How was the TOSCE tool first developed?
The Objective Structured Clinical Evaluation (OSCE) was developed in the late 1970’s and has become the criterion standard for the assessment of clinical competence in undergraduate medical training programs (Harden & Gleason, 1979). The OSCE uses a sampling strategy within which students encounter multiple patients, perform multiple tasks, and are assessed by multiple evaluators. The OSCE has been so successful in providing reliable and valid assessment that its principles have been used to make licensing decisions in the Canadian medical, chiropractic, pharmacy, and physiotherapy professions and given yield to multiple “progeny” including video-based assessment and making admissions decisions for professional programs. Students, residents and fellows have found the OSCE to be a useful tool for both education and clinical competencies assessment purposes. (Bagri et al, 2009; Wagner et al, 2009; Varkey et al, 2008).
As a result of growing interest in patient safety initiatives and interprofessional collaboration and education (IPC, IPE) educators at McMaster University and the University of Ottawa began exploring new and innovative ways of introducing and evaluating interprofessional skills and competencies within the medical school curriculum. Based on the OSCE experience and limited team-based assessment literature (Singleton et al, 1999; Morison & Stewart, 2005) these educators decided to develop a team-based OSCE. A small set of palliative care focussed Team OSCEs (TOSCEs) were developed and have been delivered to medical students and other health professional students at McMaster since January 2007 (Marshall et al, 2008).
These TOSCEs consist of health care team encounters in a mock clinical setting. Team members work through a commonly-encountered clinical presentation that requires the team to work together to develop a care plan. Interprofessional evaluators are present to assess team and interprofessional collaboration skills as well as the critical palliative care skills necessary for each station. Feedback is an integral part of the process and is provided to the students at the end of each station. Preliminary feasibility and acceptability research of the TOSCE tool used with students has been conducted (Marshall et al, 2008) and further research is in progress (Hall et al, unpublished).
"Collaboration is still a fairly new concept in primary care and just like any new skill; I believe it needs to be practiced if we expect improvement. Any opportunity to collaborate as a team could be a valuable learning experience for everyone involved and should ultimately help to enhance patient care. I believe many teams within the FHT could benefit from this type of exercise."
— Quote from TOSCE observer