Journal of General Practice

Using a Yellow Card in the Objective Structured Clinical Exam: Does it Add to the Identification of Problem Postgraduate Trainees in General Practice: An Exploratory Study to Identify High Risk Trainees

Abstract

Birgitte Schoenmakers and Lynn Ryssaert

Background: The Objective Structured Clinical Examination was designed 30 years ago by Harden ea. It is used to assess various components of medical competence. The OSCE is considered as a reliable and objective tool to evaluate clinical competences in standardized patient encounters. Although, reliability, validity and reproducibility an OSCE remain subject of debate. These days the question arises if a compensatory or an additional rating is advisable for the final pass-fail decision. Aim: The aim of the study is to add to the identification of high risk postgraduate trainees in general practice by means of ‘a yellow card system’ (red flagging). Method: During 8 OSCE-sessions, including 354 GP-trainees, observers were asked to deal a yellow card in case of ‘alarming performance’. These acts were defined as dramatic or dangerous shortcomings on three levels: theoretical, practical and behavioral level. Result: During three academic years, involving 354 trainees, only 41 yellow cards were dealt. One single observer was responsible for one quarter of all allocations. During two sessions half of all cards were dealt. Trainees remembered with a yellow card were more likely to underperform on all assessments except on the internship. During their internships, trainees with a yellow card did not show remarkable or alarming behavior. Conclusion: Flagging alarming events during the OSCE does not identify high risk trainees. The idea of ‘flagging’ is not be abandoned but moved to other assessment situations