Department of Surgery, University of Illinois, Chicago, Illinois, USA.
J Surg Educ. 2009 Nov-Dec;66(6):344-51. doi: 10.1016/j.jsurg.2009.06.010.
Objective Structured Assessment of Technical Skills (OSATS) and Objective Structured Clinical Examinations (OSCE) are common tools used to objectively evaluate surgical residents. In 2005, our institution presented a novel hybrid OSATS/OSCE, which we renamed the Objective Structured Clinical Assessment (OSCA), encompassing all 6 core competencies regarding comprehensive care of the breast care patient. This study presents an analysis of the effects of a compulsory, comprehensive OSCA on our residents' competence in this index learning category.
Completed breast OSCA, Accreditation Council for Graduate Medical Education (ACGME) operative logs, and Report D of the American Board of Surgery in Training Examination (ABSITE) were collected for 24 senior-level residents. The OSCA was implemented for post graduate year (PGY)-3 residents in the 2003-2004 year. Data were also collected for an equal number of residents before the OSCA. Competence of residents was evaluated using the procedure-based OSCA that encompasses the 6 core competencies, completed for each resident by a specialty breast surgeon. Next, ACGME operative logs for graduating seniors were analyzed. Finally, breast care questions were identified from Report D. The number of residents scoring incorrectly on these questions was divided by the total number of resident-questions to yield a percent incorrect for each group. Similarly, the percent of total incorrect ABSITE examination questions was calculated, assessing overall group improvement.
All assigned residents achieved competence in all designated categories of the OSCA. Since the OSCA, the average number of breast cases in our program has risen from a mean of 102 cases to 124 cases per graduating senior. ABSITE data showed 264 resident-questions before the OSCA, with 26.5% incorrect responses. After OSCA, there were 252 resident-questions, with 18.25% incorrect. This represents a significant decrease (p < 0.05) of incorrect responses to breast questions on the ABSITE. Before the OSCA, there were 2139 total resident-questions with 25.28% wrong responses and after, there were 2111 resident-questions with 23.97% wrong responses, representing no significant difference (p > 0.05) in incorrect responses on the entire examination.
Our data show consistent competence of residents in breast disease as evaluated by the OSCA, an increase in numbers of breast cases, and a decrease in incorrect responses on breast-related ABSITE questions. We believe a comprehensive, complete care OSCA represents a valuable learning tool for residents to increase their competence and improve their outcomes in breast care. We believe that comprehensive OSCAs will be necessary tools to evaluate resident competence and should be implemented in all areas of general surgery.
客观结构化临床考试（OSCE）和客观结构化临床技能评估（OSATS）是用于客观评估外科住院医师的常用工具。2005 年，我们机构提出了一种新颖的混合 OSATS/OSCE，我们将其命名为客观结构化临床评估（OSCA），涵盖了全面护理乳房患者的所有 6 项核心能力。本研究分析了强制性综合 OSCA 对我们住院医师在该指标学习类别中的能力的影响。
收集了 24 名高级住院医师的完成乳房 OSCA、研究生医学教育认证委员会（ACGME）手术日志和美国外科医师学会住院医师培训考试报告 D（ABSITE）。2003-2004 年，为 PGY-3 住院医师实施 OSCA。还为实施 OSCA 之前的同等数量的住院医师收集了数据。通过由专业乳房外科医生为每位住院医师完成的基于程序的 OSCA 评估住院医师的能力。接下来，分析了即将毕业的高年级住院医师的 ACGME 手术日志。最后，从报告 D 中确定了乳房护理问题。将在这些问题上答错的住院医师人数除以住院医师问题的总数，得出每个组的错误百分比。同样，计算了 ABSITE 考试中总错误问题的百分比，以评估整个组的进步。
所有指定的住院医师在 OSCA 的所有指定类别中均达到了能力要求。自从实施 OSCA 以来，我们项目中的乳房手术数量从每位毕业高年级住院医师 102 例增加到 124 例。ABSITE 数据显示，在实施 OSCA 之前有 264 个住院医师问题，错误回答率为 26.5%。实施 OSCA 后，有 252 个住院医师问题，错误回答率为 18.25%。这代表 ABSITE 乳房问题的错误回答率显著下降（p < 0.05）。在实施 OSCA 之前，有 2139 个住院医师问题，错误回答率为 25.28%，之后有 2111 个住院医师问题，错误回答率为 23.97%，整个考试的错误回答率没有显著差异（p > 0.05）。
我们的数据表明，住院医师在乳房疾病方面的能力评估结果一致，通过 OSCA 评估，乳房疾病的数量增加，以及 ABSITE 乳房相关问题的错误回答率降低。我们认为，全面、完整的护理 OSCA 是住院医师提高能力和改善乳房护理结果的有价值的学习工具。我们相信，全面的 OSCE 将是评估住院医师能力的必要工具，应在普通外科的所有领域实施。
