Assessing clinical skills – standard setting in the objective structured clinical exam (OSCE)

Abstract

Family Medicine training and assessment is becoming more formalized and developed in South Africa. Assessment of competency in relation to clinical skills can involve observation in the clinical setting, but is more usually assessed in an examination. The traditional “long case has been largely abandoned as it lacks reliability and validity. Summative assessment of family physician’s clinical skills now usually includes an Objective Structured Clinical Examination (OSCE). Although a well designed and organized OSCE can have reasonable reliability and validity, a pass mark of 50% may in fact be an arbitrary figure, which does not credibly represent the required competency of a family physician. Standardisation of the OSCE is required to define the pass mark above which a candidate performs at the level expected of a family physician. A number of standardisation processes have been described that either judge the test items prior to the exam or judge the individual during the exam. In this paper we report on an example of the latter called the borderline regression method.