Performance of an Objective Structured Clinical Examination in a National Certification Process of Trainees in Rheumatology

array:24 ["pii" => "S2173574315000064" "issn" => "21735743" "doi" => "10.1016/j.reumae.2015.01.002" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "730" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2015;11:215-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1329 "formatos" => array:3 [ "EPUB" => 68 "HTML" => 934 "PDF" => 327 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X14002186" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2014.10.007" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "730" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2015;11:215-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4870 "formatos" => array:3 [ "EPUB" => 186 "HTML" => 3259 "PDF" => 1425 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Desempeño del examen clínico objetivo estructurado como instrumento de evaluación en la certificación nacional como reumatólogo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "215" "paginaFinal" => "220" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Performance of an objective structured clinical examination in a national certification process of trainees in rheumatology" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1056 "Ancho" => 3150 "Tamanyo" => 199940 ] ] "descripcion" => array:1 [ "es" => "Correlación entre ambas pruebas, la evaluación teórica y del examen clínico objetivo estructurado en 2013 y 2014." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Virginia Pascual Ramos, Gabriel Medrano Ramírez, Eunice Solís Vallejo, Ana Guilaisne Bernard Medina, Diana Elsa Flores Alvarado, Margarita Portela Hernández, Lilia Andrade Ortega, Olga Vera Lastra, Rolando Espinosa Morales, Juan Manuel Miranda Limón, María del Rocío Maldonado Velázquez, Luis Javier Jara Quezada, Luis Manuel Amezcua Guerra, Judith López Zepeda, Miguel Ángel Saavedra Salinas, Cesar Alejandro Arce Salinas" "autores" => array:16 [ 0 => array:2 [ "nombre" => "Virginia" "apellidos" => "Pascual Ramos" ] 1 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Medrano Ramírez" ] 2 => array:2 [ "nombre" => "Eunice" "apellidos" => "Solís Vallejo" ] 3 => array:2 [ "nombre" => "Ana Guilaisne" "apellidos" => "Bernard Medina" ] 4 => array:2 [ "nombre" => "Diana Elsa" "apellidos" => "Flores Alvarado" ] 5 => array:2 [ "nombre" => "Margarita" "apellidos" => "Portela Hernández" ] 6 => array:2 [ "nombre" => "Lilia" "apellidos" => "Andrade Ortega" ] 7 => array:2 [ "nombre" => "Olga" "apellidos" => "Vera Lastra" ] 8 => array:2 [ "nombre" => "Rolando" "apellidos" => "Espinosa Morales" ] 9 => array:2 [ "nombre" => "Juan Manuel" "apellidos" => "Miranda Limón" ] 10 => array:2 [ "nombre" => "María del Rocío" "apellidos" => "Maldonado Velázquez" ] 11 => array:2 [ "nombre" => "Luis Javier" "apellidos" => "Jara Quezada" ] 12 => array:2 [ "nombre" => "Luis Manuel" "apellidos" => "Amezcua Guerra" ] 13 => array:2 [ "nombre" => "Judith" "apellidos" => "López Zepeda" ] 14 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Saavedra Salinas" ] 15 => array:2 [ "nombre" => "Cesar Alejandro" "apellidos" => "Arce Salinas" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574315000064" "doi" => "10.1016/j.reumae.2015.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315000064?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14002186?idApp=UINPBA00004M" "url" => "/1699258X/0000001100000004/v1_201506200144/S1699258X14002186/v1_201506200144/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574314001683" "issn" => "21735743" "doi" => "10.1016/j.reumae.2014.11.002" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "718" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2015;11:221-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1276 "formatos" => array:3 [ "EPUB" => 57 "HTML" => 895 "PDF" => 324 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Brief report" "titulo" => "Severe Infections in Patients With Autoimmune Diseases Treated With Cyclophosphamide" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "223" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infecciones graves en pacientes con enfermedades autoinmunes tratados con ciclofosfamida" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier A. Cavallasca, Cecilia A. Costa, Maria del Rosario Maliandi, Liliana E. Contini, Elena Fernandez de Carrera, Jorge L. Musuruana" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Javier A." "apellidos" => "Cavallasca" ] 1 => array:2 [ "nombre" => "Cecilia A." "apellidos" => "Costa" ] 2 => array:2 [ "nombre" => "Maria del Rosario" "apellidos" => "Maliandi" ] 3 => array:2 [ "nombre" => "Liliana E." "apellidos" => "Contini" ] 4 => array:2 [ "nombre" => "Elena" "apellidos" => "Fernandez de Carrera" ] 5 => array:2 [ "nombre" => "Jorge L." "apellidos" => "Musuruana" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X14002009" "doi" => "10.1016/j.reuma.2014.09.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14002009?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314001683?idApp=UINPBA00004M" "url" => "/21735743/0000001100000004/v1_201507020119/S2173574314001683/v1_201507020119/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574314001634" "issn" => "21735743" "doi" => "10.1016/j.reumae.2014.07.005" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "716" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2015;11:210-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2095 "formatos" => array:3 [ "EPUB" => 60 "HTML" => 1529 "PDF" => 506 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "New Diagnostic Criteria for Fibromyalgia: Here to Stay?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "210" "paginaFinal" => "214" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevos criterios diagnósticos de fibromialgia: ¿vinieron para quedarse?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 927 "Ancho" => 1729 "Tamanyo" => 66694 ] ] "descripcion" => array:1 [ "en" => "Intensity of somatic symptoms by type of FM." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sebastián Moyano, Jorge Guillermo Kilstein, Cayetano Alegre de Miguel" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Sebastián" "apellidos" => "Moyano" ] 1 => array:2 [ "nombre" => "Jorge Guillermo" "apellidos" => "Kilstein" ] 2 => array:2 [ "nombre" => "Cayetano" "apellidos" => "Alegre de Miguel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X14001739" "doi" => "10.1016/j.reuma.2014.07.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14001739?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314001634?idApp=UINPBA00004M" "url" => "/21735743/0000001100000004/v1_201507020119/S2173574314001634/v1_201507020119/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Performance of an Objective Structured Clinical Examination in a National Certification Process of Trainees in Rheumatology" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "215" "paginaFinal" => "220" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Virginia Pascual Ramos, Gabriel Medrano Ramírez, Eunice Solís Vallejo, Ana Guilaisne Bernard Medina, Diana Elsa Flores Alvarado, Margarita Portela Hernández, Lilia Andrade Ortega, Olga Vera Lastra, Rolando Espinosa Morales, Juan Manuel Miranda Limón, María del Rocío Maldonado Velázquez, Luis Javier Jara Quezada, Luis Manuel Amezcua Guerra, Judith López Zepeda, Miguel Ángel Saavedra Salinas, Cesar Alejandro Arce Salinas" "autores" => array:16 [ 0 => array:4 [ "nombre" => "Virginia" "apellidos" => "Pascual Ramos" "email" => array:1 [ 0 => "virtichu@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Medrano Ramírez" ] 2 => array:2 [ "nombre" => "Eunice" "apellidos" => "Solís Vallejo" ] 3 => array:2 [ "nombre" => "Ana Guilaisne" "apellidos" => "Bernard Medina" ] 4 => array:2 [ "nombre" => "Diana Elsa" "apellidos" => "Flores Alvarado" ] 5 => array:2 [ "nombre" => "Margarita" "apellidos" => "Portela Hernández" ] 6 => array:2 [ "nombre" => "Lilia" "apellidos" => "Andrade Ortega" ] 7 => array:2 [ "nombre" => "Olga" "apellidos" => "Vera Lastra" ] 8 => array:2 [ "nombre" => "Rolando" "apellidos" => "Espinosa Morales" ] 9 => array:2 [ "nombre" => "Juan Manuel" "apellidos" => "Miranda Limón" ] 10 => array:2 [ "nombre" => "María del Rocío" "apellidos" => "Maldonado Velázquez" ] 11 => array:2 [ "nombre" => "Luis Javier" "apellidos" => "Jara Quezada" ] 12 => array:2 [ "nombre" => "Luis Manuel" "apellidos" => "Amezcua Guerra" ] 13 => array:2 [ "nombre" => "Judith" "apellidos" => "López Zepeda" ] 14 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Saavedra Salinas" ] 15 => array:2 [ "nombre" => "Cesar Alejandro" "apellidos" => "Arce Salinas" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Consejo Mexicano de Reumatología, Mexico City, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desempeño del examen clínico objetivo estructurado como instrumento de evaluación en la certificación nacional como reumatólogo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1448 "Ancho" => 2822 "Tamanyo" => 245365 ] ] "descripcion" => array:1 [ "en" => "Timeline of the design strategy of the objective structured clinical examination." ] ] ] "textoCompleto" => "IntroductionThe Boards of Medical Specialties are collegial bodies formed by prominent medical professionals who cultivate the same subject and who establish a certification and recertification process. The Mexican Board of Rheumatology, AC (CMR), was founded on February 10, 1975. It currently consists of 12 advisors. Since its inception, the CMR has certified 730 adults and 49 pediatric rheumatologists through an examination, which consists of a theory and a practical part. Until 2012, the practical evaluation was carried out on a real patient, in the form of a single case.The certification exam of any medical specialty is considered a high-stakes exam, so boards must do everything possible to ensure the assessment tools are made with an appropriate technical framework and educational professionalism.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The examination of a real case or a single case evaluates medical performance in real settings, verifying the physicians capabilities for obtaining helpful information, making appropriate decisions, integ scoring previous knowledge and discussing views. However, it is poorly reliable and reproducible.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The objective structured clinical examination (OSCE) is a highly objective assessment tool that allows to examine skills and a large number of skills, leading some authors to consider it the gold standard for assessing clinical competencies.<a class="elsevierStyleCrossRefs" href="#bib0015">3–6</a> Since 1975, the OSCE has been used in Canada, the United States, Australia and Europe to evaluate undergraduate clinical skills. In Mexico, it is used since 1996 as a summative exam at the Faculty of Medicine of the Autonomous University of Mexico and as the professional practice examination phase of the undergraduate course since 2002.