Students’ performance in the different clinical skills assessed in OSCE: what does it reveal?

Figures & data

Fig. 1.  Miller's pyramid of clinical competence.

Adapted from Ref. (11).

Table 1 The OSCE stations

			Station	Station score			Clinical skill assessed
No.	Station objective	Department	type	Mean	Min	Max	History taking	Physical exam	Comm. skills	CR skills	Proc. skills	Prof
S01	Rest station	–	Rest	–	–	–	–	–	–	–	–	–
S02	To assess candidates’ ability to calculate anion gap and interpret ABG	EME	NA	5.41	0.0	8.0				√
S03	To assess candidate's skills in performing a visual field examination	OPH	IA	7.60	0.0	10.0		√	√		√	√
S04	To assess candidate's ability to treat a dehydrated paediatric patient	PED	NA	4.87	0.0	10.0				√
S05	To assess candidate's knowledge of common drugs (magnesium sulphate)	OBG	NA	6.61	0.0	9.5				√
S06	To assess candidate's ability to interpret radiological findings and communicate this to the patient	RAD	IA	5.73	0.0	10.0			√	√		√
S07	To assess candidate's ability to plan for the transport of the critically ill patient	ANE	NA	6.99	0.0	9.5				√
S08	To assess candidate's ability to diagnose and treat a common nasal illness	ENT	NA	5.43	0.0	10.0				√
S09	To assess candidate's ability to perform CPR	EME	IA	7.00	0.0	10.0			√	√	√	√
S10	To assess candidate's communication skills in explaining a common problem (prolapsed disc) to the patient	ORS	IA	5.19	0.0	9.0		√	√	√		√
S11	To assess candidate's ability to perform and interpret Rinne's test	ENT	IA	7.69	0.0	10.0			√	√	√	√
S12	To assess candidate's communication skills on ability to counsel patient on dietary advice	PCM	IA	5.60	0.0	10.0	√		√			√
S13	To assess candidate's ability to elicit first rank symptoms in Schizoprenia	PSY	IA	6.91	0.0	10.0	√		√	√		√
S14	To assess candidate's ability to teach the patient how to use an inhaler	PCM	IA	5.27	0.0	10.0			√		√	√
S15	To assess candidate's awareness of hypothermia in the operation theatre	ANE	NA	5.92	0.0	10.0					√
S16	To demonstrate the ability to clinically assess a patient with post-operative fever	SUR	IA	6.08	0.0	10.0			√	√	√
S17	To assess candidate's ability to interpret fundoscopy findings	OPH	NA	3.60	0.0	8.0				√

EME=Trauma & Emergency; OPH=Opthalmology; PED=Paediatrics; OBG=Obstetrics & Gynaecology; RAD=Radiology; SUR=Surgery; ANE=Anaesthetics; ENT=Otolaryngology; ORS=Orthopaedic Surgery; PCM=Primary Care Medicine; PSY=Psychological Medicine; IA=Interactive; NA=Non-Interactive; Comm=Communication; CR=Clinical Reasoning; Proc=Procedural; Prof=Professionalism

Table 2 Mauchly's Test of sphericity^a

	Mauchly's				Epsilon^b
Within subject effects	W	Approx. Chi-Square	df	Sig.	Greenhouse-Geisser	Huynh-Feldt	Lower-bound
Clinical skills assessed	0.050	546.824	14	0.000	0.596	0.607	0.200

^aDesign: Intercept

Within Subjects Design: Clinical skills assessed

^bMay be used to adjust the degrees of freedom for the average tests of significance. Corrected tests are displayed in Table 3

Table 3 Tests of within-subjects effects

Sources of variation	Sum of squares	df	Mean square	F	Sig.
Clinical skills
Sphericity assumed	51.876	5	10.375	20.253	0.000
Greenhouse-Geisser	51.876	2.980	17.408	20.253	0.000
Huynh-Feldt	51.876	3.035	17.095	20.253	0.000
Lower-bound	51.876	1.000	51.876	20.253	0.000
Error (clinical skills)
Sphericity assumed	471.283	920	0.512
Greenhouse-Geisser	471.283	548.332	0.859
Huynh-Feldt	471.283	558.355	0.844
Lower-bound	471.283	184.000	2.561

Table 4 Multiple comparisons (pair wise) of mean scores for the clinical skills assessed

Pairs of skills compared	Mean difference	Std. error	Sig.^a
History–examination	−0.143	0.112	1.000
History–communications	−0.087	0.074	1.000
History–CRS	0.380*	0.091	0.001
History–procedural skills	−0.340*	0.096	0.008
History–professionalism	−0.031	0.072	1.000
Examination–communication	0.055	0.077	1.000
Examination–CRS	0.523*	0.089	0.000
Examination–procedural skills	−0.197	0.089	0.425
Examination–professionalism	0.112	0.075	1.000
Communication–CRS	0.467*	0.049	0.000
Communication–procedural skills	−0.252*	0.039	0.000
Communication–professionalism	0.056	0.027	0.531
CRS–procedural skills	−0.719*	0.062	0.000
CRS–professionalism	−0.411*	0.061	0.000
Procedural skills–professionalism	0.309*	0.054	0.000

^aAdjustment for multiple comparisons: Bonferroni correction

*Mean difference is significant at the 0.05 level

CRS=Clinical Reasoning Score

Miller GE . The assessment of clinical skills/competence/performance. Acad Med. 1990; 65: s63–7.

 Google Scholar