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Open Access Research article

Modification of an OSCE format to enhance patient continuity in a high-stakes assessment of clinical performance

Rose Hatala1*, Sharon Marr2, Cary Cuncic1 and C Maria Bacchus3

Author Affiliations

1 Department of Medicine, University of British Columbia, Vancouver, BC, Canada

2 Department of Medicine, McMaster University, Hamilton, ON, Canada

3 Department of Medicine, University of Calgary, Calgary, AB, Canada

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BMC Medical Education 2011, 11:23  doi:10.1186/1472-6920-11-23

Published: 24 May 2011



Traditional Objective Structured Clinical Examinations (OSCEs) are psychometrically sound but have the limitation of fragmenting complex clinical cases into brief stations. We describe a pilot study of a modified OSCE that attempts to balance a typical OSCE format with a semblance of a continuous, complex, patient case.


Two OSCE scenarios were developed. Each scenario involved a single standardized patient and was subdivided into three sequential 10 minute sections that assessed separate content areas and competencies. Twenty Canadian PGY-4 internal medicine trainees were assessed by trained examiner pairs during each OSCE scenario. Paired examiners rated participant performance independent of each other, on each section of each scenario using a validated global rating scale. Inter-rater reliabilities and Pearson correlations between ratings of the 3 sections of each scenario were calculated. A generalizability study was conducted. Participant and examiner satisfaction was surveyed.


There was no main effect of section or scenario. Inter-rater reliability was acceptable. The g-coefficient was 0.68; four scenarios would achieve 0.80. Moderate correlations between sections of a scenario suggest a possible halo effect. The majority of examiners and participants felt that the modified OSCE provided a sense of patient continuity.


The modified OSCE provides another approach to the assessment of clinical performance. It attempts to balance the advantages of a traditional OSCE with a sense of patient continuity.