Conducting an Objective Structured Clinical Examination under COVID-Restricted Conditions

Abstract Background The administration of performance assessments during the coronavirus disease of 2019 (COVID-19) pandemic posed many challenges, especially for examinations employed as part of certification and licensure. The National Assessment Collaboration (NAC) Examination, an Objective Structured Clinical Examination (OSCE), was modified during the pandemic. Reliability and validity evidence for the modified NAC Examination is presented. This paper outlines validity and reliability evidence for modifications required due to significant interruptions or changes to OSCEs. Methods Cronbach’s alpha, decision consistency, and accuracy values were calculated to quantify measurement error. Validity evidence includes comparisons of scores and sub-scores for demographic groups: gender (male vs female), type of International Medical Graduate (IMG) (Canadians Studying Abroad (CSA) vs non-CSA), postgraduate training (PGT) (no PGT vs PGT), and language of examination (English vs French). Criterion relationships were summarized using correlations within and between NAC Examination and the Medical Council of Canada Qualifying Examination (MCCQE) Part I scores. Results Reliability estimates were consistent with other OSCEs similar in length and previous NAC Examination administrations. Both total score and sub-score differences for gender were statistically significant. Total score differences by type of IMG and PGT were not statistically significant, but sub-score differences were. Administration language was not statistically significant for either the total scores or sub-scores. Correlations were all statistically significant with some relationships being small or moderate (0.20 to 0.40) or large (> 0.40). Conclusions The NAC Examination yields reliable total scores and pass/fail decisions, expected differences in total scores and sub-scores for defined groups were consistent with previous literature, and internal relationships amongst NAC Examination sub-scores and their external relationships with the MCCQE Part I supported both discriminant and criterion-related validity arguments. Modifications to OSCEs to address health restrictions can be implemented without compromising the overall quality of the assessment. This study outlines some of the validity and reliability analyses for OSCEs that had major modifications and interruptions.