Singer P A, Cohen R, Robb A, Rothman A
Department of Medicine, University of Toronto, Ontario, Canada.
J Gen Intern Med. 1993 Jan;8(1):23-8. doi: 10.1007/BF02600289.
To develop objective structured clinical examination (OSCE) stations to assess the ability of physicians to address selected clinical-ethical situations, and to evaluate inter-rater agreement in these stations.
Two ten-minute OSCE stations were developed using video-taped encounters between attending physicians and standardized patients. One scenario involved a daughter requesting a do-not-resuscitate (DNR) order for her competent mother without the mother's knowledge; the other involved a competent elderly woman requesting not to be re-intubated if her congestive heart failure worsened. The scenarios were evaluated using foreign medical graduates taking an OSCE. Each candidate was scored on his or her interaction with a standardized patient in the two OSCE stations by two independent observers.
Eight attending physicians from the Division of General Internal Medicine at the Toronto Hospital were used to develop the OSCE stations, and 69 foreign medical graduates taking the University of Toronto Pre-Internship Program OSCE were used to evaluate the stations.
The inter-rater reliability coefficients for the DNR and intubation scenarios were 0.79 (95% CI 0.69-0.87) and 0.75 (95% CI 0.62-0.84), respectively. For the DNR station, the scores of the two examiners, on a scale of 0 to 10, agreed exactly for 34 candidates (50%), within one mark for 59 candidates (87%), and within two marks for 65 candidates (96%). For the intubation station, the scores of the two examiners agreed exactly for 27 candidates (40%), within one mark for 56 candidates (84%), and within two marks for 63 candidates (94%).
The authors produced ethics OSCE stations with face and content validity and satisfactory inter-rater agreement. Ethics OSCE stations may be suitable for evaluating the ability of medical students and residents to address selected clinical-ethical situations.
开发客观结构化临床考试（OSCE）站点，以评估医生处理特定临床伦理情况的能力，并评估这些站点中评分者间的一致性。
利用主治医生与标准化患者之间的录像会诊开发了两个10分钟的OSCE站点。一个场景是女儿在母亲不知情的情况下为其有行为能力的母亲申请不要复苏（DNR）指令；另一个场景是一位有行为能力的老年女性要求如果她的充血性心力衰竭恶化则不要再次插管。使用参加OSCE的外国医学毕业生对这些场景进行评估。两名独立观察员对每位候选人在两个OSCE站点与标准化患者的互动进行评分。
多伦多医院普通内科的8名主治医生参与开发OSCE站点，69名参加多伦多大学实习前项目OSCE的外国医学毕业生参与评估这些站点。
DNR和插管场景的评分者间可靠性系数分别为0.79（95%CI 0.69 - 0.87）和0.75（95%CI 0.62 - 0.84）。在DNR站点，两位考官的评分（0至10分）完全一致的有34名候选人（50%），相差1分以内的有59名候选人（87%），相差2分以内的有65名候选人（96%）。在插管站点，两位考官的评分完全一致的有27名候选人（40%），相差1分以内的有56名候选人（84%），相差2分以内的有63名候选人（94%）。
作者创建了具有表面效度和内容效度且评分者间一致性令人满意的伦理OSCE站点。伦理OSCE站点可能适用于评估医学生和住院医生处理特定临床伦理情况的能力。
