Can standardized patients replace physicians as OSCE examiners?

This was a cross-sectional study of third-year medical students undergoing an OSCE during the Internal Medicine clerkship rotation. Fifty-two students rotated through 8 stations (6 physician, 2 SP examiners). Statistical tests used were Pearson's correlation coefficient, two-sample t-test, effect size calculation, and multiple linear regression.Most students reported that SP stations were less stressful, that SP were as good as physicians in giving feedback, and that SP were sufficiently trained to judge clinical skills. SP scored students higher than physicians (mean 90.4% +/- 8.9 vs. 82.2% +/- 3.7, d = 1.5, p < 0.001) and there was a weak correlation between the SP and physician scores (coefficient 0.4, p = 0.003). Physician scores were predictive of summative MCQE scores (regression coefficient = 0.88 [0.15, 1.61], P = 0.019) but there was no relationship between SP scores and summative MCQE scores (regression coefficient = -0.23, P = 0.133).These results suggest that SP examiners are acceptable to medical students, SP rate students higher than physicians and, unlike physician scores, SP scores are not related to other measures of competence.The objective structured clinical examination (OSCE) is now a commonly used method of assessing clinical competence of medical students and practicing physicians in such areas as history taking, physical examination, diagnostic reasoning and management [1,2]. Compared to written evaluations the OSCE format attempts to increase the examination fidelity by more closely simulating realistic clinical problems or scenarios, and has been shown to have both reliability and construct validity as an evaluation tool [3]. Competence on the OSCE should, therefore, identify students who will subsequently perform well in similar "real life" clinical situations (i.e., competence provides the capacity to perform).Standardized patients (SP) are increasingly being used in place of 'real' patients for the OSCE as they provide a consistent clini