Introducing the Objective Structured Clinical Examination (OSCE) in the undergraduate psychiatric curriculum: evaluation after one year.

OBJECTIVE: The Objective Structured Clinical Examination (OSCE) was introduced in undergraduate psychiatry clerkship in 2008. The authors studied the effect of OSCE on the students' performance. METHODS: The ″short case″ (SC) and ″oral examination″ (OE), two of the five components of the previous assessment format, were replaced with the OSCE. Results were compared with those of the 2007 students. RESULTS: The introduction of the OSCE had little impact on the overall scores, but the 2007 students had significantly higher scores on the essay examination and long case, whereas the 2008 group had significantly higher scores on the OSCE (versus the OE for the 2007 group). In comparing the top 10 scoring students from the two classes, the 2007-year students had significantly higher overall scores, both on end-of-course tests and the annual examinations. In particular, the scores for the OSCE exams for the 2008 class were significantly lower than the scores for the OE in the 2007 class. CONCLUSION: The higher scores on OSCE in Year 2008 suggest that students performed better on clinical skills and professional development than recall on the factual-knowledge domains. Since the changes were introduced in the year 2008, the comparison can best be regarded as qualitative, and it is probably too early to judge the impact of the OSCE. Further studies to determine validity of the OSCE are needed.

Factors associated with hospital service satisfaction in a sample of Arab subjects with schizophrenia.

BACKGROUND: Assessment of patients' satisfaction with health care services could help to identify the strengths and weaknesses of the system and provide guidance for further development. The study's objectives were to: (i) assess the pattern of satisfaction with hospital care for a sample of people with schizophrenia in Kuwait, using the Verona Service Satisfaction Scale (VSSS-EU); ii) compare the pattern of satisfaction with those of similar studies; and iii) assess the association of VSSS seven domains with a number of variables representing met and unmet needs for care, family caregiver burden, severity of psychopathology, level of psychosocial functioning, socio-demographic characteristics, psychological well-being and objective quality of life. METHODS: Consecutive outpatients in stable condition and their family caregivers were interviewed with the VSSS-EU and measures of needs for care, caregiver burden, quality of life and psychopathology. RESULTS: There were 130 patients (66.1%m, mean age 36.8). While over two-thirds expressed satisfaction with the domains of "overall satisfaction", "professionals' skills", "access", "efficacy", and "relatives' involvement", only about one-third were satisfied with the domains of "information" and "types of intervention". The later two domains were the areas in which European patients had better satisfaction than our patients, while our patients expressed better satisfaction than the Europeans in the domain of "relatives' involvement". In multiple regression analyses, self-esteem, positive and negative affect were the most important correlates of the domains of service satisfaction, while clinical severity, caregiver burden and health unmet needs for care played relatively minor roles. CONCLUSION: The noted differences and similarities with the international data, as well as the predictive power of self-esteem and affective state, support the impression that patients' attitudes towards psychiatric care involve a complex relationship between clinical, personal and socio-cultural characteristics; and that many of the factors that impact on satisfaction with service relate to individual psychological characteristics. The weaknesses in the system, highlighted by the pattern of responses of the participants, indicate possible gaps in the provision of comprehensive psychiatric care in the country and obviate the need for public mental health education and development of services to enhance the quality of care.