gms | German Medical Science

Fragestellung/Einleitung: Oral exams are commonly used in medical faculties for assessment of students’ knowledge of human anatomy. At the University Medical Centre in Hamburg-Eppendorf, unstructured oral exams have been used for decades and the student’s performance was generally rated as pass or fail. The reliability of these exams has never been analysed systematically and has been questioned by students several times. In order to judge the competence of students in a more differentiated manner, we have developed a new kind of structured oral exam that allows for rating the students’ performance on a scale from 0-20. In this study we compare our structured oral exams with unstructured ones with respect to their reliability and feasibility for our newly developed integrated medical curriculum (iMED).

Methoden: We have developed structured oral exams (SOE) for the anatomy of the musculoskeletal system that cover the entire spectrum of learning objectives. SOEs were designed to assess factual knowledge as well as different levels of functional understanding of the musculoskeletal system. To measure the reliability of the assessment formats we have compared the results of SOEs, unstructured oral exams (OE) and written tests with multiple choice questions (MCQ) that all cover equivalent anatomical topics in a randomized crossover study. For better comparison, the OEs were graded in the fashion that is used in all major medical exams in Germany. Furthermore we have evaluated the students’ opinion on each kind of exam.

Ergebnisse: We could show that structured oral exams were more reliable than unstructured ones when compared to multiple choice tests. Furthermore, an evaluation of the student’s opinion revealed that the influence on the grade by the examiner appeared less in structured oral exams compared with unstructured ones. However, students experienced a higher level of time constraint in SOEs.

Diskussion/Schlussfolgerung: SOEs are more reliable than conventional OEs for assessment of students’ performance in anatomy. They allow for a more differentiated grading of students performance which implies a higher level of fairness in these exams. A comparison of the different examiners revealed that experienced anatomists and novice docents rated the students at the same level in SOEs further strengthening the aspect of fairness of SOEs. We propose that SOEs are a feasible and more reliable alternative to conventional OEs and therefore are suited for a differentiated grading of students performance.