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> In addition, the OSCE has also shown good results in evaluating<a class="elsevierStyleCrossRef" href="#bib0060">12</a> general physicians,<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> surgeons, pediatricians,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and rheumatologists<a class="elsevierStyleCrossRef" href="#bib0055">11</a> musculoskeletal ultrasound skills.Since its inception, the CMR has recognized that clinical competence is a crucial training aspect of any future rheumatologist. Two years ago, the CMR implemented an OSCE in order to apply it to applicants as part of their annual certification process. This paper describes the process and examines the validity (construct) and reliability of the OSCE.Materials and MethodsPlanning the Objective Structured Clinical Examination (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>)In February 2012, the CMR implemented a work plan to develop an OSCE, which was applied for the first time in January 2013, during the examination for certification as a rheumatologist. An OSCE committee was composed by four counselors, who on 21 May 2012 accredited a Course-Workshop on Assessment of Competence using the Objective Structured Clinical Examination, conducted within the teacher training program of the Department of Medical Education of UNAM.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In late May, the CMR prepared a table of specifications and a skills matrix, using the academic content of the Rheumatology course<a class="elsevierStyleCrossRef" href="#bib0065">13</a> and considering the estimated prevalence in our country<a class="elsevierStyleCrossRef" href="#bib0070">14</a> of rheumatic diseases. The final proposal included the design of 14 stations, with well-defined<a class="elsevierStyleCrossRef" href="#bib0035">7</a> requirements.Three committees were integrated in parallel:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-Station Validation Committee. A 3h session was programmed, in which its purpose was defined, the content of each station presented and the checklist (agreement ≥80%) was validated. 12 of the 14 stations were validated.</li><li class="elsevierStyleListItem" id="lsti0010">-Patient Training Committee, which selected and trained 18 patients.</li><li class="elsevierStyleListItem" id="lsti0015">-Committee for training evaluators. 7 counselors and 5 rheumatologists with over 10 years of experience were selected. All received indications on the role and behavior of the evaluators during the OSCE.</li></ul>The pilot test was conducted in December 2012 at the purpose-built premises of the Faculty of Medicine, UNAM. A previously validated circuit with 12 stations was designed by three certified rheumatologists with less than 3 years experience.On 19 January 2013 the first OSCE assessment was applied as a practical exam for certification by the CMR. On January 20, the theory test was applied. Examination of the CMR for the following year took place on 18 and 19 January 2014, in its theory and practical versions (OSCE), respectively. The design and the preparation thereof were similar to that described above.Design of the Objective Structured Clinical ExaminationThe circuit for the 2013 assessment consisted of 12 stations to evaluate applicants and 4 rest stations; the 2014 circuit was integrated with 15 evaluation stations and 5 rest stations. All stations lasted 8min. The pathologies addressed were Sjögren's syndrome, low back pain, progressive systemic sclerosis, rheumatoid arthritis, inflammatory myopathy, gout, shoulder pain, systemic lupus erythematosus, antiphospholipid syndrome, seronegative spondyloarthropathies and osteoarthritis.Population to Which the Objective Structured Clinical Examination and Theory Test was AppliedThe first version of the OSCE was applied to 32 and the second to 38 candidates who met the requirements of the CMR to undergo testing and had completed their education in rheumatology at different hospitals recognized for that purpose around the country.Theory Test Board ExamThe theory examination consisted of an instrument of 300 multiple choice questions, of which 250 were clinical cases consisting of 5 questions each and 50 questions from different subjects of immunology, in a multiple-choice format.Score for CertificationThe theory and practical tests were scored independently.Each station was scored by adding the scores for the checklist and projected unto a decimal scale. Subsequently, an arithmetic mean was calculated considering the value of each station and the overall score of the OSCE was determined.In 2013 no minimum score was considered to certify the OSCE and the CMR considered a score of ≥6 as a passing score.In the year 2014, a value ≥6 was considered as a passing score for the OSCE (and the same value was used as a passing score for the theory test).Statistical AnalysisDescriptive statistics were performed and appropriate distribution tests for the variables were used.Construct validity: the written test score and the OSCE were correlated through the Pearson correlation coefficient. The correlation was evaluated based on the score of the theory examination and the overall OSCE. The theory test scores were divided into quartiles and distribution of applicants who had a passing and non-passing score determined in different quartiles and a Wilcoxon test was performed. Finally, the score of each OSCE station was compared between applicants and certified rheumatologists using the Student's t test (2-tailed).To detect potential redundancy through the use of multiple stations, the interstation correlation was calculated from the total OSCE score of each participant and the score of each station, using Pearson correlation coefficients.Analyses were performed using the SPSS 20 Statistical Package.ResultsCertification Exam Score2013 (32 candidates): The overall score of the OSCE in the group was (mean±SD) 7.1±0.6; all applicants had a score ≥6. The general theory test score was 6.5±0.6; 25 applicants (78.1%) had a score ≥6.2014 (38 candidates): The overall score of the OSCE was 6.7±0.6; 35 candidates (92.1%) had a passing score (≥6). Of the 3 candidates who had a non-passing score in the OSCE, 2 of them also had a non-passing score on theory. The general theory test score was 6.4±0.5 and 31 candidates (81.6%) had a passing score (≥6). Of the seven candidates who failed theory, 2 also failed the OSCE. Finally, 30 candidates had a passing score on both tests (78.9%).In 2013, scores (mean±SD) for each station varied from 4.5±2.1 to 8.8±2.0 and in 2014 it varied from 5.0±2.7 to 8.2±1.7. In 2013, the percentage of applicants with a score ≥6 ranged from 18.8% to 96.9%, depending on the station, while in 2014 it was 36.8%–100% (Table available online).ValidityThe scores obtained by each person examined were correlated with the overall OSCE and the score of the theory examination. In 2013, a moderate and significant correlation (r=0.436) and (P=0.006) was found, whereas in 2014 the correlation was poor and not significant (r=0.203; P=NS) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>The validity of the OSCE was also assessed by the experience construct by comparing the scores of applicants with board certified rheumatologists with 2 and 3 years of experience. The scores obtained by the latter were significantly higher than those of the candidates in 8 of the 12 stations that formed the 2013 circuit and in 10 of the 15 stations that constituted the 2014 circuit (Table published online).AgreementTheory test results were divided into quartiles and the number of applicants with a passing and non-passing OSCE score was determined in each quartile (only during 2014, as in 2013 no student failed the OSCE). The results are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The pass rate in the theory test among the candidates who failed the OSCE and those who had a passing score was compared in the OSCE: 67% vs 86%, P=0.02 (chi-square). Finally, the same trend was observed when the theory test scores were compared; the average score of the 3 candidates who failed the OSCE was lower than the 35 candidates who had a passing score: 5.9±0.6 vs 6.5±0.45, P=0.2 (Wilcoxon test).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Reliability-reproducibilityGroup performance of the persons examined in 2013 (No.=32) and 2014 (No.=38) in the 9 stations that were repeated in both years was compared. Missing data due to the applicant differences between the two years were assigned according to the group average. Correlations between scores on both OSCE were good and showed r values >0.8 and P≤0.01 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Cronbach's alpha of certified rheumatologists who conducted the pilot test in both years (considering the 9 repeated stations) was 0.83–0.92.Finally, the average interstation correlation (comparison of the score for each station within each participant) was low for both years: r=0.17, range=−0.11 to 0.35 by 2013 and r=0.18, range from −0.20 to 0.57 by 2014.DiscussionThe paper describes the design, development and implementation of an OSCE to assess clinical skills in the Rheumatology Board Annual certification applied by the CMR. In recent years, it has been proposed that the OSCE is a more objective tool for assessing clinical skills, especially when compared with other modalities, as single clinical cases. However, its limitations are recognized, so it must be subjected to rigorous scrutiny and pilot testing as a prerequisite step to its application.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>OSCE was designed by a collegial panel of experts, who applied international recommendations for its development,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> among which the prior establishment of a table of specifications, validation of the stations by a group of experts and the application of a pilot test stand out. The OSCE assessment was performed with reference to a criterion, as a standard was set in advance, as recommended by the current trend of competency-based education (<a href="http://www.conacem.org/">www.conacem.org</a>).The construct validity of the OSCE was analyzed in several ways. First, the performance of the OSCE with the theory part of the certification exam was correlated. In the literature, significant correlations between the OSCE and theory evaluations have been described, with values ranging between 0.59 and 0.71,<a class="elsevierStyleCrossRefs" href="#bib0080">16–18</a> although there is little information in the field of rheumatology.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> A recent report published by Kissin et al. described a correlation of 0.52 (P≤0.001) between a n9 station circuit designed to assess musculoskeletal ultrasound skills and its corresponding theory part<a class="elsevierStyleCrossRef" href="#bib0060">12</a>; conversely, Raj et al. found no significant correlation between the theory and practical knowledge, when the latter was assessed by 2 stations for exploration of the hand and knee applied to medical students.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> We found a correlation of 0.44 in 2013, with no correlation in 2014. This could be related to a worse performance of the candidates in the theory test in 2014 and/or the fact that both assessments (theory and practice) measured different knowledge. It should be noted that finding a high correlation between the 2 assessments indicates that only a small gain in information concerning the knowledge of the applicant is obtained when both instruments are applied; a plausible hypothesis is that, in situations of high correlation between both, the OSCE explores (like the theory test) “knowledge” and “know how” and shuns the “show how” of the Miller pyramid.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> In relation to this, Matsell et al.