Assessing patient safety competencies using Objective Structured Clinical Exams: a new twist on an old tool.

To cite: Stroud L, Vidyarthi AR. BMJ Qual Saf Published Online First: [please include Day Month Year] doi:10.1136/bmjqs-2015003928 Despite the widespread attention to patient safety over the past 15 years, the subject continues to receive relatively little attention in undergraduate training for health professionals (eg, in medical and nursing schools). Recent advances such as the WHO curriculum guide and the Canadian Patient Safety Institute competency framework 2 help to guide our teaching and learning. Furthermore, some schools have implemented patient safety curricula. 4 However, evaluating the degree to which students attain these competencies remains in its infancy (‘On a scale of 1–5, rate how well you did X’), with all the limitations of self-assessment. In an effort to progress the field further, Ginsburg et al describe the findings of a pilot that used the Objective Structured Clinical Exam (OSCE) to assess patient safety competence. The OSCE provides a mechanism to move beyond assessing a learner’s knowledge to its application by allowing the learner to show how they approach a scenario in a simulated setting. As such, it has largely become the cornerstone for the assessment of skills such as history taking, physical examination and even hand hygiene. Ginsburg et al used the OSCE to assess sociocultural patient safety competencies, which is a novel application of this traditional tool. The authors created scenarios true to inpatient ward settings for the simulation, which they used to provide and report summative learner assessments. Although they note, and we agree, that a high stakes summative assessment in patient safety competencies may drive what is taught and learned, evidence suggests that students perceive summative OSCEs as ineffective for learning. They also do not successfully apply the feedback provided in these settings. With this knowledge, and leveraging the real-world aspect of the OSCE scenarios, the experience Ginsburg et al created is ripe for formative assessment and learning. By making this OSCE a formative exercise, it opens the door to interactions between faculty and learner with immediate feedback. This feature not only facilitates development of the OSCE tool, but also makes possible real-time learning and may even contribute to behaviour change. Thus, in addition to providing summative feedback, the assessment may itself enhance patient safety education overall. Ginsburg et al also analysed their assessments by profession and found that medical students performed better than nursing students. Should we be surprised that they performed differently? Individuals from different health professions enact various functions, receive diverse training, and are acculturated into their professional roles. Consequently, such differences in performance are expected. A patient safety OSCE involving clinical scenarios more often encountered in nursing would likely elicit superior performance from nursing students. Thus, this aspect of the study’s findings should not receive much attention. The pilot study was designed to assess the suitability of the assessment tool for different health professionals, not to compare the relative performance of these different professions. In its novelty, this study also raises an interesting paradox as it assesses individual performance with respect to competencies demonstrated through interactions with others. Socio-cultural competencies, such as communication and teamwork, are heavily entrenched in the interactions EDITORIAL