The dialysis orders objective structured clinical examination (OSCE): A formative assessment for nephrology fellows

Lisa K. Prince, Ruth C. Campbell, Sam W. Gao, Jessica Kendrick, Christopher J. Lebrun, Dustin J. Little, David L. Mahoney, Laura A. Maursetter, Robert Nee, Mark Saddler, Maura A. Watson, Christina M. Yuan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background:Few quantitative nephrology-specific simulations assess fellow competency. We describe the development and initial validation of a formative objective structured clinical examination (OSCE) assessing fellow competence in ordering acute dialysis. Methods: The three test scenarios were acute continuous renal replacement therapy, chronic dialysis initiation in moderate uremia and acute dialysis in end-stage renal disease-associated hyperkalemia. The test committee included five academic nephrologists and four clinically practicing nephrologists outside of academia. There were 49 test items (58 points). A passing score was 46/58 points. No item had median relevance less than 'important'. The content validity index was 0.91. Ninety-five percent of positive-point items were easy-medium difficulty. Preliminary validation was by 10 board-certified volunteers, not test committee members, a median of 3.5 years from graduation. The mean score was 49 [95% confidence interval (CI) 46-51], j=0.68 (95% CI 0.59-0.77), Cronbach's a=0.84. Results: We subsequently administered the test to 25 fellows. The mean score was 44 (95% CI 43-45); 36% passed the test. Fellows scored significantly less than validators (P<0.001). Of evidence-based questions, 72% were answered correctly by validators and 54% by fellows (P=0.018). Fellows and validators scored least well on the acute hyperkalemia question. In self-assessing proficiency, 71% of fellows surveyed agreed or strongly agreed that the OSCE was useful. Conclusions: The OSCE may be used to formatively assess fellow proficiency in three common areas of acute dialysis practice. Further validation studies are in progress.

Original languageEnglish
Pages (from-to)149-155
Number of pages7
JournalClinical Kidney Journal
Issue number2
StatePublished - 1 Apr 2018
Externally publishedYes


  • Dialysis
  • Education
  • Fellowship
  • Nephrology
  • Objective structured clinical examination
  • Testing


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