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> identified a key element in construct validity for an OSCE when it is based on the high correlation with a written evaluation. From a theory point of view, the OSCE assesses a wide variety of skills/clinical competencies, so the authors propose stations categorized into 4 major domains (knowledge, problem solving, clinical skills and patient management) and correlating stations for each domain with the corresponding theory part. This proposal, which has great theoretical foundation, will be included in the forthcoming implementation of OSCE.Regarding construct validity, the experience construct was also analyzed; a valid assessment should show how more experienced candidates perform better.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> All applicants had similar training in years. However, the same circuit was applied to 3 newly certified rheumatologists, under similar test day conditions. In general, the latter had higher scores than the applicants.Finally and indirectly, construct validity was analyzed in 2014 comparing the pass percentage of those passing the theory test (and the average score) in those who passed or did not pass the OSCE. Our results support the validity of the instrument.With respect to reliability, no evaluation was performed, although 3 ways have been proposed to increase the reliability of the OSCE and all of them were implemented: short station design to allow evaluation of multiple clinical situations, evaluation of the stations through predetermined checklists and integration of circuits with different stations, evaluators and<a class="elsevierStyleCrossRef" href="#bib0085">17</a> simulated patients. In our case, patients selected were real patients (except for 2 actors); however, they received training booklets designed to represent the condition of each station and reviewed by an expert panel. All this increases the reliability of the OSCE without affecting its validity, as when simulated patients or actors are used. In addition, 9 stations were applied in 2 consecutive years and showed excellent stability between the 2 groups of aspirants and internal consistency between certified rheumatologists in the pilot test was excellent. Finally, while a low interstation correlation was found, this indicates that each station evaluated different skills or competencies and therefore discarded redundancy of our instrument. It is important to emphasize the need to include an adequate number of stations to not affect the reliability of the OSCE.<a class="elsevierStyleCrossRefs" href="#bib0015">3,22</a> In the one similar exercise (that we know of), the exercise circuit consisted of 12 stations.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>Probably one of the biggest benefits of an OSCE (and other similar evaluations) is the ability to identify deficiencies in the training of residents and eventually modify the curriculum. It is therefore essential to have an optimal assessment tool. While it is true that the performance of our instrument was adequate, we must not forget that the OSCE is ultimately an approximation to the real problems but not a real physician-patient encounter. Our experience is limited to two years, but it is recommended that any instrument be used for 3–5 consecutive years, allowing proper calibration thereof. Furthermore, the OSCE was not reproduced in full in consecutive years. With regard to the assessment of the stations, no scientific method was applied to establish the passing score for each station,<a class="elsevierStyleCrossRef" href="#bib0115">23</a> but some previous criteria were established. The OSCE applied to certified rheumatologists (pilot) was developed on a different day than the OSCE applied to applicants, although an effort was made to reproduce the conditions of the final evaluation. The implementation of OSCE required financial and human resources; when performing the exercise to define the costs, these amounted to 120000 pesos (about $9200), a figure which is not excessive but much greater than what is usually invested in the practical assessment of residents and could affect its long-term viability.In conclusion, the OSCE designed by the CMR showed adequate construct validity and reliability, so it can be integrated as an instrument for assessing clinical skills in the board examination in order to obtain a certification as a rheumatologist. Certification boards have a social responsibility and also a responsibility to the medical community, documenting that specialists are competent to exercise their practice. It is therefore necessary to incorporate rigor, methodological quality and transparency to the certification processes. In parallel, society must require greater professionalism. The effort of the whole of society, the medical community, patients and the competent authorities must have a common goal to help increase the quality of care our population receives.Ethical ResponsibilitiesProtection of people and animalsThe authors declare this research did not perform experiments on humans or animals.Data privacyThe authors state that no patient data appears in this article.Right to privacy and informed consentThe authors state that no patient data appears in this article.Conflict of InterestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres528593" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec548830" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres528592" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec548831" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Planning the Objective Structured Clinical Examination (Fig. 1)" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Design of the Objective Structured Clinical Examination" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Population to Which the Objective Structured Clinical Examination and Theory Test was Applied" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Theory Test Board Exam" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Score for Certification" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical Analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Certification Exam Score" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Validity" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Agreement" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Reliability-reproducibility" ] ] ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0075" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "Data privacy" ] 2 => array:2 [ "identificador" => "sec0090" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0105" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-06-23" "fechaAceptado" => "2014-10-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec548830" "palabras" => array:3 [ 0 => "Objectively structured clinical examination" 1 => "Trainee" 2 => "Certification, Rheumatology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec548831" "palabras" => array:3 [ 0 => "Examen clínico objetivo estructurado" 1 => "Desempeño clínico" 2 => "Certificación, Reumatología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo assess reliability and validity of the objectively structured clinical examination (OSCE) applied in postgraduate certification processes by the Mexican Board of Rheumatology. MethodThirty-two (2013) and 38 (2014) Rheumatology trainees (RTs) underwent an OSCE consisting of 12 and 15 stations respectively, scored according to a validated check-list, as well as 300 multiple-choice question examination (MCQ). Previously, 3 certified rheumatologists underwent a pilot-OSCE. A composite OSCE score was obtained for each participant and its performance was examined. ResultsIn 2013, OSCE mean score was 7.1±0.6 with none of the RTs receiving a failing score while the MCQ score was 6.5±0.6 and 7 (21.9%) RTs received a failing (<6) score. In 2014, the OSCE score was 6.7±0.6, with 3 (7.9%) RTs receiving a failing score (2 of them also failed MCQ) while the MCQ score was 6.4±0.5 and 7 (18.5%) RTs were disqualified (2 of them also failed OSCE). A significant correlation between the MCQ and the OSCE scores was observed in 2013 (r=0.44; P=.006). Certified rheumatologists performed better than RTs at both OSCE.Overall, 86% of RTs obtaining an OSCE passing score also obtained a MCQ passing score, while this was only 67% (P=.02) among those who obtained an OSCE failing score.Nine stations were applied at both consecutive years. Their performance was similar in both certification processes, with correlation coefficients ranging from 0.81 to 0.95 (P≤.01). ConclusionThe OSCE is a valid and reliable tool to assess the Rheumatology clinical skills in RTs." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoDeterminar la validez de constructo y la confiabilidad de un examen clínico objetivo estructurado (ECOE) en la evaluación de una certificación nacional como reumatólogo. MétodoEn 2013 y 2014, se aplicaron sendos ECOE y evaluación teórica (ET) a 32 y 38 residentes aspirantes a la certificación de reumatólogo, respectivamente. Se incluyeron 12 y 15 estaciones calificadas mediante lista de cotejo validada. Previamente, 3 reumatólogos certificados realizaron sendas pruebas piloto. Se calculó la puntuación global del ECOE y se evaluó su desempeño. ResultadosEn 2013, la media ± DE del ECOE fue de 7,1±0,6) y ningún aspirante tuvo calificación reprobatoria (CR); la media de la ET fue de 6,5±0,6 y 7 aspirantes (21,9%) tuvieron CR (<6). En 2014, la media del ECOE fue de 6,7±0,6) y 3 aspirantes (7,9%) tuvieron CR, de los cuales 2 reprobaron la ET; la media de la ET fue de 6,4±0,5) y 7 aspirantes (18,5%) tuvieron CR, 2 de los cuales reprobaron el ECOE.En 2013, la correlación entre el ECOE y la ET fue de r=0,44, p=0,006. En ambos años, los reumatólogos certificados obtuvieron mejores calificaciones en el ECOE que los residentes. El porcentaje de aprobados en la ET fue mayor entre quienes aprobaron el ECOE que entre quienes lo reprobaron: 86% vs. 67%, p=0,02.Se aplicaron 9 estaciones en ambos años y sus puntuaciones mostraron correlación de 0,81 a 0,95, p≤0,01. ConclusiónEl ECOE es una herramienta adecuada para evaluar las competencias clínicas de los aspirantes a la certificación." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Pascual Ramos V, Medrano Ramírez G, Solís Vallejo E, Bernard Medina AG, Flores Alvarado DE, Portela Hernández M, et al. Desempeño del examen clínico objetivo estructurado como instrumento de evaluación en la certificación nacional como reumatólogo. Reumatol Clin. 2015;11:215–220." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0100" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1448 "Ancho" => 2822 "Tamanyo" => 245365 ] ] "descripcion" => array:1 [ "en" => "Timeline of the design strategy of the objective structured clinical examination." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1068 "Ancho" => 3152 "Tamanyo" => 224411 ] ] "descripcion" => array:1 [ "en" => "Correlation between the two tests, the theory evaluation and objective structured clinical examination in 2013 and 2014." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "P=0.07, Wilcoxon test." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First quartile 5.47 to 6.18 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Second quartile 6.19 to 6.5 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Third quartile 6.51 to 6.72 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fourth quartile 6.73 to 7.7 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">OSCE Score<6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">OSCE Score≥6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab851779.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Validity of Concurrency of the Theory and the Clinical Objectively Structured Examination." