The University of Buckingham Medical School, Hunter Street, Buckingham, MK18 1EG, UK.
University of Nottingham, Nottingham, UK.
BMC Med Educ. 2021 Apr 10;21(1):204. doi: 10.1186/s12909-021-02650-7.
Medical students often struggle to understand the relevance of Evidence Based Medicine (EBM) to their clinical practice, yet it is a competence that all students must develop prior to graduation. Objective structured clinical examinations (OSCEs) are a valued assessment tool to assess critical components of EBM competency, particularly different levels of mastery as they progress through the course. This study developed and evaluated EBM based OSCE stations with an aim to establish a spiral approach for EBM OSCE stations for undergraduate medical students.
OSCE stations were developed with increasingly complex EBM tasks. OSCE stations were classified according to the classification rubric for EBP assessment tools (CREATE) framework and mapped against the recently published core competencies for evidence-based practice (EBP). Performance data evaluation was undertaken using Classical Test Theory analysing mean scores, pass rates, and station item total correlation (ITC) using SPSS.
Six EBM based OSCE stations assessing various stages of EBM were created for use in high stakes summative OSCEs for different year groups across the undergraduate medical degree. All OSCE stations, except for one, had excellent correlation coefficients and hence a high reliability, ranging from 0.21-0.49. The domain mean score ranged from 13.33 to 16.83 out of 20. High reliability was demonstrated for the each of the summative OSCE circuits (Cronbach's alpha = 0.67-0.85). In the CREATE framework these stations assessed knowledge, skills, and behaviour of medical students in asking, searching, appraising, and integrating evidence in practice. The OSCE stations were useful in assessing six core evidence-based practice competencies, which are meant to be practiced with exercises. A spiral model of OSCEs of increasing complexity was proposed to assess EBM competency as students progressed through the MBChB course.
The use of the OSCEs is a feasible method of authentically assessing leaner EBM performance and behaviour in a high stakes assessment setting. Use of valid and reliable EBM-based OSCE stations provide evidence for continued development of a hierarchy of assessing scaffolded learning and mastery of EBM competency. Further work is needed to assess their predictive validity.
医学生在理解循证医学（EBM）与临床实践的相关性方面经常感到困难，但这是所有学生在毕业前都必须发展的能力。客观结构化临床考试（OSCE）是评估 EBM 能力关键组成部分的有价值的评估工具，特别是在课程中进展时不同层次的掌握程度。本研究开发并评估了基于 EBM 的 OSCE 站，旨在为本科生建立一个 EBM OSCE 站的螺旋式方法。
使用越来越复杂的 EBM 任务开发 OSCE 站。根据 EBP 评估工具的分类量表（CREATE）框架对 OSCE 站进行分类，并将其映射到最近发布的循证实践核心能力（EBP）上。使用 SPSS 通过经典测试理论分析均值、通过率和站项目总相关（ITC）来评估表现数据。
为不同本科医学学位年级的高风险总结性 OSCE 开发了六个评估 EBM 各个阶段的基于 EBM 的 OSCE 站。除了一个站之外，所有 OSCE 站的相关系数都非常好，因此可靠性很高，范围从 0.21 到 0.49。在 20 分制中，域平均得分范围从 13.33 到 16.83。每个总结性 OSCE 电路的可靠性都很高（Cronbach's alpha = 0.67-0.85）。在 CREATE 框架中，这些站评估了医学生在实践中提出、搜索、评估和整合证据的知识、技能和行为。OSCE 站在评估六个核心循证实践能力方面非常有用，这些能力旨在通过练习来实践。提出了一个 OSCE 螺旋模型，随着学生在 MBChB 课程中的进展，该模型将评估 EBM 能力。
OSCE 的使用是在高风险评估环境中真实评估学习者 EBM 表现和行为的可行方法。使用有效和可靠的基于 EBM 的 OSCE 站为继续评估分层学习和 EBM 能力掌握提供了证据。需要进一步的工作来评估其预测效度。
