Outcome-based education (OBE) is a major reframing of how medical educators think about teaching, learning, and assessment. There are many alternative versions of OBE and the implications of this framework are not always well-understood. A review of the literature on OBE and an analysis of the educational implications suggest seven areas of contrast with traditional educational frameworks. Key contrasts center around how educational outcomes are defined, the emphasis of learning over teaching, the centrality of rigorous assessment, the need for flexibility and individualization in the curriculum, and shifting roles and responsibilities of teachers and learners. OBE has the potential for dramatic and even revolutionary changes in medical education. However, it carries with it significant challenges that include the expenses of additional assessment, uncertainty among students and faculty about their responsibilities, and complexities in planning and organizing the educational process. Instead, of whole-hearted adoption of the OBE model, most medical schools and residency programsare exploring OBE in small-scale "experiments" that will inform the field about the best ways to incorporate the critical features of OBE into medical education. Such experiments are invaluable for helping us better understand the promise and possibilities of OBE.
Adoption ; Curriculum ; Education, Medical ; Humans ; Internship and Residency ; Learning ; Mental Competency ; Pliability ; Schools, Medical ; Uncertainty

INTRODUCTIONConcerns have been raised in the literature about how well the undergraduate curriculum prepares medical students for residency. An assessment was designed and administered to entering postgraduate residents in surgery to test their preparedness vis-a-vis the competence level expected of them at the beginning of their training. This paper explores the role and place of such an assessment in the medical education continuum.

MATERIALS AND METHODSFaculty members from the Department of Surgery at Bharati Vidyapeeth University Medical College (BVUMC), Pune, India and experts from the Department of Medical Education, University of Michigan Medical School, Ann Arbor designed and administered an assessment based on the multiple-choice question examination (MCQE) and objective structured clinical examination (OSCE) in June 2005 to 24 examinees from 3 different training levels at BVUMC.

RESULTSAll subsections of the MCQE showed significant correlation except the breast and endocrine section. The test showed an overall reliability of 0.8 (Cronbach's alpha). The scores and level of difficulty of the OSCE were inversely related. There was a significant difference in performance between the 3 groups and these differences were more pronounced for more complex tasks, specifically the procedural skills station, where the intern performance was particularly poor. Clinical skills reliability was 0.85. The communication skills score correlated well with the clinical skills score and also showed good reliability. Four out of the 5 new residents had below-satisfactory levels of competence for this level.

CONCLUSIONThis pilot study reveals definite educational gaps in both knowledge and skills among the residents studied. Such an intervention can be very informative, providing immense educational benefit to the learner, faculty and programme, and has an important place in the continuum of medical training.

Clinical Competence ; Education, Medical, Continuing ; standards ; Educational Measurement ; General Surgery ; education ; Humans ; Internship and Residency ; standards ; Licensure, Medical ; standards ; Pilot Projects ; Retrospective Studies

OBJECTIVES: Our school introduced a new curriculum based on faculty-directed, intensive, small-group teaching of clinical skills in the third-year medical students. To examine its effects, we compared the mean scores on an OSCE between the third- and fourth-year medical students. METHODS: Third- and fourth-year students did rotations at the same five OSCE stations. They then completed a brief self-reporting questionnaire survey to examine the degree of satisfaction with new curriculum in the third-year students and clinical practice in the fourth-year students, as well as their perception of confidence and preparedness. We analyzed the OSCE data obtained from 158 students, 133 of whom also completed the questionnaire. RESULTS: Mean OSCE scores on the breast examination and wet smear stations were significantly higher in the third-year group (P < 0.001). But mean OSCE scores of motor-sensory examination and lumbar puncture were significantly higher in the fourth-year group (P < 0.05). The mean OSCE scores had no significant correlation with satisfaction. In addition, the self-ratings of confidence had a high degree of correlation with satisfaction with new curriculum (r = 0.673) and clinical practice (r = 0.692). Furthermore, there was a moderate degree of correlation between satisfaction and preparedness in both groups (r = 0.403 and 0.449). CONCLUSIONS: There is no significant difference in the effect on the degree of clinical performance and confidence between an intensive-small group teaching and a 1-year clinical practice. If combined, intensive small group teaching and clinical practice would be useful to improve the degree of ability and confidence in medical students.
Breast ; Clinical Competence ; Curriculum ; Humans ; Spinal Puncture ; Students, Medical