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Station \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score OSCE-2013 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score OSCE-2014 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pearson correlation coefficient (r) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.4±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.941 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6±4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.818 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0±2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.809 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.2±1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.869 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5±1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.937 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.1±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.5±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.845 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0±1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.6±2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.926 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.9±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.942 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.947 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab851780.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of the Scores of the Stations Implemented in the Objective Structured Clinical Examination in 2013 and 2014 (P≤0.01)." ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 124669 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "Educational measurement" "edicion" => "4th ed." "serieFecha" => "2006" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The death of the long case?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.J. Norcini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2002" "volumen" => "324" "paginaInicial" => "408" "paginaFinal" => "409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11850375" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Objective structured clinical examination (OSCE): review of literature and implications for nursing education" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.E. Rushforth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nedt.2006.08.009" "Revista" => array:6 [ "tituloSerie" => "Nurse Educ Today" "fecha" => "2007" "volumen" => "27" "paginaInicial" => "481" "paginaFinal" => "490" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17070622" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of internal medicine house medicine officers on a short station OSCE" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Petrusa" 1 => "T. Blackwell" 2 => "M. Ainsworth" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Further development in assessing clinical competence" "paginaInicial" => "598" "paginaFinal" => "608" "serieFecha" => "1987" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Objective structured clinical examinations (OSCEs) and objective structured performance-related examinations (OSPREs)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Curtis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "The CanMEDS competencies" "paginaInicial" => "23" "paginaFinal" => "25" "serieFecha" => "2006" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of clinical competence using an objective structured clinical examination (OSCE)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.M. Harden" 1 => "F.A. Gleeson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Educ" "fecha" => "1979" "volumen" => "13" "paginaInicial" => "41" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/763183" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elaboración de estaciones para el examen clínico objetivo estructurado (ECOE)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Trejo-Mejía" 1 => "G. Blee-Sánchez" 2 => "J. Peña-Balderas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Investig Educ Med" "fecha" => "2014" "volumen" => "3" "paginaInicial" => "56" "paginaFinal" => "59" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Content validity of the Quebec licensing examination (OSCE)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Grand’Maison" 1 => "C.A. Brailovsky" 2 => "J. Lescop" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can Fam Physician" "fecha" => "1996" "volumen" => "42" "paginaInicial" => "254" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9222574" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of objective structured clinical examination (OSCE) for evaluation and instruction in graduate medical education" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.A. Sloan" 1 => "M.B. Donnelly" 2 => "R.W. Schwartz" 3 => "J.L. Felts" 4 => "A.V. Blue" 5 => "W.E. Strodel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Surg Res" "fecha" => "1996" "volumen" => "63" "paginaInicial" => "1225" "paginaFinal" => "1230" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reliability and validity of the objective structured clinical examination in paediatrics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.G. Matsell" 1 => "N.M. Wolfish" 2 => "E. Hsu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Educ" "fecha" => "1991" "volumen" => "25" "paginaInicial" => "293" "paginaFinal" => "299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1890958" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of specialist registrars in rheumatology: experience of an objective structured clinical examination (OSCE)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "West Midlands Rheumatology Services and Training Committee" "etal" => false "autores" => array:1 [ 0 => "A.B. Hassell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2002" "volumen" => "41" "paginaInicial" => "1323" "paginaFinal" => "1328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12422008" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Musculoskeletal ultrasound objective structured clinical examination: an assessment of the test" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.Y. Kissin" 1 => "P.C. Grayson" 2 => "A.C. Cannella" 3 => "P.J. Demarco" 4 => "A. Evangelisto" 5 => "J. Goyal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2014" "volumen" => "66" "paginaInicial" => "2" "paginaFinal" => "6" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plan único de especializaciones médicas en Reumatología, México" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Facultad de Medicina UNAM, División de estudios de posgrado, Subdivisión de especializaciones médicas, Departamento de desarrollo curricular" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2013" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of musculoskeletal pain and rheumatic diseases in the southeastern region of Mexico. A COPCORD-based community survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Alvarez-Nemegyei" 1 => "I. Peláez-Ballestas" 2 => "L.H. Sanin" 3 => "M.H. Cardiel" 4 => "A. Ramirez-Angulo" 5 => "M.V. Goycochea-Robles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.100954" "Revista" => array:6 [ "tituloSerie" => "J Rheumatol Suppl" "fecha" => "2011" "volumen" => "86" "paginaInicial" => "21" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21196595" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Setting standards on educations tests" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.J. Norcini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Educ" "fecha" => "2003" "volumen" => "37" "paginaInicial" => "464" "paginaFinal" => "469" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12709190" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of clinical competence using objective structured examination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.M. Harden" 1 => "M. Stevenson" 2 => "W.W. Downie" 3 => "G.M. Wilson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br Med J" "fecha" => "1975" "volumen" => "1" "paginaInicial" => "447" "paginaFinal" => "451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/837162" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of clinical simulations in assessment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.W. Schuwirth" 1 => "C.P. van der Vleuten" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Educ" "fecha" => "2003" "volumen" => "37" "paginaInicial" => "65" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14641641" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The objective structured clinical examination: a step in the direction of competency-based evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Carraccio" 1 => "R. Englander" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Pediatr Adolesc Med" "fecha" => "2000" "volumen" => "154" "paginaInicial" => "736" "paginaFinal" => "741" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10891028" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Design and validation of 2 objective structured clinical examination stations to assess core undergraduate examination skills of the hand and knee" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Raj" 1 => "L.J. Badcock" 2 => "G.A. Brown" 3 => "C.M. Deighton" 4 => "S.C. O’Reilly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2007" "volumen" => "34" "paginaInicial" => "421" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17304661" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The assessment of clinical skills/competence/performance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.E. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Acad Med" "fecha" => "1990" "volumen" => "65" "numero" => "Suppl." "paginaInicial" => "S63" "paginaFinal" => "S67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2400509" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The objective structured clinical examination. The new gold standard for evaluating postgraduate clinical performance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.A. Sloan" 1 => "M.B. Donnelly" 2 => "R.W. Schwartz" 3 => "W.E. Strodel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1995" "volumen" => "222" "paginaInicial" => "735" "paginaFinal" => "742" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8526580" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of an OSCE assessment tool for abdominal ultrasound courses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Hofer" 1 => "L. Kamper" 2 => "M. Sadlo" 3 => "K. Sievers" 4 => "N. Heussen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0029-1246049" "Revista" => array:6 [ "tituloSerie" => "Ultraschall Med" "fecha" => "2011" "volumen" => "32" "paginaInicial" => "184" "paginaFinal" => "190" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21321843" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Passing scores. A manual for setting standards of performance on educational and occupational tests" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.A. Livingston" 1 => "M.J. Zieky" 2 => "J. Michael" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "1982" "editorial" => "Educational Testing Service" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001100000004/v1_201507020119/S2173574315000064/v1_201507020119/en/main.assets" "Apartado" => array:4 [ "identificador" => "17338" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001100000004/v1_201507020119/S2173574315000064/v1_201507020119/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315000064?idApp=UINPBA00004M"]

