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by Richard I. Zraick
Assessment in medical education has expanded its focus in recent years from simply testing cognitive knowledge of medical science to testing actual performance in a clinical situation. A widely accepted method of performance-based clinical assessment is the Objective Structured Clinical Examination (OSCE), a method of evaluation requiring students to perform specific clinical tasks in a highly structured encounter, usually within a prescribed period of time. Students' skills in history taking, physical or other examination, and problem-solving are evaluated, as are their behaviors related to interpersonal and professional communication.
Authentic Skills Assessment
Predetermined performance criteria are scored on a rating scale or checklist by a trained observer, either at the time of the encounter or immediately subsequent to it, or later from videotape. Sometimes an OSCE may include a short, post-encounter written examination related to the clinical situation. The appeal of an OSCE is that it places the student in a simulation where each encounter is largely uncued, open-ended, and standardized, thereby providing an opportunity for more authentic skills assessment than is available through pen and paper testing.
The OSCE typically uses standardized patients (SPs), individuals trained to portray specific patient cases in a highly consistent and measurable manner, and may be either real patients or individuals simulating patients. The SP's role in the OSCE is to present the case history in response to questioning by the student, to undergo physical or other examination by the student, and to serve as an evaluator of student performance.
SPs and OSCEs have been used to assess the clinical skills and competencies of students and professionals in a variety of allied health disciplines, but their use has received little formal attention in the discipline of speech-language pathology. My colleagues and I at the University of Arkansas for Medical Sciences have been exploring the use of SPs and OSCEs for the past four years, and have found them to be a useful adjunct to traditional teaching and testing methods.
We have developed SPs to portray different classic aphasia syndromes, acquired apraxia of speech, and Alzheimer's disease, and we have also developed associated standardized "family" members for use during counseling sessions. We have used these SPs both in the classroom and the clinic for teaching, and in our Clinical Skills Center for performance-based assessment. Our plans for the near future include developing a case library of 45 SPs portraying aphasia and Alzheimer's disease of varying severities, and using this library for teaching and testing.
Positive Curriculum Addition
Feedback about the use of SPs and OSCEs has been positive from faculty colleagues and students alike, as well as off-campus clinical supervisors. Students have demonstrated improved clinical skills in many areas-from professional communication, to test administration, to test interpretation.
Developing and implementing SPs and OSCEs for the training and assessment of clinical skills of student clinicians is a complex process. Essential requirements for success are thorough planning, strong support of faculty, and well-trained SPs and judges. The use of SPs for teaching and testing can be a positive addition to a curriculum and help to evaluate those curricular components that address providing students with the clinical skills necessary for quality patient care.
Richard I. Zraick is an associate professor in the department of audiology and speech pathology at the University of Arkansas for Medical Sciences and the University of Arkansas at Little Rock. His interests are in neurogenic communication disorders, voice and resonance, and clinical skills development. Contact him by e-mail at RIZraick@uams.edu.
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