Background: The concept of EPAs is increasingly applied to assess trainees’ workplace performance by means of
entrustment ratings. OSCEs assess performance in a simulated setting, and it is unclear whether entrustment ratings
can be integrated into these exams. This study explores the introduction of an entrustment rating scale into an
existing OSCE.
Methods: A 6-point entrustment scale was added to the standard ratings in an OSCE administered prior to
students’ final clerkship year in an undergraduate medical programme. Standard OSCE ratings assess clinical and
communication skills. Assessors (n = 54) rated students’ performance (n = 227) on a diverse set of clinical tasks
and evaluated the addition of entrustment scales to OSCEs. Descriptive and inferential statistics were calculated
for analyses.
Results: Student performance varied across the stations, as reflected in both the standard OSCE ratings and the
added entrustment ratings. Students received generally high standard OSCE ratings, whereas entrustment ratings
were more widely distributed. All students passed the OSCE, and only a small proportion of students did not reach
the expected pass threshold of 60% on the standard ratings in the single stations. The proportion of students who
did not reach the expected entrustment level in the respective stations was noticeably higher. Both the clinical and
communication skill ratings were related to the entrustment rating in most OSCE stations. A majority of the
assessors positively evaluated the addition of entrustment ratings into the OSCE.
Discussion: The findings provide an empirical basis to broaden our understanding of the potential use of
entrustment ratings in existing OSCEs. They provide directions for future, more specific studies. The ratings might
be used for formative feedback on students’ readiness for workplace practice
