Search

In a clinical skills assessment, the decision to pass or fail an examinee should be based on the test content or on the examinees' performance. The process of deciding a pass score is known as setting a standard of the examination. This requires a properly selected panel of expert judges and a suitable standard setting method, which best fits the purpose of the examination. Six standard setting methods that are often used in clinical skills assessment are described to provide an overview of the standard setting process.

Objective structured clinical examination (OSCE) is an effective assessment method to evaluate medical students' clinical competencies performance. Postgraduate year 1 (PGY1) residents have been initiated in a general medicine training program in Taiwan since 2003. However, little is known about the learning effectiveness of trainees from this program. This pilot study aimed to evaluate the clinical core competencies of PGY1 residents using OSCE, and to reflect on the strengths and weaknesses of this pilot assessment project. OSCE was conducted for five PGY1 examinees (4 men, 1 woman) with five stations covering core themes, including history taking, physical examination, clinical procedure of airway intubation, clinical reasoning, and communication skills for informing bad news. Itemized checklists and five-point Likert scale global ratings were used for evaluating performance. The results showed that the performance of our PGY1 residents on history taking was significantly better after about 2 months of postgraduate training on general internal medicine. Self-evaluation on performance by examinees revealed significantly lower global ratings on post-course OSCE (4.14 ± 0.80 vs. 3.68 ± 0.66; p < 0.02). Surveys from tutors and standardized patients (SPs) completed at pre- and post-course OSCEs showed consistently favorable responses on the purposes, content, process, and environment of this assessment (4.0 ± 0.17 vs. 4.0 ± 0.12, nonsignificant). However, a survey of the examinees completed at preand post-course OSCEs showed relatively unfavorable responses to the same aspects, and to tutors and SPs (4.1 ± 0.09 vs. 3.7 ± 0.18; p < 0.05). Qualitative information revealed that tutors and SPs remarked that PGY1 residents' medical knowledge performance was satisfactory but their clinical reasoning performance, communication skills (giving bad news) and self-confidence were unsatisfactory. In conclusion, this pilot study has demonstrated that OSCE is a rational and feasible assessment method for evaluating the effectiveness of our PGY general medicine training program. The quantitative data and qualitative information provide a foundation to improve the quality of the program design and evaluation in implementing postgraduate general medicine training.

This study aimed to examine the correlations between academic achievement and levels of anxiety and depression in medical students who were experiencing curriculum reform. The differences in academic achievement and the directions of correlations between academic achievement and anxiety and depression among the medical students with different levels of anxiety and depression were also examined. Grade 1 students from graduate-entry program and grade 3 students from undergraduate-entry program in their first semester of the new curriculum were recruited to complete the Zung's Anxiety and Depression Scale twice to examine their levels of anxiety and depression. Their academic achievement ratings in the four blocks of the first semester of the new curriculum were collected. The results indicated that no significant correlation was found between academic achievement and global anxiety and depression. However, by dividing the medical students into low, moderate and high level anxiety or depression groups, those who had poorer academic achievement in the first learning block were more likely to have higher levels of depression in the first psychologic assessment. Among the medical students who were in the high anxiety level group in the first psychologic assessment, those who had more severe anxiety had poorer academic achievement in the fourth learning block. Among the medical students who were in the low anxiety level group in the second psychologic assessment, those who had more severe anxiety had better academic achievement in the fourth learning block. Among the medical students who were in the moderate anxiety level group in the second psychologic assessment, those who had more severe anxiety had poorer academic achievement in the second learning block. Among the medical students who were in the high depression level group in the second psychologic assessment, those who had more severe depression had poorer academic achievement in the fourth learning block. The results of this study indicate that there are both positive and negative correlations between academic achievement and anxiety and depression in medical students, regarding differing levels of severity of anxiety or depression. The results could represent a reference for teachers on the planning of teaching and assessment programs.

The Objective Structured Clinical Examination (OSCE), a tool to objectively and fairly assess medical students' clinical competences, has become widely used in medical education worldwide. However, most medical schools in Taiwan have just begun to adopt this assessment method. In 2003, Kaohsiung Medical University (KMU) established the first standardized patient (SP) program in Taiwan and applied SPs with an OSCE. This study reports the process of the implementation of an OSCE at KMU, which includes collecting information, visiting leading clinical skills centers, consulting medical educators from other countries, holding international conferences, establishing an OSCE committee, writing cases, training SPs, administrating the OSCE, and receiving feedback from medical students. Most students were satisfied with the assessment and appreciated the learning experience. Based on the experience in 2003, the OSCE committee decided to incorporate the OSCE into the medical curriculum as a measure to assess medical students' clinical competences. In addition to assessing medical students' clinical competence, the OSCE can also be applied to other professional health education, such as dentistry, nursing, and pharmacy. We are currently sharing our experience with other colleges at KMU.

Medical students are assumed to be competent to provide basic patient care independently on graduation. However, there is a gap between what students are expected to learn and what they have actually learned. This may be due to the lack of clearly defined learning objectives, well- organized curriculum, and properly administered assessment. In an attempt to tackle this problem, we conducted a three-step study. Firstly, we identified the core clinical competencies required of medical graduates in Taiwan. Secondly, we incorporated these clinical competencies into a new medical curriculum. Finally, we identified the most appropriate assessment methods for each clinical competency. In 2004, a set of minimally required clinical competencies for medical undergraduates in Taiwan was developed, which included 92 clinical skills, four communication skills, and seven kinds of attitudes. In order to prepare 3rd and 4th year medical students at Kaohsiung Medical University (KMU) for later clinical work, the medical curriculum committee integrated the teaching and assessment of the core clinical skills identified previously into relevant organ-system blocks of the new curriculum. To identify appropriate assessment methods for each clinical skill, a structured questionnaire of assessment methods based on the Toolbox of Assessment Methods (Accreditation Council for Graduate Medical Education) and The Scottish Doctor (Scottish Deans' Medical Curriculum Group) was developed and distributed to 40 senior clinical faculty members at KMU. Simulations and Models, Standardized Patient Examination (SP), and Objective Structured Clinical Examination (OSCE) were suggested to be most suitable to assess two-thirds of the core clinical skills. These assessment methods are commonly used in American and European medical schools. We believe that the implementation of the new curriculum at KMU accompanied by the use of Simulations and Models, SP, OSCE, and other teaching and assessment methods will help 3rd and 4th year students to prepare better for clinical practice in clerkships.

The objective, structured clinical examination (OSCE) is a method to assess clinical competency based on objective testing, through direct observation in a formal setting. The Kaohsiung Medical University (KMU) has pioneered OSCEs in Taiwan. In KMU, three groups of examinees—medical students in years 3 and 4, medical students in years 5 and 6, and medical students in year 7—were assessed using different OSCEs. Each OSCE was set up using the following five steps: (1) create cases; (2) decide on the items or clinical skills to be evaluated; (3) train standardized patients; (4) run the OSCE and (5) review videos to improve the curriculum. We expect that KMU will become the premier OSCE center in Taiwan.