The structure of medical competence and results of an OSCE

BACKGROUND: Medical competence is a central concept in medical education. Educational efforts in medical training are directed at the achievement of a maximal medical competence. The concept of the structure of medical competence (multidimensional or one-dimensional with strongly interrelated competences) therefore affects the educational developments and assessment procedures.

PURPOSE: To examine the applicability of a one or more dimensional character of medical competence in student assessments, by analysing the results of 356 students in the history taking station of an objective structured clinical examination (OSCE), in relation to other assessment procedures.

METHODS: The performances of 356 students in a history taking station of an OSCE were analysed. Analyses of the checklist scores were aimed at the dimensionality of history taking skills. External criteria were used to test the validity of the scores on the checklist.

RESULTS: The analyses of the scores on the history taking checklist indicated at least five dimensions of history taking skills: the frequency of patient-centred skills, the quality of performance of patient-centred skills, complaint-oriented skills, general social skills, and the provision of procedural information.

CONCLUSION: Medical competence, as a subject of assessment, can be seen as a multifaceted construct. This study shows that history taking alone might be composed of five different dimensions, suggesting that medical competence in respect of assessment might be viewed as a multifaceted construct which in that sense has implications for the assessment of medical competence.