Sequential testing in a high stakes OSCE: Determining number of screening tests
Sequential testing in a high stakes OSCE: Determining number of screening tests
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DOI：
10.3109/0142159x.2015.1079309
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发表时间：
2016-07-01
期刊：
影响因子：
4.7
通讯作者：
Cleland, Jennifer
中科院分区：
文献类型：
--
作者：
Currie, Graeme P.;Sivasubramaniam, Selvaraj;Cleland, Jennifer
目的：顺序客观结构化临床考试（OSCE）是传统OSCE的独立变体，所有学生都参加筛选测试。那些通过初步评估的学生将不再接受进一步的测试，而表现较差的学生将参加额外的（顺序）测试，以确定他们的总体合格/不合格状态。我们的目的是确定采用顺序欧安组织方法使用不同数量的筛选站和及格分数的结果。方法：我们对阿伯丁大学医学院两组学生OSCE期末考试结果的匿名数据库进行了回顾性观察性研究。对2013-2014年参加考试的学生（n=388）进行数据访问。我们使用Stata模拟程序来比较结果-在敏感性和特异性方面-在5000个随机选择的6-14个欧安组织站点中使用随机选择的100组学生（具有不同的筛选测试通过分数）与在15个站点中获得的结果。结果：在6-14个站点中，2013年敏感性为87%，2014年为84%，特异性为60% - 100%。特异性通常随着筛查站数量的增加而增加（95%置信区间随之缩小），而敏感性在84%至98%之间变化。筛选合格分数为+1，+2和+3的测量标准误差（SEM），发现相似的灵敏度和特异性。就高灵敏度（88-89%）和特异性（83-86%）而言，8个站点作为筛选试验似乎是一个合理的折衷方案。结论：本研究扩展了当前连续的欧安组织文献，使用一种新颖而稳健的方法来确定筛选站数量和通过标记方面的理想。我们讨论了我们的研究结果对教育和资源的影响，并就在医学教育中使用连续的欧安组织提出建议。
Objective: The sequential objective structured clinical exam (OSCE) is a stand-alone variation of the traditional OSCE whereby all students sit a screening test. Those who pass this initial assessment undergo no further testing while weakly performing students sit an additional (sequential) test to determine their overall pass/fail status. Our aim was to determine outcomes of adopting a sequential OSCE approach using different numbers of screening stations and pass marks.Method: We carried out a retrospective, observational study of anonymised databases of two cohorts of student outcomes from the final OSCE examination at the University of Aberdeen Medical School. Data were accessed for students (n=388) who sat the exam in the years 2013-2014. We used Stata simulate program to compare outcomes - in terms of sensitivity and specificity - across 5000 random selections of 6-14 OSCE stations using random selections of groups of 100 students (with different screening test pass marks) versus those obtained across 15 stations.Results: Across 6-14 stations, the sensitivity was 87% in 2013 and 84% in 2014 while the specificity ranged from 60% to 100% in both years. Specificity generally increased as the number of screening stations increased (with concomitant narrowing of the 95% confidence interval), while sensitivity varied between 84 and 98%. Similar sensitivities and specificities were found with screening pass marks of +1, +2 and +3 standard errors of measurement (SEM). Eight stations as a screening test appeared to be a reasonable compromise in terms of high sensitivity (88-89%) and specificity (83-86%).Conclusion: This research extends current sequential OSCE literature using a novel and robust approach to identify the ideal in terms of number of screening stations and pass mark. We discuss the educational and resource implications of our findings and make recommendations for the use of the sequential OSCE in medical education.