Use of objective structured clinical examinations (OSCEs) in training and evaluating community health aides.

Community Health Aides (CHAs) provide village-based health services throughout Alaska. The Objective Structured Clinical Examination (OSCE) was developed approximately 20 years ago in Scotland in an effort to make exams more valid, reliable, and practical. OSCEs have been used by medical schools to assess more objectively a variety of clinical skills; this structured examination format is being used during the four four-week basic training sessions for CHAs to assess clinical competency in both common problem and critical skills. The OSCE consists of multiple-timed stations where each CHA is presented with the same situation and evaluated using a check list of predetermined detailed evaluation criteria. In the regular clinical setting CHAs demonstrate skills managing a variety of medical problems; the OSCE setting presents each examinee with an identical, controlled, simulated situation in which only particular skills are evaluated. The testing stations are designed to evaluate a variety of clinical skills: history-taking, physical exam, making assessments, developing plans, using the CHA manual, documentation, reporting, laboratory and procedure techniques, and emergency skills.