ABSTRACT
The traditional assessment of clinical competence since time immemorial consisted of bedside oral examinations, ward observations, casual conversations between clinical teachers and students, and chart audits. Multiple-choice questions which provide objective measurements of biomedical knowledge primarily at the lower levels of Bloom’s taxonomy are too superficial and lack ecological validity and are also disconnected from the real clinical context between patients and physicians. Clinical competence involves a complex interplay between attributes displayed within the physician–patient encounters which enable physicians to effectively deliver care. The objective structured clinical exams (OSCEs) concentrates on skills, clinical reasoning, and attitudes; to a lesser degree, basic knowledge. Most OSCEs utilize standardized patients, who are typically actors trained to depict the clinical problems and presentations of real issues commonly taken from real patient cases. Generalizability theory, though underemployed, has an important place in performance-based measurement particularly when OSCEs are employed.