Statistics

Original Article

Performance of an Objective Structured Clinical Examination in a National Certification Process of Trainees in Rheumatology

Desempeño del examen clínico objetivo estructurado como instrumento de evaluación en la certificación nacional como reumatólogo

Virginia Pascual Ramos

Corresponding author

virtichu@gmail.com

Corresponding author.

, Gabriel Medrano Ramírez, Eunice Solís Vallejo, Ana Guilaisne Bernard Medina, Diana Elsa Flores Alvarado, Margarita Portela Hernández, Lilia Andrade Ortega, Olga Vera Lastra, Rolando Espinosa Morales, Juan Manuel Miranda Limón, María del Rocío Maldonado Velázquez, Luis Javier Jara Quezada, Luis Manuel Amezcua Guerra, Judith López Zepeda, Miguel Ángel Saavedra Salinas, Cesar Alejandro Arce Salinas

Consejo Mexicano de Reumatología, Mexico City, Mexico

Read

6170

Times
was read the article

2242

Total PDF

3928

Total HTML

Share statistics

 array:24 [
  "pii" => "S2173574315000064"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2015.01.002"
  "estado" => "S300"
  "fechaPublicacion" => "2015-07-01"
  "aid" => "730"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;. All rights reserved"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Reumatol Clin. 2015;11:215-20"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1329
    "formatos" => array:3 [
      "EPUB" => 68
      "HTML" => 934
      "PDF" => 327
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X14002186"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2014.10.007"
      "estado" => "S300"
      "fechaPublicacion" => "2015-07-01"
      "aid" => "730"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Reumatol Clin. 2015;11:215-20"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4870
        "formatos" => array:3 [
          "EPUB" => 186
          "HTML" => 3259
          "PDF" => 1425
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Desempe&#241;o del examen cl&#237;nico objetivo estructurado como instrumento de evaluaci&#243;n en la certificaci&#243;n nacional como reumat&#243;logo"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "215"
            "paginaFinal" => "220"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Performance of an objective structured clinical examination in a national certification process of trainees in rheumatology"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1056
                "Ancho" => 3150
                "Tamanyo" => 199940
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Correlaci&#243;n entre ambas pruebas&#44; la evaluaci&#243;n te&#243;rica y del examen cl&#237;nico objetivo estructurado en 2013 y 2014&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Virginia Pascual Ramos, Gabriel Medrano Ram&#237;rez, Eunice Sol&#237;s Vallejo, Ana Guilaisne Bernard Medina, Diana Elsa Flores Alvarado, Margarita Portela Hern&#225;ndez, Lilia Andrade Ortega, Olga Vera Lastra, Rolando Espinosa Morales, Juan Manuel Miranda Lim&#243;n, Mar&#237;a del Roc&#237;o Maldonado Vel&#225;zquez, Luis Javier Jara Quezada, Luis Manuel Amezcua Guerra, Judith L&#243;pez Zepeda, Miguel &#193;ngel Saavedra Salinas, Cesar Alejandro Arce Salinas"
            "autores" => array:16 [
              0 => array:2 [
                "nombre" => "Virginia"
                "apellidos" => "Pascual Ramos"
              ]
              1 => array:2 [
                "nombre" => "Gabriel"
                "apellidos" => "Medrano Ram&#237;rez"
              ]
              2 => array:2 [
                "nombre" => "Eunice"
                "apellidos" => "Sol&#237;s Vallejo"
              ]
              3 => array:2 [
                "nombre" => "Ana Guilaisne"
                "apellidos" => "Bernard Medina"
              ]
              4 => array:2 [
                "nombre" => "Diana Elsa"
                "apellidos" => "Flores Alvarado"
              ]
              5 => array:2 [
                "nombre" => "Margarita"
                "apellidos" => "Portela Hern&#225;ndez"
              ]
              6 => array:2 [
                "nombre" => "Lilia"
                "apellidos" => "Andrade Ortega"
              ]
              7 => array:2 [
                "nombre" => "Olga"
                "apellidos" => "Vera Lastra"
              ]
              8 => array:2 [
                "nombre" => "Rolando"
                "apellidos" => "Espinosa Morales"
              ]
              9 => array:2 [
                "nombre" => "Juan Manuel"
                "apellidos" => "Miranda Lim&#243;n"
              ]
              10 => array:2 [
                "nombre" => "Mar&#237;a del Roc&#237;o"
                "apellidos" => "Maldonado Vel&#225;zquez"
              ]
              11 => array:2 [
                "nombre" => "Luis Javier"
                "apellidos" => "Jara Quezada"
              ]
              12 => array:2 [
                "nombre" => "Luis Manuel"
                "apellidos" => "Amezcua Guerra"
              ]
              13 => array:2 [
                "nombre" => "Judith"
                "apellidos" => "L&#243;pez Zepeda"
              ]
              14 => array:2 [
                "nombre" => "Miguel &#193;ngel"
                "apellidos" => "Saavedra Salinas"
              ]
              15 => array:2 [
                "nombre" => "Cesar Alejandro"
                "apellidos" => "Arce Salinas"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574315000064"
          "doi" => "10.1016/j.reumae.2015.01.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315000064?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14002186?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001100000004/v1_201506200144/S1699258X14002186/v1_201506200144/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574314001683"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2014.11.002"
    "estado" => "S300"
    "fechaPublicacion" => "2015-07-01"
    "aid" => "718"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2015;11:221-3"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1276
      "formatos" => array:3 [
        "EPUB" => 57
        "HTML" => 895
        "PDF" => 324
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>"
      "titulo" => "Severe Infections in Patients With Autoimmune Diseases Treated With Cyclophosphamide"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "221"
          "paginaFinal" => "223"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Infecciones graves en pacientes con enfermedades autoinmunes tratados con ciclofosfamida"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Javier A&#46; Cavallasca, Cecilia A&#46; Costa, Maria del Rosario Maliandi, Liliana E&#46; Contini, Elena Fernandez de Carrera, Jorge L&#46; Musuruana"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Javier A&#46;"
              "apellidos" => "Cavallasca"
            ]
            1 => array:2 [
              "nombre" => "Cecilia A&#46;"
              "apellidos" => "Costa"
            ]
            2 => array:2 [
              "nombre" => "Maria del Rosario"
              "apellidos" => "Maliandi"
            ]
            3 => array:2 [
              "nombre" => "Liliana E&#46;"
              "apellidos" => "Contini"
            ]
            4 => array:2 [
              "nombre" => "Elena"
              "apellidos" => "Fernandez de Carrera"
            ]
            5 => array:2 [
              "nombre" => "Jorge L&#46;"
              "apellidos" => "Musuruana"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X14002009"
        "doi" => "10.1016/j.reuma.2014.09.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14002009?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314001683?idApp=UINPBA00004M"
    "url" => "/21735743/0000001100000004/v1_201507020119/S2173574314001683/v1_201507020119/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173574314001634"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2014.07.005"
    "estado" => "S300"
    "fechaPublicacion" => "2015-07-01"
    "aid" => "716"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2015;11:210-4"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2095
      "formatos" => array:3 [
        "EPUB" => 60
        "HTML" => 1529
        "PDF" => 506
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "New Diagnostic Criteria for Fibromyalgia&#58; Here to Stay&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "210"
          "paginaFinal" => "214"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Nuevos criterios diagn&#243;sticos de fibromialgia&#58; &#191;vinieron para quedarse&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 927
              "Ancho" => 1729
              "Tamanyo" => 66694
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Intensity of somatic symptoms by type of FM&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Sebasti&#225;n Moyano, Jorge Guillermo Kilstein, Cayetano Alegre de Miguel"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Sebasti&#225;n"
              "apellidos" => "Moyano"
            ]
            1 => array:2 [
              "nombre" => "Jorge Guillermo"
              "apellidos" => "Kilstein"
            ]
            2 => array:2 [
              "nombre" => "Cayetano"
              "apellidos" => "Alegre de Miguel"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X14001739"
        "doi" => "10.1016/j.reuma.2014.07.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X14001739?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314001634?idApp=UINPBA00004M"
    "url" => "/21735743/0000001100000004/v1_201507020119/S2173574314001634/v1_201507020119/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Performance of an Objective Structured Clinical Examination in a National Certification Process of Trainees in Rheumatology"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "215"
        "paginaFinal" => "220"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Virginia Pascual Ramos, Gabriel Medrano Ram&#237;rez, Eunice Sol&#237;s Vallejo, Ana Guilaisne Bernard Medina, Diana Elsa Flores Alvarado, Margarita Portela Hern&#225;ndez, Lilia Andrade Ortega, Olga Vera Lastra, Rolando Espinosa Morales, Juan Manuel Miranda Lim&#243;n, Mar&#237;a del Roc&#237;o Maldonado Vel&#225;zquez, Luis Javier Jara Quezada, Luis Manuel Amezcua Guerra, Judith L&#243;pez Zepeda, Miguel &#193;ngel Saavedra Salinas, Cesar Alejandro Arce Salinas"
        "autores" => array:16 [
          0 => array:4 [
            "nombre" => "Virginia"
            "apellidos" => "Pascual Ramos"
            "email" => array:1 [
              0 => "virtichu&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Gabriel"
            "apellidos" => "Medrano Ram&#237;rez"
          ]
          2 => array:2 [
            "nombre" => "Eunice"
