Bergus George R, Woodhead Jerold C, Kreiter Clarence D
Performance Based Assessment Program, Office of Student Affairs and Curriculum, The University of Iowa, Iowa City, IA, USA ; Department of Family Medicine, The University of Iowa, Iowa City, IA, USA ; Department of Psychiatry, The University of Iowa, Iowa City, IA, USA.
Adv Med Educ Pract. 2010 Nov 19;1:67-73. doi: 10.2147/AMEP.S12962. Print 2010.
The Objective Structured Clinical Examination (OSCE) is widely used to assess the clinical performance of medical students. However, concerns related to cost, availability, and validity, have led educators to investigate alternatives to the OSCE. Some alternatives involve assessing students while they provide care to patients - the mini-CEX (mini-Clinical Evaluation Exercise) and the Long Case are examples. We investigated the psychometrics of systematically observed clinical encounters (SOCEs), in which physicians are supplemented by lay trained observers, as a means of assessing the clinical performances of medical students.
During the pediatrics clerkship at the University of Iowa, trained lay observers assessed the communication skills of third-year medical students using a communication checklist while the students interviewed and examined pediatric patients. Students then verbally presented their findings to faculty, who assessed students' clinical skills using a standardized form. The reliability of the combined communication and clinical skills scores was calculated using generalizability theory.
Fifty-one medical students completed 199 observed patient encounters. The mean combined clinical and communication skills score (out of a maximum 45 points) was 40.8 (standard deviation 3.3). The calculated reliability of the SOCE scores, using generalizability theory, from 10 observed patient encounters was 0.81. Students reported receiving helpful feedback from faculty after 97% of their observed clinical encounters.
The SOCE can reliably assess the clinical performances of third-year medical students on their pediatrics clerkship. The SOCE is an attractive addition to the other methods utilizing real patient encounters for assessing the skills of learners.
客观结构化临床考试（OSCE）被广泛用于评估医学生的临床能力。然而，由于对成本、可用性和效度的担忧，教育工作者开始研究OSCE的替代方法。一些替代方法涉及在学生为患者提供护理时对其进行评估——例如迷你临床评估练习（mini-CEX）和长案例。我们研究了系统观察临床问诊（SOCEs）的心理测量学特性，即在医生的基础上增加经过培训的非专业观察者，以此作为评估医学生临床能力的一种手段。
在爱荷华大学儿科实习期间，经过培训的非专业观察者在三年级医学生问诊和检查儿科患者时，使用沟通检查表评估他们的沟通技巧。然后，学生向教员口头汇报他们的发现，教员使用标准化表格评估学生的临床技能。使用概化理论计算沟通和临床技能综合得分的可靠性。
51名医学生完成了199次观察到的患者问诊。临床和沟通技能综合平均得分（满分45分）为40.8分（标准差3.3）。使用概化理论，10次观察到的患者问诊的SOCE得分计算出的可靠性为0.81。97%的学生表示在观察到的临床问诊后收到了教员提供的有益反馈。
SOCE能够可靠地评估三年级医学生在儿科实习期间的临床能力。SOCE是利用真实患者问诊评估学习者技能的其他方法的一个有吸引力的补充。
