A ‘Fair Play’? Comparison of an Objective Structured Clinical Examination of Final Year Medical Students Training in Psychiatry and their Supervisors' Appraisals

Abstract

Objective: Expected standards for student performance in psychiatry can vary between supervisors and institutions. Recently, the University of Auckland required its academic departments to have an objective standard assessment or test for each student on a clinical attachment. We aimed to compare an objective structured clinical examination of final year medical students training in psychiatry and their supervisors' appraisals. Method: Assessment in psychiatry initially consisted of a two-hour written test. Subsequently, the test in psychiatry changed to a standardised, modified, objective, structured, clinical examination (OSCE) using simulated patients. The clinical supervisor rated each student on a set of clinical parameters using a scale of 1-6. In addition, members of the academic department of psychiatry separately tested the students with a modified OSCE on the last day of their clinical attachment. The results of the OSCE are compared with clinical attachment assessments and the previous method of evaluation, the written test. Results: There was no correlation between the written test and the supervisor's assessment for the clinical attachment indicating that the written test was not a good method of evaluating student performance. The correlation between the clinical attachment grading and the OSCE for year 1 was 0.4 (p=0.002) and for year 2 was 0.5 (p=0.001). However, marks for the OSCE were consistently lower than those given for the clinical attachment. Conclusions: The introduction of the modified OSCE had the desired outcome of changing students' focus from the pursuit of theoretical knowledge to the attainment of practical skills.