Money makes the (medical assessment) world go round: The cost of components of a summative final year Objective Structured Clinical Examination (OSCE)

Abstract

Introduction: The widely used Objective Structured Clinical Examination (OSCE) is undoubtedly expensive. Cost-effectiveness is one of the components of the assessment utility index defining its usefulness. Our current financial climate demands increased transparency in the costs associated with medical education and it is now vital to ascertain how much is spent on assessments, such as the OSCE, and in particular costs associated with the different types of stations within the OSCE.

Methods: A retrospective case-study approach was used to identify all costs associated with the development, production, administration and post-examination phases of the 2013 final year MBChB OSCE at the University of Aberdeen, Scotland. This 15 station OSCE was held over 2 days for 185 students.

Results: This OSCE cost £65,328 to run. Costs per station ranged from £3108 (prescribing) to £6577 (eye examination). The cost per student was £355.

Discussion: The costs of a “high stakes” OSCE are sobering. The bulk of costs identified are not modifiable in light of what is currently known about the metrics of OSCE utility, particularly reliability and validity.

Conclusion: Providers, and funders, of medical education must be prepared to assign significant resource to OSCE assessment and centres should be encouraged to calculate precise costs associated with assessment to inform resource allocation decisions.

Practice points

• Our retrospective case study analysis identified that the costs of a “high stakes” OSCE are sobering.

• Most of these costs are not modifiable in light of what is currently known about the other metrics of OSCE utility.

• Providers and funders of medical education must be prepared to assign significant resources to OSCE assessment and consider cost-effectiveness as a measure of the OSCE’s overall utility.

• Centres should be encouraged to calculate precise costs associated with assessment to inform resource allocation decisions, plan realistic economies and enable comparisons across different settings.

Acknowledgments

The authors would like to thank Ms Isabel McPhee, Senior Assessment Secretary, and Ms Ulrike Sperling, ACT Officer, University of Aberdeen for their help in gathering information regarding the OSCE and costs involved.

Declaration of interest: The authors report no declarations of interest.