OSCE

Abstract: Introducción. El objetivo del Sistema de Residencia es la adquisición de competencias profesionales. El examen clínico estructurado objetivo (ECEO) constituye una valiosa herramienta de evaluación. Para optimizar la evaluación de las competencias clínicas de los médicos residentes implementamos un ECEO, experiencia que se describe. Población, material y métodos. Implementamos un ECEO con 7 estaciones en 25 residentes de 1 año de Pediatría. Se estimó mediana y percentilos de puntaje total y cada estación. Se realizó encuesta de satisfacción de usuario. Resultados. Sobre un puntaje total de 100, la mediana obtenida fue de 50,6 (rango intercuartílico: 45-59). La estación “Pautas madurativas” mostró el mayor puntaje y “Caso interactivo” el menor. En la encuesta de satisfacción, 22 residentes consideraron que esta metodología permitió identificar puntos débiles en su formación. Conclusiones. El ECEO es una metodología de evaluación aplicable en nuestro medio. Los residentes consideran que les permite identificar puntos débiles en su formación. Palabras clave: competencia profesional, evaluación.

 education;  health;  capacitacionssp;  OSCE;  

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Abstract: Introducción: El Examen Clínico Objetivo Estructurado (ECOE) se utiliza ampliamente como método de evaluación sumativa. Su aplicación como evaluación formativa es menos difundida aunque constituye una estrategia educacional muy valiosa. Objetivos: Proporcionar a los internos la oportunidad de experimentar la vivencia de un ensayo de ECOE en la mitad del período de Internado de Medicina (IM), con el fin de promover la autoevaluación, familiarizarlos con el examen final y retroalimentar el proceso docente. Material y método: Participan 23 internos en práctica de IM; se implementa un ECOE con 10 estaciones, en dos sesiones consecutivas y 10 minutos por estación. Los internos acuden obligatoriamente a revisar la corrección del examen y reciben retroalimentación directa e individual. La evaluación de la actividad se realiza con encuestas semiestructuradas que los estudiantes responden al término de los ECOEs formativos y final del IM. Este estudio es de tipo descriptivo. Resultados: Al finalizar el ECOE formativo, 52,2% de los internos expresa ansiedad y nerviosismo frente a la convocatoria al ensayo de ECOE; 91,3% considera que los contenidos y el tiempo asignado a cada estación son adecuados; 87% responde que el tipo de problemas presentados y el grado de complejidad son adecuados; 47,8% considera perturbadora la presencia del docente observador; 78,3% opina que el beneficio más importante es la oportunidad de autoevaluarse. Al término del ECOE final, 91,3% expresa que es de gran utilidad realizar un ECOE formativo; 95,7% expresa que es de gran utilidad revisar la corrección del ensayo; 95,7% responde que modifican su método de estudio; 78,3% valoran positivamente el ECOE formativo. Conclusiones: Esta actividad formativa cumple con los objetivos de promover la autoevaluación y familiarizar a los internos con el ECOE final del IM. Sin embargo, a nuestro juicio el impacto más relevante es el cambio del método de estudio de los estudiantes.

 capacitacionssp;  OSCE;  

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Abstract: INTRODUCTION: The main aim of medical education is to foster the development of clinical competence in students at all levels. Differences in experiences, methods of instruction and ambiguous forms of assessment are obstacles to attaining this goal. Dissatisfaction with the conventional methods of clinical assessment on the part of teachers and students led assessors to search for appropriate alternatives and in 1975, Harden and his colleagues introduced the objective structured clinical examination (OSCE). It is nearly impossible to have a test that satisfies all the criteria of a good test. Sometimes, a compromise has to be made between the available resources (in terms of man, money and time), and the method and quality of assessment (in terms of reliability, validity, objectivity and practicability). METHODS: This critique on the OSCE is based on the published findings of researchers from its inception in 1975 to 2004. RESULTS: The reliability, validity, objectivity and practicability or feasibility of this examination are based on the number of stations, construction of stations, method of scoring (checklists and/ or global scoring) and number of students assessed. For a comprehensive assessment of clinical competence, other methods should be used in conjunction with the OSCE. CONCLUSION: The OSCE can be a reasonably reliable, valid and objective method of assessment, but its main drawback is that it is resource-intensive.

 education;  capacitacionssp;  OSCE;  

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Abstract: Background: The Objective Structured Clinical Examination (OSCE) has become a respected and widely used tool for the assessment of clinical competence in medical education. Aim: To describe the first experience of an OSCE as a summative assessment in undergraduate Pediatric Internship, in two universities. Material and Methods: The OSCE was structured by a committee of faculty members of the 5 campi of University of Chile and I campus of the Catholic University. A 21 station OSCE was administered simultaneously to 124 Pediatric Interns (University of Chile =104, Catholic University=20), in 3 centers. A total of 50 faculty members participated in the examination. The OSCE consisted of 20 clinical problems, including videotape recordings, photographs, x-rays and laboratory exams, phantoms and 7 simulated standardized parents. Results: The average total OSCE score was 67.3% (range: 84.5%-43.5%). The maximum theoretic score was achieved in 19 stations. A significant correlation between station and total score, was found for 18 of the 20 clinical problems. Conclusions: The experience of using OSCE has been a success. The OSCE was an adequate procedure to assess a large number of interns simultaneously and it allowed us to measure the main objectives in all domains and a wide range of clinical competence of Pediatric Internship Programs.

 capacitacionssp;  OSCE;  

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Abstract: BACKGROUND: The Accreditation Council for Graduate Medical Education is embarking on the major task of a paradigm shift in graduate education in the direction of competency-based medical education and evaluation of outcomes. The Objective Structured Clinical Examination (OSCE), a measure of clinical competence that focuses on outcomes via observable behaviors, is gaining national recognition. OBJECTIVE: To review the pediatric literature relevant to the OSCE. METHOD: A MEDLINE search from the date of the original report of the OSCE (1975) to the present was performed. All English-language studies regarding the use of the OSCE in pediatric education published in the United States and Great Britain were reviewed. MAIN OUTCOME MEASURES: Reliability and validity of the OSCE were examined. Use of standardized pediatric patients was discussed. RESULTS: A greater number of stations and similarity between tasks at different stations increased the reliability of the OSCE. A greater number of stations increased sampling of material and content validity. Correlation between the OSCE and precertification examinations ranged between 0.59 and 0.71, with P< or =.01. Correlation between the OSCE and monthly clinical evaluations was much lower (0.39-0.57), but still statistically significant at P< or =.05. Gaps between expected and actual performance were documented. Overall, the experience of being a standardized patient was viewed as positive by children and their parents. CONCLUSIONS: With appropriate attention to design, acceptable reliability and validity can be achieved for the OSCE. Significant correlations between the OSCE and precertification examinations as well as monthly clinical evaluations were found, the former being stronger than the latter. We conclude that the combination of the OSCE, standardized board examinations, and direct observation in the clinical setting has the potential to become the gold standard for measuring physician competence.

 education;  capacitacionssp;  OSCE;  

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