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Clin Kidney J. 2018 Apr;11(2):149-155. doi: 10.1093/ckj/sfx082. Epub 2017 Aug 23.

The dialysis orders objective structured clinical examination (OSCE): a formative assessment for nephrology fellows.

Author information

1
Nephrology Division, Walter Reed National Military Medical Center, Bethesda, MD, USA.
2
Nephrology Division, Medical University of South Carolina, Charleston, SC, USA.
3
Nephrology Division, Portsmouth Naval Medical Center, Portsmouth, VA, USA.
4
Department of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA.
5
Department of Internal Medicine, Baptist Memorial Hospital, Golden Triangle, Columbus, MS, USA.
6
Nephrology Associates, Fairfax, VA, USA.
7
Nephrology Division, University of Wisconsin, Madison, WI, USA.
8
Nephrology Associates, Mercy Regional Medical Center, Durango, CO, USA.

Abstract

Background:

Few quantitative nephrology-specific simulations assess fellow competency. We describe the development and initial validation of a formative objective structured clinical examination (OSCE) assessing fellow competence in ordering acute dialysis.

Methods:

The three test scenarios were acute continuous renal replacement therapy, chronic dialysis initiation in moderate uremia and acute dialysis in end-stage renal disease-associated hyperkalemia. The test committee included five academic nephrologists and four clinically practicing nephrologists outside of academia. There were 49 test items (58 points). A passing score was 46/58 points. No item had median relevance less than 'important'. The content validity index was 0.91. Ninety-five percent of positive-point items were easy-medium difficulty. Preliminary validation was by 10 board-certified volunteers, not test committee members, a median of 3.5 years from graduation. The mean score was 49 [95% confidence interval (CI) 46-51], κ = 0.68 (95% CI 0.59-0.77), Cronbach's α = 0.84.

Results:

We subsequently administered the test to 25 fellows. The mean score was 44 (95% CI 43-45); 36% passed the test. Fellows scored significantly less than validators (P < 0.001). Of evidence-based questions, 72% were answered correctly by validators and 54% by fellows (P = 0.018). Fellows and validators scored least well on the acute hyperkalemia question. In self-assessing proficiency, 71% of fellows surveyed agreed or strongly agreed that the OSCE was useful.

Conclusions:

The OSCE may be used to formatively assess fellow proficiency in three common areas of acute dialysis practice. Further validation studies are in progress.

KEYWORDS:

dialysis; education; fellowship; nephrology; objective structured clinical examination; testing

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