Carpenter J L
University of Texas Southwestern Medical Center at Dallas Southwestern Medical School 75235-9065, USA.
Acad Med. 1995 Sep;70(9):828-33.
The costs of objective structured clinical examinations (OSCEs) and other patient-centered examinations have not been well established. The published literature contains cost estimates ranging from $21 to over $1,000 per examinee. This wide range in cost estimates is due in part to both a lack of a consistent definition as to what should be included as an expense and a lack of understanding of how these expenses can be minimized.
In 1993-94 the authors conducted a literature review and defined and subcategorized costs related to the production and implementation of an OSCE into costs for personnel, standardized patients (SPs), and administration. An analysis was undertaken of how each of the subcategory costs can be minimized.
Costs for physicians, patient trainers, support personnel, and data analysis are negligible if the personnel who perform these duties do so as part of their overall academic responsibilities. Costs for SPs can be minimized by developing a cadre of experienced patients as well as professional personnel who participate in a comprehensive program in which SPs are used in both teaching and evaluative modes. This contributes to the development of a psychometrically valid OSCE with a minimum number of stations and decreased costs. Administrative costs are fixed and not amenable to significant cost saving. A detailed cost analysis of a comprehensive OSCE given at the end of an Introduction to Clinical Medicine course at one institution is presented, illustrating the practical aspects of these cost-containment methods.
Based on these considerations it appears financially feasible for an individual academic institution to develop and implement an OSCE.
客观结构化临床考试（OSCE）及其他以患者为中心的考试成本尚未明确界定。已发表的文献中，每位考生的成本估算从21美元到超过1000美元不等。成本估算范围如此之广，部分原因在于对于哪些应计入费用缺乏一致的定义，以及对如何将这些费用降至最低缺乏了解。
1993 - 1994年，作者进行了文献综述，并将与OSCE的编制和实施相关的成本进行定义和细分，分为人员成本、标准化病人（SP）成本和管理成本。分析了如何将每个子类别成本降至最低。
如果履行这些职责的人员将其作为整体学术职责的一部分来进行，那么医生、患者培训师、支持人员和数据分析的成本可以忽略不计。通过培养一批经验丰富的患者以及参与综合项目的专业人员（在该项目中，标准化病人同时用于教学和评估模式），可以将标准化病人的成本降至最低。这有助于开发一个心理测量有效的OSCE，减少站点数量并降低成本。管理成本是固定的，无法大幅节省。文中给出了一所机构在临床医学导论课程结束时进行的一次综合OSCE的详细成本分析，说明了这些成本控制方法的实际应用。
基于这些考虑，单个学术机构开发和实施OSCE在财务上似乎是可行的。
