Morag E, Lieberman G, Volkan K, Shaffer K, Novelline R, Lang E V
Harvard Medical School and the Department of Radiology at the Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Acad Radiol. 2001 Jan;8(1):74-81. doi: 10.1016/S1076-6332(03)80746-8.
Traditional oral and written examinations can be limited in predicting future clinical performance. Therefore Objective Structured Clinical Examinations (OSCEs) have been introduced in other specialties. The authors assessed their value in radiology.
The study includes 122 Harvard medical students who undertook 1-month compulsory clerkships at one of three hospitals (A, B, or C) in their 3rd and 4th year and a compulsory OSCE in their 4th year. The OSCE was constructed from five cases. Each had eight or nine standardized questions designed to test, within a set time, the perception of essential findings, their interpretation, and clinical judgment (maximum possible score, 100). Clerkship grades were high honors (score of 3), honors (score of 2), satisfactory (score of 1), and fail (score of 0). Predictors of OSCE scores-clerkship grade and affiliated hospital-were modeled as linear functions. Time elapsed between clerkship and OSCE was modeled as a nonlinear function.
Although there was a positive relation between clerkship grade and OSCE grade, it accounted for an increase of only 5.7% in OSCE score per clerkship grade and did not predict performance of individual students. Students who trained in hospital B showed significantly higher OSCE grades. OSCE scores were highest when the examination was taken 8 months after the clerkship.
The OSCE may be useful to uncover deficits in individuals and groups beyond the ones detected with traditional clerkship evaluations and provide guidance for remediation. The improved performance after additional clinical exposure suggests that the OSCE may be well suited to test the integration of radiologic and clinical knowledge.
传统的口试和笔试在预测未来临床能力方面可能存在局限性。因此，其他专业引入了客观结构化临床考试（OSCE）。作者评估了其在放射学中的价值。
该研究纳入了122名哈佛医学院学生，他们在三、四年级时在三家医院（A、B或C）之一进行为期1个月的强制实习，并在四年级时参加一次强制OSCE。OSCE由五个病例组成。每个病例有八到九个标准化问题，旨在在规定时间内测试对关键发现的识别、解读以及临床判断（最高可能得分100分）。实习成绩分为优秀（得分3）、良好（得分2）、满意（得分1）和不及格（得分0）。将OSCE成绩的预测因素——实习成绩和附属医院——建模为线性函数。将实习与OSCE之间的时间间隔建模为非线性函数。
虽然实习成绩与OSCE成绩之间存在正相关关系，但每个实习成绩等级仅使OSCE得分提高5.7%，且无法预测个体学生的表现。在医院B接受培训的学生OSCE成绩显著更高。在实习8个月后参加考试时，OSCE得分最高。
OSCE可能有助于发现传统实习评估未检测到的个人和群体的不足之处，并为补救提供指导。额外临床接触后表现的改善表明，OSCE可能非常适合测试放射学知识与临床知识的整合。