            "apellidos" => "Sol&#237;s Vallejo"
          ]
          3 => array:2 [
            "nombre" => "Ana Guilaisne"
            "apellidos" => "Bernard Medina"
          ]
          4 => array:2 [
            "nombre" => "Diana Elsa"
            "apellidos" => "Flores Alvarado"
          ]
          5 => array:2 [
            "nombre" => "Margarita"
            "apellidos" => "Portela Hern&#225;ndez"
          ]
          6 => array:2 [
            "nombre" => "Lilia"
            "apellidos" => "Andrade Ortega"
          ]
          7 => array:2 [
            "nombre" => "Olga"
            "apellidos" => "Vera Lastra"
          ]
          8 => array:2 [
            "nombre" => "Rolando"
            "apellidos" => "Espinosa Morales"
          ]
          9 => array:2 [
            "nombre" => "Juan Manuel"
            "apellidos" => "Miranda Lim&#243;n"
          ]
          10 => array:2 [
            "nombre" => "Mar&#237;a del Roc&#237;o"
            "apellidos" => "Maldonado Vel&#225;zquez"
          ]
          11 => array:2 [
            "nombre" => "Luis Javier"
            "apellidos" => "Jara Quezada"
          ]
          12 => array:2 [
            "nombre" => "Luis Manuel"
            "apellidos" => "Amezcua Guerra"
          ]
          13 => array:2 [
            "nombre" => "Judith"
            "apellidos" => "L&#243;pez Zepeda"
          ]
          14 => array:2 [
            "nombre" => "Miguel &#193;ngel"
            "apellidos" => "Saavedra Salinas"
          ]
          15 => array:2 [
            "nombre" => "Cesar Alejandro"
            "apellidos" => "Arce Salinas"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Consejo Mexicano de Reumatolog&#237;a&#44; Mexico City&#44; Mexico"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Desempe&#241;o del examen cl&#237;nico objetivo estructurado como instrumento de evaluaci&#243;n en la certificaci&#243;n nacional como reumat&#243;logo"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1448
            "Ancho" => 2822
            "Tamanyo" => 245365
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Timeline of the design strategy of the objective structured clinical examination&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The Boards of Medical Specialties are collegial bodies formed by prominent medical professionals who cultivate the same subject and who establish a certification and recertification process&#46; The <span class="elsevierStyleItalic">Mexican Board of Rheumatology</span>&#44; <span class="elsevierStyleItalic">AC</span> &#40;CMR&#41;&#44; was founded on February 10&#44; 1975&#46; It currently consists of 12 advisors&#46; Since its inception&#44; the CMR has certified 730 adults and 49 pediatric rheumatologists through an examination&#44; which consists of a theory and a practical part&#46; Until 2012&#44; the practical evaluation was carried out on a real patient&#44; in the form of a single case&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The certification exam of any medical specialty is considered a <span class="elsevierStyleItalic">high-stakes</span> exam&#44; so boards must do everything possible to ensure the assessment tools are made with an appropriate technical framework and educational professionalism&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The examination of a real case or a single case evaluates medical performance in real settings&#44; verifying the physicians capabilities for obtaining helpful information&#44; making appropriate decisions&#44; integ scoring previous knowledge and discussing views&#46; However&#44; it is poorly reliable and reproducible&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The objective structured clinical examination &#40;OSCE&#41; is a highly objective assessment tool that allows to examine skills and a large number of skills&#44; leading some authors to consider it the gold standard for assessing clinical competencies&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a> Since 1975&#44; the OSCE has been used in Canada&#44; the United States&#44; Australia and Europe to evaluate undergraduate clinical skills&#46; In Mexico&#44; it is used since 1996 as a summative exam at the Faculty of Medicine of the Autonomous University of Mexico and as the professional practice examination phase of the undergraduate course since 2002&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In addition&#44; the OSCE has also shown good results in evaluating<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> general physicians&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> surgeons&#44; pediatricians&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and rheumatologists<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> musculoskeletal ultrasound skills&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Since its inception&#44; the CMR has recognized that clinical competence is a crucial training aspect of any future rheumatologist&#46; Two years ago&#44; the CMR implemented an OSCE in order to apply it to applicants as part of their annual certification process&#46; This paper describes the process and examines the validity &#40;construct&#41; and reliability of the OSCE&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Planning the Objective Structured Clinical Examination &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;</span><p id="par0020" class="elsevierStylePara elsevierViewall">In February 2012&#44; the CMR implemented a work plan to develop an OSCE&#44; which was applied for the first time in January 2013&#44; during the examination for certification as a rheumatologist&#46; An OSCE committee was composed by four counselors&#44; who on 21 May 2012 accredited a <span class="elsevierStyleItalic">Course-Workshop on Assessment of Competence using the Objective Structured Clinical Examination&#44; conducted within the teacher training program of the Department of Medical Education of UNAM</span>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In late May&#44; the CMR prepared a table of specifications and a skills matrix&#44; using the academic content of the Rheumatology course<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and considering the estimated prevalence in our country<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> of rheumatic diseases&#46; The final proposal included the design of 14 stations&#44; with well-defined<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> requirements&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Three committees were integrated in parallel&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Station Validation Committee&#46;</span> A 3<span class="elsevierStyleHsp" style=""></span>h session was programmed&#44; in which its purpose was defined&#44; the content of each station presented and the checklist &#40;agreement &#8805;80&#37;&#41; was validated&#46; 12 of the 14 stations were validated&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patient Training Committee</span>&#44; which selected and trained 18 patients&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Committee for training evaluators&#46;</span> 7 counselors and 5 rheumatologists with over 10 years of experience were selected&#46; All received indications on the role and behavior of the evaluators during the OSCE&#46;</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">The pilot test was conducted in December 2012 at the purpose-built premises of the Faculty of Medicine&#44; UNAM&#46; A previously validated circuit with 12 stations was designed by three certified rheumatologists with less than 3 years experience&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">On 19 January 2013 the first OSCE assessment was applied as a practical exam for certification by the CMR&#46; On January 20&#44; the theory test was applied&#46; Examination of the CMR for the following year took place on 18 and 19 January 2014&#44; in its theory and practical versions &#40;OSCE&#41;&#44; respectively&#46; The design and the preparation thereof were similar to that described above&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Design of the Objective Structured Clinical Examination</span><p id="par0060" class="elsevierStylePara elsevierViewall">The circuit for the 2013 assessment consisted of 12 stations to evaluate applicants and 4 rest stations&#59; the 2014 circuit was integrated with 15 evaluation stations and 5 rest stations&#46; All stations lasted 8<span class="elsevierStyleHsp" style=""></span>min&#46; The pathologies addressed were Sj&#246;gren&#39;s syndrome&#44; low back pain&#44; progressive systemic sclerosis&#44; rheumatoid arthritis&#44; inflammatory myopathy&#44; gout&#44; shoulder pain&#44; systemic lupus erythematosus&#44; antiphospholipid syndrome&#44; seronegative spondyloarthropathies and osteoarthritis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Population to Which the Objective Structured Clinical Examination and Theory Test was Applied</span><p id="par0065" class="elsevierStylePara elsevierViewall">The first version of the OSCE was applied to 32 and the second to 38 candidates who met the requirements of the CMR to undergo testing and had completed their education in rheumatology at different hospitals recognized for that purpose around the country&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Theory Test Board Exam</span><p id="par0070" class="elsevierStylePara elsevierViewall">The theory examination consisted of an instrument of 300 multiple choice questions&#44; of which 250 were clinical cases consisting of 5 questions each and 50 questions from different subjects of immunology&#44; in a multiple-choice format&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Score for Certification</span><p id="par0075" class="elsevierStylePara elsevierViewall">The theory and practical tests were scored independently&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Each station was scored by adding the scores for the checklist and projected unto a decimal scale&#46; Subsequently&#44; an arithmetic mean was calculated considering the value of each station and the overall score of the OSCE was determined&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In 2013 no minimum score was considered to certify the OSCE and the CMR considered a score of &#8805;6 as a passing score&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the year 2014&#44; a value &#8805;6 was considered as a passing score for the OSCE &#40;and the same value was used as a passing score for the theory test&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical Analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">Descriptive statistics were performed and appropriate distribution