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推进拉丁美洲临床能力评估:对资源有限环境下客观结构化临床考试(OSCE)实施情况及挑战的范围综述

Advancing the assessment of clinical competence in Latin America: a scoping review of OSCE implementation and challenges in resource-limited settings.

作者信息

Armijo-Rivera Soledad, Fuenzalida-Muñoz Brenda, Vicencio-Clarke Scarlett, Elbers-Arce Alexandra, Bozzo-Navarrete Sergio, Kunakov Natasha, Miranda-Hurtado Cesar, Shibao-Miyasato Hector, Sanhueza Jacqueline, Cornejo Carla, Soublette Alix, Sandoval Ana María, Casas-Bueno Fresia Cicibel, Delgado Ximena

机构信息

Facultad de Medicina, Universidad del Desarrollo, Las Condes, Chile.

Unidad de Simulación e Innovación en Salud, Universidad San Sebastián, Los Ríos, Chile.

出版信息

BMC Med Educ. 2025 Apr 21;25(1):587. doi: 10.1186/s12909-025-07151-5.

Abstract

BACKGROUND

Objective Structured Clinical Examination (OSCE) is important to assess clinical competencies in health professions. However, in Latin America, a region with limited resources, the implementation and quality of OSCEs remain underexplored despite their increasing use. This study analyses how the OSCE has been applied and how its quality has evolved in Latin America.

METHODS

A scoping review methodology was used, including a search across PubMed, Scopus, WOS, LILACS and Scielo, including studies on the implementation of OSCE in Latin America, written in English, French, Portuguese, or Spanish. Their quality was assessed using the AMEE guidelines 81 and 49 criteria and MMERSQI. Data were extracted regarding OSCE structure, evaluator training, validity, reliability, and the use of simulated patients.

RESULTS

365 articles were obtained, of which 69 met the inclusion criteria. The first report on OSCE implementation in the region dates back to 2000. Three countries accounted for 84.06% of the reports (Chile, Mexico, Brazil). 68.12% was applied in undergraduate programs. In this group, the implementation was mainly in Medicine (69.57%), with lesser use in physiotherapy (7.95%) and nursing (2.9%). The number of stations and duration of each varied, with 18-station circuits being the most common. Evidence of validity and reliability of the OSCE was reported in 26.09%, feedback to students in 33,33%, and simulated patient training in 37.68% of the reports. A notable trend in the quinquennial analysis is the increased use of high-fidelity simulations and the shift towards remote OSCEs during the pandemic. The inclusion of inactive stations, inadequate training for simulated patients, and the absence of evidence supporting instrument validation are recurrently reported challenges in OSCE studies. The overall methodological quality has improved, as evidenced by OSCE Committee and Blueprint in nearly 50% of the studies and rising MMERSQI scores, especially in recent years.

CONCLUSION

While there has been progress in OSCE implementation, particularly in medical education, gaps remain in standardization, validation, training, and resource allocation. Further efforts are needed to ensure consistent quality, particularly in training simulated patients, addressing inactive stations, and ensuring instrument reliability. Addressing these gaps is crucial for enhancing the effectiveness of OSCEs in resource-limited settings and advancing health professional education across the region.

摘要

背景

客观结构化临床考试(OSCE)对于评估卫生专业人员的临床能力至关重要。然而,在资源有限的拉丁美洲地区,尽管OSCE的使用越来越多,但其实施情况和质量仍未得到充分探索。本研究分析了OSCE在拉丁美洲的应用方式及其质量的演变情况。

方法

采用了范围综述方法,包括在PubMed、Scopus、WOS、LILACS和Scielo上进行检索,纳入以英语、法语、葡萄牙语或西班牙语撰写的关于拉丁美洲OSCE实施情况的研究。使用AMEE指南81和49标准以及MMERSQI对其质量进行评估。提取了有关OSCE结构、评估人员培训、有效性、可靠性以及模拟患者使用情况的数据。

结果

共获得365篇文章,其中69篇符合纳入标准。该地区关于OSCE实施的第一份报告可追溯到2000年。三个国家占报告的84.06%(智利、墨西哥、巴西)。68.12%应用于本科课程。在这一组中,主要应用于医学专业(69.57%),物理治疗专业(7.95%)和护理专业的应用较少(2.9%)。站点数量和每个站点的时长各不相同,18个站点的考试流程最为常见。26.09%的报告中提到了OSCE有效性和可靠性的证据,33.33%的报告提到了对学生的反馈,37.68%的报告提到了模拟患者培训。五年期分析中的一个显著趋势是高保真模拟的使用增加,以及在疫情期间向远程OSCE的转变。OSCE研究中反复报告的挑战包括设置无效站点、对模拟患者培训不足以及缺乏支持工具验证的证据。总体方法质量有所提高,近50%的研究中有OSCE委员会和蓝图的相关内容,且MMERSQI分数不断上升,尤其是近年来。

结论

虽然OSCE实施方面取得了进展,特别是在医学教育方面,但在标准化、验证、培训和资源分配方面仍存在差距。需要进一步努力确保质量的一致性,特别是在培训模拟患者、解决无效站点以及确保工具可靠性方面。解决这些差距对于提高OSCE在资源有限环境中的有效性以及推动该地区卫生专业教育至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e08/12013031/25842a03a71d/12909_2025_7151_Fig1_HTML.jpg

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