Cost Analysis of Objective Structured Clinical Examinations

BACKGROUND: The costs of objective structured clinical examinations (OSCEs) and other patient-centered examinations have not been well established. The published literature contains cost estimates ranging from 21 to over 1, 000 per examinee. This wide range in cost estimates is due in part to both a lack of a consistent definition as to what should be included as an expense and a lack of understanding of how these expenses can be minimized. METHOD: In 1993-94 the authors conducted a literature review and defined and subcategorized costs related to the production and implementation of an OSCE into costs for personnel, standardized patients (SPs), and administration. An analysis was undertaken of how each of the subcategory costs can be minimized. RESULTS: Costs for physicians, patient trainers, support personnel, and data analysis are negligible if the personnel who perform these duties do so as part of their overall academic responsibilities. Costs for SPs can be minimized by developing a cadre of experienced patients as well as professional personnel who participate in a comprehensive program in which SPs are used in both teaching and evaluative modes. This contributes to the development of a psychometrically valid OSCE with a minimum number of stations and decreased costs. Administrative costs are fixed and not amenable to significant cost saving. A detailed cost analysis of a comprehensive OSCE given at the end of an Introduction to Clinical Medicine course at one institution is presented, illustrating the practical aspects of these cost-containment methods. CONCLUSION: Based on these considerations it appears financially feasible for an individual academic institution to develop and implement an OSCE.