Objective structured clinical examination and board certification in anesthesiology.

4 January 2014 M ILLER’S Pyramid of Assessment, the well-recognized and widely used model for the development and assessment of medical competence, defines four stages of capability: “knows,” “knows how,” “shows how,” and “does.”1 Each stage builds on the prior and each stage requires specific assessment tools. Nearly 4 decades of experience with the Objective Structured Clinical Examination (OSCE) has amassed substantial evidence of the usefulness of this approach in testing higher levels of competency.2–4 The American Board of Anesthesiology (ABA) recently announced its intent to add the OSCE to enhance the part 2 (oral) board examination for primary certification of physicians in anesthesiology beginning in 2017.* In this issue of ANESthESIOLOgy, hastie et al.5 review the history of the development of the OSCE, its current application in medical education, and its limited use in assessing anesthesiologists and warn that careful assessment of validity and reliability is essential to assure that the examination is sound. In the paragraphs that follow we present a brief discussion on why the ABA is incorporating the OSCE into the primary board certification process and how the Board is working to assure that the new examination is methodically developed and thoroughly evaluated to ensure that it adds a valid measure of competence to the current certification process. In the field of anesthesiology, there is evidence that use of the OSCE for assessment of physicians captures information about examinees that is not captured by either written or oral examinations. Examinees that do well on written and oral tests do not necessarily do well in OSCE evaluations, and vice versa.6 heretofore, assessment of physician performance in the clinical setting has been largely a subjective process. Use of standardized anesthesia OSCE performance offers hope of greater objectivity and has demonstrated excellent inter-rater reliability.7,8 The Israeli Board of Anesthesiology has used OSCEs as part of its board certification process since April 2003.9–11 The Israeli Board of Anesthesiology examination incorporates five 15-min, hands-on simulationbased examination stations in OSCE format: trauma management, resuscitation, operating room crisis management, mechanical ventilation, and regional anesthesia. The Israeli Board of Anesthesiology has closely examined candidate satisfaction and validity of its OSCEs, demonstrating overall examinee satisfaction and good inter-rater reliability in use of the OSCE format.10 In the United Kingdom, the Royal College of Anaesthetists has used the OSCE as an integral part of its examination process for nearly a decade.† The OSCE portion of assessment by the Royal College of Anaesthetists includes evaluation in 16 different OSCE stations, including: resuscitation, Objective Structured Clinical Examination and Board Certification in Anesthesiology