Standardized and quality-assured video-recorded examination in undergraduate education: informed consent prior to surgery

Abstract

Background: Communication skills combined with specialized knowledge are fundamental to the doctor-patient relationship in surgery. During a single-station video-recorded objective structured clinical examination (VOSCE), students were tasked with obtaining informed consent. Our aim was to develop a standardized and quality-assured assessment method in undergraduate education. Methods: One hundred fifty-five students in their fifth year of medical school (78 videos) participated in a summative VOSCE within the framework of the teaching module "Operative Medicine." They prepared for three clinical scenarios and the surgical procedures involved. The examination comprised participants having to obtain informed consent from simulated patients, video recording their performance. Students were assessed by two independent raters, the background of one of whom was nonsurgical. Results were statistically tested using SPSS. Results: Students' scores were all beyond the pass mark of 70%, averaging 91.0% (+/- 4.0%), 88.4% (+/- 4.4%), and 87.0% (+/- 4.7%) for the appendectomy, cholecystectomy, and inguinal hernia repair checklist, respectively. Most items (68%-89% of the checklists) were found to have fair to excellent discrimination values. Cronbach's alpha values ranged between 0.565 and 0.605 for the individual checklists. Interrater agreement was strong (Pearson correlation coefficient = 0.80, P < 0.01; intraclass correlation coefficient 2.1 = 0.78). Conclusions: The VOSCE is both feasible and reliable as a method of assessing student communication skills and the application of clinical knowledge while obtaining informed consent in surgery. This method is efficient (flexible rating outside normal working hours possible with reductions in administrative load) and may be used for high-stakes evaluation of student performance. (C) 2014 The Authors. Published by Elsevier Inc. All rights reserved.