Article Text

Development and testing of an objective structured clinical exam (OSCE) to assess socio-cultural dimensions of patient safety competency
  1. Liane R Ginsburg1,
  2. Deborah Tregunno2,
  3. Peter G Norton3,
  4. Sydney Smee4,
  5. Ingrid de Vries4,
  6. Stefanie S Sebok5,
  7. Elizabeth G VanDenKerkhof6,
  8. Marian Luctkar-Flude2,
  9. Jennifer Medves2
  1. 1School of Health Policy & Management, York University, Toronto, Ontario, Canada
  2. 2School of Nursing, Queen's University, Kingston, Ontario, Canada
  3. 3Department of Family Medicine (Emeritus), University of Calgary, Calgary, Canada
  4. 4Medical Council of Canada, Ottawa, Ontario, Canada
  5. 5Faculty of Education, Queen's University, Kingston, Ontario, Canada
  6. 6Department of Anesthesiology and Perioperative Medicine, School of Nursing, Queen's University, Kingston, Ontario, Canada
  1. Correspondence to Dr Liane R Ginsburg, School of Health Policy & Management, HNES Bldg. Rm. 413, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3; lgins{at}


Background Patient safety (PS) receives limited attention in health professional curricula. We developed and pilot tested four Objective Structured Clinical Examination (OSCE) stations intended to reflect socio-cultural dimensions in the Canadian Patient Safety Institute's Safety Competency Framework.

Setting and participants 18 third year undergraduate medical and nursing students at a Canadian University.

Methods OSCE cases were developed by faculty with clinical and PS expertise with assistance from expert facilitators from the Medical Council of Canada. Stations reflect domains in the Safety Competency Framework (ie, managing safety risks, culture of safety, communication). Stations were assessed by two clinical faculty members. Inter-rater reliability was examined using weighted κ values. Additional aspects of reliability and OSCE performance are reported.

Results Assessors exhibited excellent agreement (weighted κ scores ranged from 0.74 to 0.82 for the four OSCE stations). Learners’ scores varied across the four stations. Nursing students scored significantly lower (p<0.05) than medical students on three stations (nursing student mean scores=1.9, 1.9 and 2.7; medical student mean scores=2.8, 2.9 and 3.5 for stations 1, 2 and 3, respectively where 1=borderline unsatisfactory, 2=borderline satisfactory and 3=competence demonstrated). 7/18 students (39%) scored below ‘borderline satisfactory’ on one or more stations.

Conclusions Results show (1) four OSCE stations evaluating socio-cultural dimensions of PS achieved variation in scores and (2) performance on this OSCE can be evaluated with high reliability, suggesting a single assessor per station would be sufficient. Differences between nursing and medical student performance are interesting; however, it is unclear what factors explain these differences.

  • Patient safety
  • Health professions education
  • Teamwork

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