The clerking portfolio as an OSCE station: preliminary correlation with clerking skills

Context and setting Why the innovation was introduced What was done Evaluation of results / impact Context and setting At the University of Bristol, clinical skills and attitudes are tested in finals using an observed long case and a 24 x 10 min station OSCE divided into 12 examined- and 12 invigilated stations. A clerking portfolio station was introduced in 2006. Why the innovation was introduced Our aim was to optimize new graduates’ clinical skills by increasing their perception of the importance of carrying out a complete clerking including a concise summary and a plan for initial investigations and management, in real time in a busy hospital setting. What was done Students were asked to anonymize and keep all of their original final year clerkings (signed and validated by a member of the ward staff) in a portfolio. These were collected (but not evaluated) two days in advance of the exam and assessed in the presence of the student by two examiners during the 10 minute OSCE station. Portfolios were marked for legibility, use of English, organization and completeness, plan of investigation and, where relevant, evidence of improvement over time. Evaluation and impact • After initial resentment with the task, student feedback was excellent. The portfolio acted as an incentive to clerking more thoughtfully, more completely and more frequently. • Nine of 172 students failed the clerking portfolio station, of whom five subsequently failed to satisfy the examiners in the first long case (out of 24 long case fails). Of the nine portfolio station fails, one failed overall and was required to re-sit the final year. • The station has excellent consequential validity and appears to have predictive value for failure to satisfy the examiners in the long case on first attempt. • The predictive value of the clerking portfolio station will be further investigated in the final examination in 2007