Performance-based assessment of clinical ethics using an objective structured clinical examination

Acad Med. 1996 May;71(5):495-8. doi: 10.1097/00001888-199605000-00021.


Purpose: To further examine the objective structured clinical examination (OSCE) as a performance-based assessment method for clinical ethics.

Method: In the spring of 1993, a volunteer sample of 88 final-year medical students from all five Ontario medical schools took a four-station OSCE that used standardized patients and involved decisions to forego life-sustaining treatment. Performance was scored on a checklist of behaviors unique to each case. Data were analyzed for reliability using intraclass correlation coefficients and the Spearman-Brown prophecy formula.

Results: Reliability of the test was only .28 as a result of a low average inter-station correlation of .07. To achieve a test reliability of .8, 41 stations (almost seven hours of testing time) would be required.

Conclusion: Because of its low test reliability, the OSCE is not a feasible stand-alone method for summative evaluation of clinical ethics. This performance-based evaluation method should be combined with other, more reliable evaluation methods. The OSCE has promise for formative evaluation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Educational Measurement*
  • Ethics, Medical / education*
  • Humans
  • Professional Competence*
  • Psychometrics
  • Reproducibility of Results
  • Students, Medical / psychology*