Marina Sawdon¹
Lucy Ambrose¹
1 University of York, Hull York Medical School 

Background
The Objective Structured Long Examination Record (OSLER) assesses clinical skills in an integrated manner (1). It is longer in duration and uses real patients and therefore more closely simulates a real clinical encounter. However, OSLERs may suffer lower reliability than OSCEs due to fewer cases, assessor variability and the use of different patients. 

Summary of work
In preparation for the upcoming national licence assessment in the UK, we aimed to improve the reliability of our 6 station OSLER by clinical examiner training and calibration, incorporating standardised stations using simulated patients while retaining some real patient stations, and providing standardised examiner questions. In addition, we have introduced a conjunctive standard of a minimum level of competence in each clinical competency domain assessed. Candidates are assessed in 5 clinical competency domains in all stations. 

Results
Following the changes described we have seen an increase in the reliability of the OSLER from 0.636 to 0.803. The conjunctive standard will be introduced in the current academic year and will be described in the presentation. 

Discussion
We have seen a 20% increase in reliability after introducing more rigorous clinical examiner training and calibration exercises, incorporating some common, standardised cases across all students, and standardised examiner questions. 

Conclusions
We have demonstrated that the reliability of OSLERs can be improved and further standardised whilst maintaining authenticity. Implementation of the conjunctive standard described is innovative, has face validity, and avoids compensation between competencies. 

Take home message
We have shown that the OSLER can be a reliable method for assessing the clinical competencies required to become a Foundation Doctor, it is authentic, and holistic, and with the addition of the conjunctive method described will increase public confidence that our graduates are all round competent doctors. 

References (maximum three) 

1. Gleeson FA (1997) Assessment of clinical competence using the objective structured long examination record (OSLER). Medical Teacher. 19: 7-14