Predictive validity of measurements of clinical competence using the Team Objective Structured Bedside Assessment (TOSBA): Assessing the clinical competence of final year medical students

Figures & data

Table

Practice points
The team objective structured bedside assessment (TOSBA) is a novel and feasible approach to formative ward-based assessment. Performance in the TOSBA is predictive of subsequent student performance in the final examination. Further research is required to evaluate the TOSBA as a summative assessment tool and to establish its utility in predicting clinical performance during internship.

Table 1.  TOSBA and OSLER grading scheme

Grade	Descriptor
P+	Honours standard
P/P+	Pass but potential to achieve honours standard
P	Pass standard
P/P− (TOSBA only)	Borderline standard
P−	Fail standard

Figure 1. Association of OSLER and TOSBA grades to final total mark. OSLER r² = 0.15; TOSBA r² = 0.35.

Table 2.  Comparative performance of the OSLER and TOSBA

Assessment
	Grade	Percentage	Average final mark (out of 100)	Average clinical mark (out of 100)
OSLER	P−	12	54	56
	P	7	51	49
	P/P+	26	56	57
	P+	56	59	60
TOSBA	P−	9	50	50
	P/P−	17	54	53
	P	57	58	59
	P/P+	14	62	62
	P+	3	64	64

Figure 2. Association gradients for failure rates and honour rates.

Figure 3. Association gradients for failure rates and honour rates.

Appendix: OSLER grading system

Extended criterion Referenced grading scheme		Extended marking scheme
P+	80	Outstandingly clear and factually correct presentation of the patient history, demonstration of physical signs and organisation of the case management. Clearly a candidate displaying outstanding communication skills and clinical acumen. First call honours.
	75	Excellent overall case presentation, communication skills, examination technique and demonstration of the correct facts and physical signs of the case. The candidate may even display outstanding attributes in some but not all measurable criteria. First class honours.
	70	Excellent in most aspects of overall case presentation, communication skills, examination technique and demonstration of the correct facts and physical signs of the case. Also excellent communicator and demonstrates the ability to investigate
	65	Very good overall presentation covering all major aspects; few omissions, good priorities. Very clearly an above average candidate in terms of communication and clinical acumen. Second class honours, grade 1
	60	Very good in most respects of presentation and communication but not in all aspects. However, a good solid performance in most areas assessed with a well developed clinical acumen. Second class honours, grade 2
P	55	Good sound overall presentation and communication of the case without displaying any attributes out of the ordinary. The candidate displays an overall adequate standard of examination technique. The patient's problems are identified and a reasonable management outline suggested.
	50	Adequate presentation of the case and communication ability. Nothing to suggest more than just reaching an acceptable standard in physical examination and identification of the patient's problems.
P−	45	Poor performance in most areas of case presentation, communication with the patient and demonstration of physical signs. Inadequate attempt at a clear identification of the patient's problems. The candidate may display some adequate attributes but does not reach an acceptable pass standard overall.
	40	Poor performance overall The candidate does not reach an acceptable pass standard in almost all categories. The candidate's performance in all areas is 'so poor’ that the standard required is not even remotely approached. Quite clearly this candidate requires a further period of training