Background: In the German medical education program practical examinations at the end of the neurology clerkship are sparsely performed. By this way, motivation for practical learning and a method to assure quality of learning are not used.
Method: The Anglo-Saxon concept of "objective structured clinical examination" (OSCE) is picked up and implemented as a practical examination at the end of the neurology clerkship of medical students in their 4th and 5th year. A catalogue of learning goals was defined and an OSCE of 5 stations was developed. A standard of a successful examination was defined. In two OSCE stations the competence in clinical decision making and reasoning were tested, in two stations the competence in practical examination skills and in one station the practical skill to perform a lumbar puncture at the phantom. The results of the OSCE stations were analysed for task difficulty, discriminatory power, normalized discrimination index and reliability. Using a questionnaire, the students evaluated the OSCE.
Results: N = 123 students (73 female, 50 male) with a mean age of 26.1 years (22 - 46 years) participated. The mean score was 40 +/- 3.6 of a total of 50 points (range 29 - 46). Female students (40.8 +/- 3.1) scored significantly higher than male ones (38.8 +/- 4; p = .002). One student (0.8 %) failed the examination. The difficulty of the stations ranged between 0.63 and 0.91, normalized discrimination index between 0.1 and 0.18 and the discriminatory power from r = 0.25 to r = 0.53. The reliability of the 5 stations was 0.65 (Cronbach's alpha). In the evaluation, the rating for innovation, organisation, length, clarity of the tasks, clinical reality and compatibility with general physician's competence, atmosphere during the examination and fairness was extremely positive. Most students would prefer an OSCE compared with a multiple-choice test.
Conclusion: An OSCE at the end of the neurology clerkship is feasible. The quantitative analyses of the results are concordant with requirements of medical examinations. The OSCE is positively evaluated by the students.
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