tests for the variables were used&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Construct validity</span>&#58; the written test score and the OSCE were correlated through the Pearson correlation coefficient&#46; The correlation was evaluated based on the score of the theory examination and the overall OSCE&#46; The theory test scores were divided into quartiles and distribution of applicants who had a passing and non-passing score determined in different quartiles and a Wilcoxon test was performed&#46; Finally&#44; the score of each OSCE station was compared between applicants and certified rheumatologists using the Student&#39;s <span class="elsevierStyleItalic">t</span> test &#40;2-tailed&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">To detect potential redundancy through the use of multiple stations&#44; the interstation correlation was calculated from the total OSCE score of each participant and the score of each station&#44; using Pearson correlation coefficients&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Analyses were performed using the SPSS 20 Statistical Package&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Certification Exam Score</span><p id="par0115" class="elsevierStylePara elsevierViewall">2013 &#40;32 <span class="elsevierStyleItalic">candidates</span>&#41;&#58; The overall score of the OSCE in the group was &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; 7&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#59; all applicants had a score &#8805;6&#46; The general theory test score was 6&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#59; 25 applicants &#40;78&#46;1&#37;&#41; had a score &#8805;6&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">2014 &#40;38 <span class="elsevierStyleItalic">candidates</span>&#41;&#58; The overall score of the OSCE was 6&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#59; 35 candidates &#40;92&#46;1&#37;&#41; had a passing score &#40;&#8805;6&#41;&#46; Of the 3 candidates who had a non-passing score in the OSCE&#44; 2 of them also had a non-passing score on theory&#46; The general theory test score was 6&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5 and 31 candidates &#40;81&#46;6&#37;&#41; had a passing score &#40;&#8805;6&#41;&#46; Of the seven candidates who failed theory&#44; 2 also failed the OSCE&#46; Finally&#44; 30 candidates had a passing score on both tests &#40;78&#46;9&#37;&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In 2013&#44; scores &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; for each station varied from 4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1 to 8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0 and in 2014 it varied from 5&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7 to 8&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&#46; In 2013&#44; the percentage of applicants with a score &#8805;6 ranged from 18&#46;8&#37; to 96&#46;9&#37;&#44; depending on the station&#44; while in 2014 it was 36&#46;8&#37;&#8211;100&#37; &#40;Table available online&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Validity</span><p id="par0130" class="elsevierStylePara elsevierViewall">The scores obtained by each person examined were correlated with the overall OSCE and the score of the theory examination&#46; In 2013&#44; a moderate and significant correlation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleMonospace">&#61;</span>0&#46;436&#41; and &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41; was found&#44; whereas in 2014 the correlation was poor and not significant &#40;<span class="elsevierStyleItalic">r</span>&#61;0&#46;203&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">The validity of the OSCE was also assessed by the <span class="elsevierStyleItalic">experience construct by</span> comparing the scores of applicants with board certified rheumatologists with 2 and 3 years of experience&#46; The scores obtained by the latter were significantly higher than those of the candidates in 8 of the 12 stations that formed the 2013 circuit and in 10 of the 15 stations that constituted the 2014 circuit &#40;Table published online&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Agreement</span><p id="par0140" class="elsevierStylePara elsevierViewall">Theory test results were divided into quartiles and the number of applicants with a passing and non-passing OSCE score was determined in each quartile &#40;only during 2014&#44; as in 2013 no student failed the OSCE&#41;&#46; The results are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The pass rate in the theory test among the candidates who failed the OSCE and those who had a passing score was compared in the OSCE&#58; 67&#37; vs 86&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02 &#40;chi-square&#41;&#46; Finally&#44; the same trend was observed when the theory test scores were compared&#59; the average score of the 3 candidates who failed the OSCE was lower than the 35 candidates who had a passing score&#58; 5&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6 vs 6&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;45&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;2 &#40;Wilcoxon test&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Reliability-reproducibility</span><p id="par0145" class="elsevierStylePara elsevierViewall">Group performance of the persons examined in 2013 &#40;No&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41; and 2014 &#40;No&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41; in the 9 stations that were repeated in both years was compared&#46; Missing data due to the applicant differences between the two years were assigned according to the group average&#46; Correlations between scores on both OSCE were good and showed <span class="elsevierStyleItalic">r</span> values &#62;0&#46;8 and <span class="elsevierStyleItalic">P</span>&#8804;0&#46;01 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Cronbach&#39;s alpha of certified rheumatologists who conducted the pilot test in both years &#40;considering the 9 repeated stations&#41; was 0&#46;83&#8211;0&#46;92&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Finally&#44; the average interstation correlation &#40;comparison of the score for each station within each participant&#41; was low for both years&#58; <span class="elsevierStyleItalic">r</span>&#61;0&#46;17&#44; range<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;11 to 0&#46;35 by 2013 and <span class="elsevierStyleItalic">r</span>&#61;0&#46;18&#44; range from &#8722;0&#46;20 to 0&#46;57 by 2014&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0160" class="elsevierStylePara elsevierViewall">The paper describes the design&#44; development and implementation of an OSCE to assess clinical skills in the Rheumatology Board Annual certification applied by the CMR&#46; In recent years&#44; it has been proposed that the OSCE is a more objective tool for assessing clinical skills&#44; especially when compared with other modalities&#44; as single clinical cases&#46; However&#44; its limitations are recognized&#44; so it must be subjected to rigorous scrutiny and pilot testing as a prerequisite step to its application&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">OSCE was designed by a collegial panel of experts&#44; who applied international recommendations for its development&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> among which the prior establishment of a table of specifications&#44; validation of the stations by a group of experts and the application of a pilot test stand out&#46; The OSCE assessment was performed <span class="elsevierStyleItalic">with reference to a criterion</span>&#44; as a standard was set in advance&#44; as recommended by the current trend of competency-based education &#40;<a href="http://www.conacem.org/">www&#46;conacem&#46;org</a>&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The construct validity of the OSCE was analyzed in several ways&#46; First&#44; the performance of the OSCE with the theory part of the certification exam was correlated&#46; In the literature&#44; significant correlations between the OSCE and theory evaluations have been described&#44; with values ranging between 0&#46;59 and 0&#46;71&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> although there is little information in the field of rheumatology&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> A recent report published by Kissin et al&#46; described a correlation of 0&#46;52 &#40;<span class="elsevierStyleItalic">P</span>&#8804;0&#46;001&#41; between a n9 station circuit designed to assess musculoskeletal ultrasound skills and its corresponding theory part<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#59; conversely&#44; Raj et al&#46; found no significant correlation between the theory and practical knowledge&#44; when the latter was assessed by 2 stations for exploration of the hand and knee applied to medical students&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> We found a correlation of 0&#46;44 in 2013&#44; with no correlation in 2014&#46; This could be related to a worse performance of the candidates in the theory test in 2014 and&#47;or the fact that both assessments &#40;theory and practice&#41; measured different knowledge&#46; It should be noted that finding a high correlation between the 2 assessments indicates that only a small gain in information concerning the knowledge of the applicant is obtained when both instruments are applied&#59; a plausible hypothesis is that&#44; in situations of high correlation between both&#44; the OSCE explores &#40;like the theory test&#41; &#8220;knowledge&#8221; and &#8220;know how&#8221; and shuns the &#8220;show how&#8221; of the Miller pyramid&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In relation to this&#44; Matsell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> identified a key element in construct validity for an OSCE when it is based on the high correlation with a written evaluation&#46; From a theory point of view&#44; the OSCE assesses a wide variety of skills&#47;clinical competencies&#44; so the authors propose stations categorized into 4 major domains &#40;knowledge&#44; problem solving&#44; clinical skills and patient management&#41; and correlating stations for each domain with the corresponding theory part&#46; This proposal&#44; which has great theoretical foundation&#44; will be included in the forthcoming implementation of OSCE&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Regarding construct validity&#44; the experience construct was also analyzed&#59; a valid assessment should show how more experienced candidates perform better&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> All