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Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school

Alexandre Matet 1, 2 Ludovic Fournel 3 François Gaillard 4 Laurence Amar 4 Jean-Benoit Arlet 4 Stéphanie Baron 4 Anne-Sophie Bats 4 Celine Buffel Du Vaure 5 Caroline Charlier 6, 7 Victoire de Lastours 8 Albert Faye 9 Eve Jablon 5 Natacha Kadlub 10 Julien Leguen 4 David Lebeaux 4 Alexandre Malmartel 5 Tristan Mirault 11, 4 Benjamin Planquette 12, 4 Alexis Régent 13 Jean-Laurent Thebault 5 Alexy Tran Dinh 14, 15 Alexandre Nuzzo 16 Guillaume Turc 17 Gérard Friedlander 18 Philippe Ruszniewski 17, 19 Cécile Badoual 11, 4 Brigitte Ranque 11, 4 Mehdi Oualha 20 Marie Courbebaisse 18, 4
Abstract : Purpose: Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing number of students admitted to medical schools, and the necessity of objectively evaluating practical skills. This study aimed at investigating the relationships between OSCE grades and current evaluation modalities. Methods: Three-hundred seventy-nine 4th-year students of University-of-Paris Medical School participated to the first large-scale OSCE at this institution, consisting in three OSCE stations (OSCE#1–3). OSCE#1 and #2 focused on cardiovascular clinical skills and competence, whereas OSCE#3 focused on relational skills while providing explanations before planned cholecystectomy. We investigated correlations of OSCE grades with multiple choice (MCQ)-based written examinations and evaluations of clinical skills and behavior (during hospital traineeships); OSCE grade distribution; and the impact of integrating OSCE grades into the current evaluation in terms of student ranking. Results: The competence-oriented OSCE#1 and OSCE#2 grades correlated only with MCQ grades (r = 0.19, P<0.001) or traineeship skill grades (r = 0.17, P = 0.001), respectively, and not with traineeship behavior grades (P>0.75). Conversely, the behavior-oriented OSCE#3 grades correlated with traineeship skill and behavior grades (r = 0.19, P<0.001, and r = 0.12, P = 0.032), but not with MCQ grades (P = 0.09). The dispersion of OSCE grades was wider than for MCQ examinations (P<0.001). When OSCE grades were integrated to the final fourth-year grade with an incremental 10%, 20% or 40% coefficient, an increasing proportion of the 379 students had a ranking variation by ±50 ranks (P<0.001). This ranking change mainly affected students among the mid-50% of ranking. Conclusion: This large-scale French experience showed that OSCE designed to assess a combination of clinical competence and behavioral skills, increases the discriminatory capacity of current evaluations modalities in French medical schools.
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Submitted on : Friday, June 11, 2021 - 4:23:01 PM
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Alexandre Matet, Ludovic Fournel, François Gaillard, Laurence Amar, Jean-Benoit Arlet, et al.. Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school. PLoS ONE, Public Library of Science, 2021, 16 (1), pp.e0245439. ⟨10.1371/journal.pone.0245439⟩. ⟨hal-03258630⟩

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