Sharing of information by students in examinations that use standardized patient cases

Abstract

Purpose: During the high-stakes exam such as OSCE(Objective structured clinical examination) or CPX(clinical performance exam), the test security was generally accepted as a major concern for the test validity. This study was conducted to investigate the effect on examinee`s scores of repeated, serial administrations of essentially the same SP-based performance exam.

Method: A performance-based examination using eight SP cases was administered to 123 senior medical students at Hanyang University, School of Medicine. Students were randomly assigned to one of 16 groups of 8 students each. Three groups were tested serially each day and it took 5 days for the whole administrations. We compared the means of the five groups of examinee tested at different days with ANOVA and linear trends with multiple regression analyses.

Results: For both checklist scores and written scores during the interstation work, the means of the first day groups were significantly lower compared to those of other groups of later days. However, there were slight linear trends in those scores over five days. Scores related to case-specific history taking, information sharing, and clinical courtesy were significantly affected by sharing of information by students. Scores related to patient satisfaction, physical exam, and physician-patient interaction were not influenced by information sharing by students.

Conclusions: Test security may be violated during the SP-based performance exam even though the checklists are not accessible to examinee. It would be desirable for the test-givers to prepare alternative forms of cases for maintaining the validity of SP-based performance exams.