D Boudreau, R Tamblyn and L Dufresne
Department of Medicine, McGill University, Montreal, Quebec, Canada.

An essential component of competency in respiratory medicine is the acquisition of consultative skills. The American Board of Internal Medicine (ABIM) and other certification bodies have recommended a greater emphasis on the evaluation of clinical skills by direct observation. In this study, consultative abilities are assessed using the format of an objective structured clinical examination (OSCE). A six-case, 160-min-long, examination was administered to three groups of physicians: faculty members, respiratory residents, and junior residents in internal medicine. The overall quality of the consultations was significantly better for the attending physicians when compared with the junior residents, and there was a systematic trend for the quality to improve with increased training. The educational value of the consultation improved significantly with the level of training. There was a tendency for physicians with greater experience to report less of the findings from the history and physical on their consultations. Patient satisfaction, as measured by the standardized patients using an ABIM patient satisfaction questionnaire, did not differ between groups of examinees. The test reliability for the overall quality of consultation score was 0.65. The reliability of a 14-station exam was estimated to be 0.81. This exam proved to be a useful, valid, and moderately reliable tool for assessing the consultative skills of physicians and could prove to be of benefit to clinical training programs.