Large-scale use of an objective, structured clinical examination for licensing family physicians.

Since 1988 in Quebec the completion of a residency training program in family medicine or a specialty and of a comprehensive examination has been necessary to obtain a licence. An objective, structured clinical examination (OSCE) was designed by the Corporation professionnelle des médecins du Québec and Quebec's four medical schools to evaluate the clinical competence of newly trained family physicians. The certification examination of the College of Family Physicians of Canada was added to the OSCE. More than 500 candidates have been assessed: 262 in the spring of 1990, 42 in the fall of 1990 and 235 in the spring of 1991. The spring session occurs in four centres, three offering it in French and one in English, and the fall session takes place in one bilingual centre. In each centre 25 standardized patients and 25 examiners are required on each day of the 2-day OSCE. The scores obtained by the candidates who completed the OSCE in the first three sessions showed a normal distribution. No more than 5% failed the OSCE, the pass level having been set at two standard deviations below the mean. Equivalence was shown among the OSCE tracks, and reliability coefficients of 0.644, 0.723 and 0.736 were obtained for the three sessions respectively. The overall success rate for the licensing examination was 92%. The integration of such a large-scale OSCE into a licensing examination and the results obtained show that assessment of clinical competence for licensing purposes is feasible. The Quebec experience may help other organizations that are developing OSCEs for summative purposes.