Send to

Choose Destination
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

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



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.


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.


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.


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


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

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center