Reece Ashley, Chung Eddie M K, Gardiner R Mark, Williams Sian E
Department of Paediatrics, Watford General Hospital, Watford, UK.
Med Educ. 2008 Jun;42(6):600-6. doi: 10.1111/j.1365-2923.2008.03021.x.
Following a 15-week attachment in paediatrics and child health, general practice and dermatology medical students in their second clinical year at this medical school undertake a high-stakes assessment including an objective structured clinical examination (OSCE). There were 2 hypotheses. Firstly, groups of similar stations map to competency domains identifiable by factor analysis. Secondly, poor performance in individual domains is compensated for by achieving the required standard of performance across the whole assessment.
A total of 647 medical students were assessed by an OSCE during 5 individual examination sittings (diets) over 2 years. Ten scoring stations in the OSCE were analysed and confirmatory factor analysis performed comparing a 1-factor model (where all the stations are discrete entities related to one underlying domain) with a 3-factor model (where the stations load onto 3 domains from a previously reported exploratory factor analysis).
The 3-factor model yielded a significantly better fit to the data (chi(2 )=( )15.3, P < 0.01). Assessing the compensation data of 1 diet, 29 of 127 students failed in 1 or more domains described, whereas only 5 failed if compensation was allowed across all domains.
Confirmatory factor analysis showed a significant fit of the data to previously described competency domains for a high-stakes undergraduate OSCE. Compensation within but not between competency domains would provide a more robust standard, improve validity, and substantially reduce the pass rate.
在这所医学院校，儿科与儿童健康、全科医学及皮肤病学专业的二年级临床医学生在经历为期15周的实习后，要参加一项高风险评估，其中包括客观结构化临床考试（OSCE）。有两个假设。其一，相似站点组对应于通过因素分析可识别的能力领域。其二，在整个评估中达到所需表现标准可弥补个别领域的表现不佳。
在两年内的5次单独考试场次（考试时段）中，共有647名医学生接受了OSCE评估。对OSCE中的10个评分站点进行分析，并进行验证性因素分析，将单因素模型（所有站点都是与一个潜在领域相关的离散实体）与三因素模型（站点从先前报告的探索性因素分析中加载到3个领域）进行比较。
三因素模型对数据的拟合度显著更好（卡方值=15.3，P<0.01）。评估一次考试时段的补偿数据，127名学生中有29名在所述的1个或多个领域不及格，而如果允许在所有领域进行补偿，只有5名学生不及格。
验证性因素分析表明，对于高风险的本科OSCE，数据与先前描述的能力领域有显著拟合。能力领域内而非能力领域间的补偿将提供更可靠的标准，提高效度，并大幅降低通过率。
