Berkenstadt Haim, Ziv Amitai, Gafni Naomi, Sidi Avner
The Israeli Board Examination Committee in Anesthesiology, The Israel Center for Medical Simulation (MSR), Sheba Medical Center, Tel Hashomer, Israel.
Anesth Analg. 2006 Mar;102(3):853-8. doi: 10.1213/01.ane.0000194934.34552.ab.
We describe the unique process whereby simulation-based, objective structured clinical evaluation (OSCE) has been incorporated into the Israeli board examination in anesthesiology. Development of the examination included three steps: a) definition of clinical conditions that residents are required to handle competently, b) definition of tasks pertaining to each of the conditions, and c) incorporation of the tasks into hands-on simulation-based examination stations in the OSCE format, including 1) trauma management, 2) resuscitation, 3) crisis management in the operating room, 4) regional anesthesia, and 5) mechanical ventilation. Members of the Israeli Board of Anesthesiology Examination Committee assisted by experts from the Israel Center for Medical Simulation and from Israel's National Institute for Testing and Evaluation were involved in this process and in the development of the assessment tools, orientation of examinees, and preparation of examiners. The examination has been administered 4 times in the past 2 yr to 104 examinees and has gradually progressed from being a minor part of the oral board examination to a prerequisite component of this test. The pass rate ranged from 70% in resuscitation to 91% in regional anesthesia. The mean inter-rater correlations for all the checklist items, for the score based on the critical checklist items only, and for the general rating were 0.89, 0.86, and 0.76, respectively. The overall Kappa coefficients (the inter-rater agreement coefficient) for the total score and the critical checklist items were 0.71 and 0.76, respectively. The correlation between the total score and the general score was 0.76. According to a subjective feedback questionnaire, most (70%-90%) participants found the difficulty level of the examination stations reasonable to very easy and prefer this method of examination to a conventional oral examination. The incorporation of OSCE-driven modalities in the certification of anesthesiologists in Israel is a continuing process of evaluation and assessment.
我们描述了一种独特的过程，即基于模拟的客观结构化临床评估（OSCE）已被纳入以色列麻醉学委员会考试。考试的开发包括三个步骤：a）定义住院医师需要熟练处理的临床情况；b）定义与每种情况相关的任务；c）将任务纳入基于模拟操作的OSCE形式的考试站，包括1）创伤管理，2）复苏，3）手术室危机管理，4）区域麻醉，以及5）机械通气。以色列麻醉学委员会考试委员会的成员在以色列医学模拟中心和以色列国家测试与评估研究所的专家协助下，参与了这一过程以及评估工具的开发、考生指导和考官准备工作。在过去两年中，该考试已对104名考生进行了4次，并且已逐渐从口试的一小部分发展成为该测试的必备组成部分。通过率从复苏部分的70%到区域麻醉部分的91%不等。所有检查表项目、仅基于关键检查表项目的得分以及总体评分的平均评分者间相关性分别为0.89、0.86和0.76。总分和关键检查表项目的总体Kappa系数（评分者间一致性系数）分别为0.71和0.76。总分与总体得分之间的相关性为0.76。根据一份主观反馈问卷，大多数（70%-90%）参与者认为考试站的难度水平合理至非常容易，并且比起传统口试更喜欢这种考试方式。在以色列麻醉医师认证中纳入OSCE驱动的模式是一个持续的评估过程。
