Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Teach Learn Med. 2020 Jun-Jul;32(3):294-307. doi: 10.1080/10401334.2019.1704763. Epub 2020 Mar 6.
: The construct addressed in this study is assessment of advanced communication skills among senior medical students. : The question of who should assess participants during objective structured clinical examinations (OSCEs) has been debated, and options discussed in the literature have included peer, self, standardized patient, and faculty assessment models. What is not known is whether same-level peer assisted learning can be utilized for formative assessment of advanced communication skills when no faculty, standardized patients, or other trained assessors are involved in providing feedback. If successful, such an educational model would optimize resource utilization and broaden the scope of topics that could be covered in formative OSCEs. : The investigators developed a 4-station formative OSCE focused on advanced communication skills for senior medical students, and evaluated the concordance of assessment done by same-level peers, self, standardized patients, and faculty for 45 students. After each station, examinees completed a self-assessment checklist and received checklist-based assessment and verbal feedback from same-level peers only. Standardized patients completed checklist-based assessments outside the room, and faculty did so after the OSCE via video review; neither group provided direct feedback to examinees. The investigators assessed inter-rater agreement and mean difference scores on the checklists using faculty score as the gold standard. : There was fair to good overall agreement among self, same-level peer, standardized patient, and faculty-assessment of advanced communication skills. Relative to faculty, peer and standardized patient assessors overestimated advanced communication skills, while self-assessments underestimated skills. : Self and same-level peer-assessment may be a viable alternative to faculty assessment for a formative OSCE on advanced communication skills for senior medical students.
本研究探讨的是评估高年级医学生高级沟通技巧的方法。在客观结构化临床考试（OSCE）中，应该由谁来评估参与者一直是一个争论的问题，文献中讨论的选项包括同伴、自我、标准化患者和教师评估模型。目前还不清楚的是，在没有教师、标准化患者或其他经过培训的评估员参与提供反馈的情况下，同级协助学习是否可以用于高级沟通技巧的形成性评估。如果成功，这种教育模式将优化资源利用，并拓宽形成性 OSCE 中涵盖的主题范围。
研究人员开发了一个针对高年级医学生高级沟通技巧的 4 站形成性 OSCE，并评估了 45 名学生的同级、自我、标准化患者和教师评估的一致性。在每个站后，考生完成自我评估检查表，并仅从同级获得基于检查表的评估和口头反馈。标准化患者在房间外完成基于检查表的评估，教师则在 OSCE 后通过视频审查完成评估；两组均不向考生提供直接反馈。研究人员使用教师评分作为金标准，评估检查表上的评分者间一致性和平均差异分数。
自我、同级同伴、标准化患者和教师对高级沟通技巧的评估总体上具有良好的一致性。与教师相比，同伴和标准化患者评估者高估了高级沟通技巧，而自我评估则低估了技能。
自我和同级同伴评估可能是高级医学生形成性 OSCE 中教师评估的可行替代方法。
