Chenot Jean-François, Simmenroth-Nayda Anne, Koch Alexandra, Fischer Thomas, Scherer Martin, Emmert Birgit, Stanske Beate, Kochen Michael M, Himmel Wolfgang
Department of General Practice, University of Göttingen, Göttingen, Germany.
Med Educ. 2007 Nov;41(11):1032-8. doi: 10.1111/j.1365-2923.2007.02895.x.
The dissemination of objective structured clinical examinations (OSCEs) is hampered by requirements for high levels of staffing and a significantly higher workload compared with multiple-choice examinations. Senior medical students may be able to support faculty staff to assess their peers. The aim of this study is to assess the reliability of student tutors as OSCE examiners and their acceptance by their peers.
Using a checklist and a global rating, teaching doctors (TDs) and student tutors (STs) simultaneously assessed students in basic clinical skills at 4 OSCE stations. The inter-rater agreement between TDs and STs was calculated by kappa values and paired t-tests. Students then completed a questionnaire to assess their acceptance of student peer examiners.
All 214 Year 3 students at the University of Göttingen Medical School were evaluated in spring 2005. Student tutors gave slightly better average grades than TDs (differences of 0.02-0.20 on a 5-point Likert scale). Inter-rater agreement at the stations ranged from 0.41 to 0.64 for checklist assessment and global ratings; overall inter-rater agreement on the final grade was 0.66. Most students felt that assessment by STs would result in the same grades as assessment by TDs (64%) and that it would be similarly objective (69%). Nearly all students (95%) felt confident that they could evaluate their peers themselves in an OSCE.
On the basis of our results, STs can act as examiners in summative OSCEs to assess basic medical skills. The slightly better grades observed are of no practical concern. Students accepted assessment performed by STs.
与多项选择题考试相比，客观结构化临床考试（OSCE）因对高水平人员配备的要求以及显著更高的工作量而受到阻碍。高年级医学生或许能够协助教师评估他们的同龄人。本研究的目的是评估学生导师作为OSCE考官的可靠性以及他们被同龄人接受的程度。
使用一份检查表和整体评分，教学医生（TDs）和学生导师（STs）在4个OSCE站点同时对学生的基本临床技能进行评估。通过kappa值和配对t检验计算TDs和STs之间的评分者间一致性。然后学生完成一份问卷以评估他们对学生同伴考官的接受程度。
2005年春季，哥廷根大学医学院的所有214名三年级学生都接受了评估。学生导师给出的平均成绩略高于教学医生（在5分量表上相差0.02 - 0.20）。各站点检查表评估和整体评分的评分者间一致性范围为0.41至0.64；最终成绩的总体评分者间一致性为0.66。大多数学生认为由学生导师进行评估会得到与教学医生评估相同的成绩（64%），并且认为其客观性相当（69%）。几乎所有学生（95%）都相信他们自己能够在OSCE中评估同龄人。
基于我们的结果，学生导师可以在总结性OSCE中担任考官来评估基本医学技能。观察到的略高成绩并无实际影响。学生接受由学生导师进行的评估。
