian medical school Translated title: Avaliação de habilidades clínicas: limitações à introdução de um exame clínico objetivo estruturado ("OSCE") em uma escola médica brasileira tradicional

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          Abstract

          CONTEXT: Assessment of clinical skills has a central role in medical education and the selection of suitable methods is highly relevant. The OSCE (Objective Structured Clinical Examination) is now established as one of the most valid, reliable and effective tests for the assessment of clinical skills. OBJECTIVE: To describe student and faculty perceptions of an OSCE introduced in a traditional Brazilian medical school. TYPE OF STUDY: Descriptive, semi-quantitative study. SETTING: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. PARTICIPANTS: 258 junior medical students finishing an introductory course on basic clinical skills and six faculty members deeply involved with the OSCE administration. PROCEDURES: Over a period of three consecutive years, student perceptions on the examination were evaluated using a structured questionnaire containing several five-point scales; faculty members' opinions were collected using a structured questionnaire plus a personal interview. MAIN MEASUREMENTS: Student satisfaction or dissatisfaction with aspects of OSCE administration and positive or negative opinions from faculty members. RESULTS: Students were comfortable with cases and tasks, but nearly half (48%) of them criticized organizational aspects of the OSCE. Substantial proportions of students reported difficulties with both time management (70%) and stress control (70%). Improvement of several aspects of exams reduced criticism of organization to a minority (5%) of students, but the proportions of students reporting difficulties with time management (40%) and stress control (75%) during the exam remained virtually unchanged. Faculty members acknowledged the accuracy of the OSCE, but criticized its limitations for assessing the integrated approach to patients and complained that the examination was remarkably time and effort-consuming. The educational impact of the OSCE was felt to be limited, since other faculty members did not respond to the communication of exam results. CONCLUSIONS: In addition to shortage of resources and organizational difficulties, local cultural aspects and the absence of a more favorable educational climate may hinder lasting improvements in assessment methods in traditional medical schools.

          Translated abstract

          CONTEXTO: A avaliação das habilidades clínicas tem um papel central na educação médica, sendo importante o uso de métodos apropriados para esta finalidade. O exame clínico objetivo estruturado ("OSCE") constitui um dos mais válidos, fidedignos e efetivos meios de avaliação de habilidades clínicas. OBJETIVOS: Descrever as percepções de estudantes e professores frente à introdução de um exame "OSCE" em uma escola médica tradicional. TIPO DE ESTUDO: Estudo descritivo, semiquantitativo. LOCAL: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. PARTICIPANTES: Um total de 258 estudantes de Medicina que terminaram um curso sobre habilidades clínicas básicas e seis professores que se envolveram na administração da "OSCE". PROCEDIMENTOS: Aplicou-se aos estudantes um questionário estruturado para a medida da sua percepção sobre vários aspectos do exame. As opiniões dos professores foram colhidas com outro questionário, cuja aplicação foi seguida por uma entrevista pessoal. PRINCIPAIS MEDIDAS: Percentuais de estudantes satisfeitos ou insatisfeitos com os vários aspectos do exame e opiniões globais positivas ou negativas dos professores sobre a avaliação. RESULTADOS: Os estudantes mostraram-se satisfeitos com os casos e as tarefas clínicas solicitadas, mas 48% deles criticaram aspectos organizacionais do exame. Proporções substanciais dos estudantes relataram dificuldades em controlar o tempo (70%) e o estresse emocional (70%) durante o exame. O aperfeiçoamento de vários aspectos do exame associou-se à redução do percentual de estudantes insatisfeitos com a sua organização (5%), mas as proporções de estudantes relatando dificuldades com o controle do tempo (40%) e do estresse (75%) permaneceram inalteradas. Os professores reconheceram a acurácia do exame, mas criticaram a sua limitação em prover avaliação mais integral da abordagem do paciente. Houve, também, queixas de que o exame era consideravelmente dispendioso em termos do tempo e do esforço necessários para a sua aplicação. O impacto educacional do exame foi percebido como sendo limitado, visto que outros professores, não diretamente envolvidos com a sua administração, não mostraram interesse em discutir os seus resultados. CONCLUSÕES: Junto com a falta de recursos e a complexidade organizacional, particularidades de ordem cultural e a ausência de um ambiente educacional mais favorável podem dificultar o aperfeiçoamento dos métodos de avaliação nas escolas médicas tradicionais.

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          Most cited references32

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          Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina

          AM Roquete (2001)
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            Skill based assessment.

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              Assessing clinical competence at the undergraduate level.

              D Newble (1992)
              This booklet aims to provide relevant background information and guidelines for medical school teachers in clinical departments charged with assessing the clinical competence of undergraduate students. It starts by emphasizing the difference between clinical competence and clinical performance. An approach to defining what should be assessed is outlined. The technical considerations of validity, reliability and practicability are discussed with reference to the ward- or practice-based setting and to the examination setting. The various methods available to assess aspects of competence are described and their strengths and weaknesses reviewed. The paper concludes with a discussion of the important issues of scoring and standard setting. The conclusion is reached that the quality of many current assessments could be improved. To do so will require a multi-format approach using both the practice and examination settings. Some of the traditional methods will have to be abandoned or modified and new methods introduced.
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                Author and article information

                Contributors
                Role: ND
                Journal
                spmj
                Sao Paulo Medical Journal
                Sao Paulo Med. J.
                Associação Paulista de Medicina - APM (São Paulo )
                1806-9460
                February 2004
                : 122
                : 1
                : 12-17
                Affiliations
                [1 ] Universidade de São Paulo Brazil
                Article
                S1516-31802004000100004
                10.1590/S1516-31802004000100004
                43b396fb-ec1d-4303-af47-c8b5e72bc1c1

                http://creativecommons.org/licenses/by/4.0/

                Product
                Product Information: website
                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1516-3180&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Assessment,Clinical skills,University hospitals,Medical students,Undergraduate medical education,Estudantes de Medicina,Educação médica,Avaliação educacional,Ensino,Medicina,Faculdades de Medicina

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