研究報告Original Paper理学療法専攻学生の臨床技能教育を推進することを目的に、学生の臨床技能の習得と、その到達度を客観的に評価する客観的臨床能力評価試験(Objective Structured Clinical Examination;OSCE)を試行した。本研究は、OSCEの試行結果を分析し、その有効性を検討した。対象はPT専攻2年次生全員32名(男性20名、女性12名)、平均年齢19.2歳(偏差1.5、範囲18-25歳)であった。OSCE課題は、1ブース1学生に対し、右変形性股関節症のシナリオで股関節の徒手筋力テストと関節可動域測定の1課題を提示した。評価尺度は4名の教員(模擬患者役1名)が作成し、評価は3名の評価者(教員)が同時に行った。OSCEの評価者間信頼性(ICC;0.84)は高く、評価者間の評価点にも差はなかった。評価項目の評価者間の完全一致率は7割程度であった。学生へのアンケート調査の結果は、OSCEに対する学生の評価は高かった。今回試行したOSCEの信頼性は高く、学生の臨床能力を客観的に把握し得る結果であり、学生の問題点を明確にし、有益なフィードバックが得られると考えられた。BACKGROUND AND OBJECTIVES: The objective structured clinical examination (OSCE) is an examination format with particular emphasis on examining students\u27 clinical and communication skills. The purpose of this study was to examine the feasibility, reliability and validity, and the educational impact of an OSCE for students in the second year of a 4-year physical therapy program. METHODS: Thirty-two students were examined at one OSCE session. The station evaluated skills required for the interaction with patients and physical examination (joint range of motion and manual muscle test) of mimic persons with chronic musculoskeletal conditions. Three examiners recorded an overall judgment of each student\u27s performance (pass, borderline, or fail) and wrote comments on each student\u27s performance using a checklist for each student\u27s performance content. Intraclass correlation coefficient (ICC) among the examiners was analyzed to quantify the intrarater reliability. Intra-observer variations were analyzed by ANOVA. The agreement rate of the examiners was also calculated. A self-administered questionnaire was completed by students immediately after the OSCE at the end of session. This questionnaire was measured the students\u27 perception of examination attributes, which included the quality of performance, authenticity of the process, and usefulness of the OSCE as an assessment instrument compared to other formats. RESULTS: Intrarater reliability ICC was 0.84 ranged from 0.47 to 0.98. No statistically significant differences were found among the three examiners in all the OSCE items. The overall agreement rate among examiners was 72%. The category of Physical examination (60%) was lower than other categories (Interaction with patients; 78%, Knowledge of examination; 79%). Self-administered questionnaire completed by students was excellent acceptance of the OSCE as an assessment instrument. CONCLUSIONS: The OSCE is credible as a test for the evaluation of basic clinical skill and interaction with patients for physical therapy students. The OSCE experience provides students with a rich resource for defining clerkship-related learning needs. Further study is required to improve performance of objectively assessed clinical skills
