Entrustment within an objective structured clinical examination (OSCE) progress test: Bridging the gap towards competency-based medical education

Abstract

Purpose

Progress testing aligns well with competency-based medical education (CBME) frameworks, which stress the importance of continuous improvement. Entrustment is a useful assessment concept in CBME models. The purpose of this study was to explore the use of an entrustability rating scale within the context of an objective structured clinical examination (OSCE) Progress Test.

Methods

A 9-case OSCE Progress Test was administered to Internal Medicine residents (PGYs 1–4). Residents were assessed using a checklist (CL), global rating scale (GRS), training level rating scale (TLRS), and entrustability scale (ENT). Reliability was calculated using Cronbach's alpha. Differences in performance by training year were explored using ANOVA and effect sizes were calculated using partial eta-squared. Examiners completed a post-examination survey.

Results

Ninety one residents and forty two examiners participated in the OSCE. Inter-station reliability was high for all instruments. There was an overall effect of training level for all instruments (p < 0.001). Effect sizes were large. 88% of examiners completed the survey. Most (62%) indicated feeling comfortable in making entrustment decisions during the OSCE.

Conclusions

An entrustability scale can be used in an OSCE Progress Test to generate highly reliable ratings that discriminate between learners at different levels of training.

Keywords:

• Entrustment
• progress testing
• OSCE
• CBME

Acknowledgments

The authors would like to acknowledge the Ottawa Exam Center for their help in data compilation.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Entrustment: The action of entrusting or the fact of being entrusted. Translated to clinical training, the object of care may be the patient in a general sense, and the task is a professional activity that usually involves this patient.

Ten Cate et al. Entrustment decision making in clinical training. Acad Med. 91(2):191–198.

Progress Test: An examination that is offered repeatedly throughout training with the aim of monitoring progress over time.

Schuwirth LWT, van der Vleuten CPM. 2012. The use of progress testing. Perspect Med Educ. 1(1): 24–30.

Additional information

Notes on contributors

Samantha Halman

Samantha Halman, MD, MMEd, FRCPC, is an Assistant Professor, Department of Medicine, University of Ottawa.

Angel Yi Nam Fu

Angel Yi Nam Fu, MD, is a PGY4 resident in Cardiology, University of Ottawa.

Debra Pugh

Debra Pugh, MD, MHPE, FRCPC, is an Associate Professor, Department of Medicine, University of Ottawa.