Clinical competencies of students in urgent and emergency care: evolutive analysis through OSCE

Abstract: Introduction: One of the major challenges in evaluating medical education is measuring practical skills, crossing the limits of theoretical knowledge. The Objective Structured Clinical Examination (OSCE) is an alternative for active and standardized assessment of clinical competencies. Despite its growing implementation, longitudinal studies that support its evaluative potential are still scarce. Objective: To analyze the learning curve of medical students based on continuous assessment of their OSCE exams and individual performances within the discipline of Urgent and Emergency Care. Method: This retrospective study is based on the analysis of data taken from assessment checklists from three consecutive OSCEs applied to sixth-year Brazilian medical students within the Urgent and Emergency Care program of the 2019 academic year. Result: 270 assessment sheets from a total of 90 students were analyzed. The group was made up of 51 females (56.7 percentage points) and 69 of the students (or 76.7 percentage points) were aged between 23 and 26 years old. Between the first and third OSCE, 67 students (74.4 percentage points) increased their final grade, the median of which increased by an average of 1.5 points. Of the four medical components evaluated - conduct, recognition, interaction and follow-up - there was an improvement of 15.5 percentage points in correct conduct, zero impact on the results concerning recognition and drops of 19.4 and 16.1 percentage points in the areas of communication and follow-up, respectively. Conclusion: The study points to an increasing curve in OSCE scores, suggesting an increase in general learning in Urgent and Emergency Care over the course of the year. However, careful analysis of the components reveals different performance curves. Since it is not possible to presume the causes of these counterpoints, further studies in the area are suggested.摘要： 引言：医学教育评估的核心挑战之一在于如何衡量实践技能，突破仅考核理论知识的局限。客观结构化临床考试（Objective Structured Clinical Examination，OSCE）是实现临床能力主动化、标准化评估的可选方案。尽管其应用范围不断扩大，但支持其评估效能的纵向研究仍较为稀缺。 目的：本研究旨在通过对急诊医学学科内医学生的连续OSCE考试与个体表现进行持续评估，分析医学生的学习曲线。 方法：本回顾性研究分析了2019学年急诊医学项目中，针对巴西六年级医学生开展的三轮连续OSCE考试的评估检查表数据。 结果：本研究共分析了90名学生的270份评估表。该群体包含51名女性（占比56.7%），其中69名学生（占比76.7%）年龄介于23至26岁之间。在首次至第三次OSCE考试期间，67名学生（占比74.4%）的最终成绩有所提升，成绩中位数平均提高1.5分。在所评估的四项医学能力维度——诊疗行为、病情识别、沟通互动与后续跟进中，正确诊疗行为的占比提升了15.5个百分点，病情识别维度的成绩无显著变化，而沟通互动与后续跟进领域的得分占比分别下降19.4和16.1个百分点。 结论：本研究显示OSCE总成绩呈上升趋势，提示本学年急诊医学的整体学习效果有所提升。然而，对各能力维度的细致分析则揭示了差异化的表现曲线。由于无法明确这些反向变化的成因，建议该领域开展进一步的相关研究。