Berman Jessica R, Lazaro Deana, Fields Theodore, Bass Anne R, Weinstein Elena, Putterman Chaim, Dwyer Edward, Krasnokutsky Svetlana, Paget Stephen A, Pillinger Michael H
New York Hospital/The Hospital for Special Surgery, New York, NY, USA.
Arthritis Rheum. 2009 Dec 15;61(12):1686-93. doi: 10.1002/art.24738.
Traditional means of testing rheumatology fellows do not adequately assess some skills that are required to practice medicine well, such as humanistic qualities, communication skills, or professionalism. Institution of the New York City Rheumatology Objective Structured Clinical Examination (ROSCE) and our sequential 5 years of experience have provided us with a unique opportunity to assess its usefulness and objectivity as a rheumatology assessment tool.
Prior to taking the examination, all of the fellows were rated by their program directors. Fellows from the participating institutions then underwent a multistation patient-interactive examination observed and rated by patient actors and faculty raters. Assessments were recorded by all of the participants using separate but overlapping sets of instruments testing the Accreditation Council of Graduate Medical Education (ACGME) core competencies of patient care, interpersonal and communication skills, professionalism, and overall medical knowledge.
Although the program directors tended to rate their fellows more highly than the ROSCE raters, typically there was agreement between the program directors and the ROSCE faculty in distinguishing between the highest- and lowest- performing fellows. The ROSCE faculty and patient actor assessments of individual trainees were notable for a high degree of concordance, both quantitatively and qualitatively.
The ROSCE provides a unique opportunity to obtain a patient-centered assessment of fellows' ACGME-mandated competencies that traditional knowledge-based examinations, such as the rheumatology in-service examination, cannot measure. The ability of the ROSCE to provide a well-rounded and objective assessment suggests that it should be considered an important component of the rheumatology training director's toolbox.
传统的风湿病学专科培训学员考核方法无法充分评估一些良好行医所需的技能，如人文素质、沟通技巧或职业素养。纽约市风湿病学客观结构化临床考试（ROSCE）的设立以及我们连续5年的经验，为我们提供了一个独特的机会来评估其作为风湿病学评估工具的实用性和客观性。
在参加考试之前，所有学员均由其项目主任进行评分。来自参与机构的学员随后接受了多站式患者互动考试，由患者演员和教员评分员进行观察和评分。所有参与者使用单独但有重叠部分的工具记录评估结果，这些工具用于测试研究生医学教育认证委员会（ACGME）规定的患者护理、人际沟通技巧、职业素养和整体医学知识等核心能力。
尽管项目主任对其学员的评分往往高于ROSCE评分员，但通常项目主任和ROSCE教员在区分表现最佳和最差的学员方面意见一致。ROSCE教员和患者演员对个别学员的评估在数量和质量上都具有高度的一致性。
ROSCE提供了一个独特的机会，以患者为中心对学员的ACGME规定能力进行评估，而传统的基于知识测试，如风湿病学在职考试，则无法做到这一点。ROSCE能够提供全面且客观的评估，这表明它应被视为风湿病学培训主任工具箱中的重要组成部分。
