Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school.

PURPOSE: Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing number of students admitted to medical schools, and the necessity of objectively evaluating practical skills. This study aimed at investigating the relationships between OSCE grades and current evaluation modalities. METHODS: Three-hundred seventy-nine 4th-year students of University-of-Paris Medical School participated to the first large-scale OSCE at this institution, consisting in three OSCE stations (OSCE#1-3). OSCE#1 and #2 focused on cardiovascular clinical skills and competence, whereas OSCE#3 focused on relational skills while providing explanations before planned cholecystectomy. We investigated correlations of OSCE grades with multiple choice (MCQ)-based written examinations and evaluations of clinical skills and behavior (during hospital traineeships); OSCE grade distribution; and the impact of integrating OSCE grades into the current evaluation in terms of student ranking. RESULTS: The competence-oriented OSCE#1 and OSCE#2 grades correlated only with MCQ grades (r = 0.19, P<0.001) or traineeship skill grades (r = 0.17, P = 0.001), respectively, and not with traineeship behavior grades (P>0.75). Conversely, the behavior-oriented OSCE#3 grades correlated with traineeship skill and behavior grades (r = 0.19, P<0.001, and r = 0.12, P = 0.032), but not with MCQ grades (P = 0.09). The dispersion of OSCE grades was wider than for MCQ examinations (P<0.001). When OSCE grades were integrated to the final fourth-year grade with an incremental 10%, 20% or 40% coefficient, an increasing proportion of the 379 students had a ranking variation by ±50 ranks (P<0.001). This ranking change mainly affected students among the mid-50% of ranking. CONCLUSION: This large-scale French experience showed that OSCE designed to assess a combination of clinical competence and behavioral skills, increases the discriminatory capacity of current evaluations modalities in French medical schools.

How Drug Use by French Elderly Patients Has Changed During the Last Decade.

BACKGROUND: In France the most recent data on drug use by the elderly living at home were published in 2000. Since then the available drugs and their use have changed. OBJECTIVE: We compared data collected in 2011 with the 2000 data to evaluate how drug use has changed in France. METHODS: The study analysed retrospectively the 2011 data collected prospectively in France from a sample of 600,000 people representative (1/97th) of the French population. All prescribed drugs reimbursed by the French national health insurance were recorded. Due to the reimbursement procedure the unit of analysis was the trimester. The drugs were coded using the Anatomical Therapeutic Chemical (ATC) Classification System. RESULTS: Data from 580,989 patients were analysed (133,411 (23.0 %) aged ≥60 years, 32,314 (5.6 %) ≥80 years). The percentage of patients who used medication increased from 55.9 % for patients in their fourth decade to 88.6 % for patients in their eighth decade, remained stable till 90 years of age and decreased to 26.3 % in centenarians. The median number of drugs prescribed was five (IQR: 3-8) in those aged under 80 years and ten (IQR: 7-14) in those aged over 80 years. Cardiovascular drugs were the most used, by 70.9, 78.1, and 69.6 % of patients aged 70-79, 80-89, and 90-99 years, respectively. Analgesics, non-steroidal anti-inflammatory drugs, and antibiotics were prescribed in almost half of the patients. CONCLUSION: Polypharmacy is common among the elderly in France. Although this may be explained by the multiple co-morbidities, our results suggest an overuse of drugs for which the risk-benefit ratio is unknown in these age ranges. Consequently, numerous elderly patients are exposed to iatrogenic risks without the certainty of therapeutic benefits.