applicants had similar training in years&#46; However&#44; the same circuit was applied to 3 newly certified rheumatologists&#44; under similar test day conditions&#46; In general&#44; the latter had higher scores than the applicants&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Finally and indirectly&#44; construct validity was analyzed in 2014 comparing the pass percentage of those passing the theory test &#40;and the average score&#41; in those who passed or did not pass the OSCE&#46; Our results support the validity of the instrument&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">With respect to reliability&#44; no evaluation was performed&#44; although 3 ways have been proposed to increase the reliability of the OSCE and all of them were implemented&#58; short station design to allow evaluation of multiple clinical situations&#44; evaluation of the stations through predetermined checklists and integration of circuits with different stations&#44; evaluators and<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> simulated patients&#46; In our case&#44; patients selected were real patients &#40;except for 2 actors&#41;&#59; however&#44; they received training booklets designed to represent the condition of each station and reviewed by an expert panel&#46; All this increases the reliability of the OSCE without affecting its validity&#44; as when simulated patients or actors are used&#46; In addition&#44; 9 stations were applied in 2 consecutive years and showed excellent stability between the 2 groups of aspirants and internal consistency between certified rheumatologists in the pilot test was excellent&#46; Finally&#44; while a low interstation correlation was found&#44; this indicates that each station evaluated different skills or competencies and therefore discarded redundancy of our instrument&#46; It is important to emphasize the need to include an adequate number of stations to not affect the reliability of the OSCE&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;22</span></a> In the one similar exercise &#40;that we know of&#41;&#44; the exercise circuit consisted of 12 stations&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Probably one of the biggest benefits of an OSCE &#40;and other similar evaluations&#41; is the ability to identify deficiencies in the training of residents and eventually modify the curriculum&#46; It is therefore essential to have an optimal assessment tool&#46; While it is true that the performance of our instrument was adequate&#44; we must not forget that the OSCE is ultimately an approximation to the real problems but not a real physician-patient encounter&#46; Our experience is limited to two years&#44; but it is recommended that any instrument be used for 3&#8211;5 consecutive years&#44; allowing proper calibration thereof&#46; Furthermore&#44; the OSCE was not reproduced in full in consecutive years&#46; With regard to the assessment of the stations&#44; no scientific method was applied to establish the passing score for each station&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> but some previous criteria were established&#46; The OSCE applied to certified rheumatologists &#40;pilot&#41; was developed on a different day than the OSCE applied to applicants&#44; although an effort was made to reproduce the conditions of the final evaluation&#46; The implementation of OSCE required financial and human resources&#59; when performing the exercise to define the costs&#44; these amounted to 120<span class="elsevierStyleHsp" style=""></span>000 pesos &#40;about &#36;9200&#41;&#44; a figure which is not excessive but much greater than what is usually invested in the practical assessment of residents and could affect its long-term viability&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In conclusion&#44; the OSCE designed by the CMR showed adequate construct validity and reliability&#44; so it can be integrated as an instrument for assessing clinical skills in the board examination in order to obtain a certification as a rheumatologist&#46; Certification boards have a social responsibility and also a responsibility to the medical community&#44; documenting that specialists are competent to exercise their practice&#46; It is therefore necessary to incorporate rigor&#44; methodological quality and transparency to the certification processes&#46; In parallel&#44; society must require greater professionalism&#46; The effort of the whole of society&#44; the medical community&#44; patients and the competent authorities must have a common goal to help increase the quality of care our population receives&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Ethical Responsibilities</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Protection of people and animals</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare this research did not perform experiments on humans or animals&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Data privacy</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors state that no patient data appears in this article&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Right to privacy and informed consent</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors state that no patient data appears in this article&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of Interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres528593"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Method"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec548830"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres528592"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec548831"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and Methods"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Planning the Objective Structured Clinical Examination &#40;Fig&#46; 1&#41;"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Design of the Objective Structured Clinical Examination"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Population to Which the Objective Structured Clinical Examination and Theory Test was Applied"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Theory Test Board Exam"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Score for Certification"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Statistical Analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Certification Exam Score"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Validity"
            ]
            2 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Agreement"
            ]
            3 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Reliability-reproducibility"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Discussion"
        ]
        8 => array:3 [
          "identificador" => "sec0075"
          "titulo" => "Ethical Responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Protection of people and animals"
            ]
            1 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Data privacy"
            ]
            2 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Conflict of Interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-06-23"
    "fechaAceptado" => "2014-10-18"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec548830"
          "palabras" => array:3 [
            0 => "Objectively structured clinical examination"
            1 => "Trainee"
            2 => "Certification&#44; Rheumatology"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec548831"
          "palabras" => array:3 [
            0 => "Examen cl&#237;nico objetivo estructurado"
            1 => "Desempe&#241;o cl&#237;nico"
            2 => "Certificaci&#243;n&#44; Reumatolog&#237;a"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess reliability and validity of the objectively structured clinical examination &#40;OSCE&#41; applied in postgraduate certification processes by the Mexican Board of Rheumatology&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirty-two &#40;2013&#41; and 38 &#40;2014&#41; Rheumatology trainees &#40;RTs&#41; underwent an OSCE consisting of 12 and 15 stations respectively&#44; scored according to a validated check-list&#44; as well as 300 multiple-choice question examination &#40;MCQ&#41;&#46; Previously&#44; 3 certified rheumatologists underwent a pilot-OSCE&#46; A composite OSCE score was obtained for each participant and its performance was examined&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In 2013&#44; OSCE mean score was 7&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6 with none of the RTs receiving a failing score while the MCQ score was 6&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6 and 7 &#40;21&#46;9&#37;&#41; RTs received a failing &#40;&#60;6&#41; score&#46; In 2014&#44; the OSCE score was 6&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#44; with 3 &#40;7&#46;9&#37;&#41; RTs receiving a failing score &#40;2 of them also failed MCQ&#41; while the MCQ score was 6&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5 and 7 &#40;18&#46;5&#37;&#41; RTs were disqualified &#40;2 of them also failed OSCE&#41;&#46; A significant correlation between the MCQ and the OSCE scores was observed in 2013 &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;44&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#46; Certified rheumatologists performed better than RTs at both OSCE&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Overall&#44; 86&#37; of RTs obtaining an OSCE passing score also obtained a MCQ passing score&#44; while this was only 67&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41; among those who obtained an OSCE failing score&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nine stations were applied at both consecutive years&#46; Their performance was similar in both certification processes&#44; with correlation coefficients ranging from 0&#46;81 to 0&#46;95 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The OSCE is a valid and reliable tool to assess the Rheumatology clinical skills in RTs&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Determinar la validez de constructo y la confiabilidad de un examen cl&#237;nico objetivo estructurado &#40;ECOE&#41; en la evaluaci&#243;n de una certificaci&#243;n nacional como reumat&#243;logo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En 2013 y 2014&#44; se aplicaron sendos ECOE y evaluaci&#243;n te&#243;rica &#40;ET&#41; a 32 y 38 residentes aspirantes a la certificaci&#243;n de reumat&#243;logo&#44; respectivamente&#46; Se incluyeron 12 y 15 estaciones calificadas mediante lista de cotejo validada&#46; Previamente&#44; 3 reumat&#243;logos certificados realizaron sendas pruebas piloto&#46; Se calcul&#243; la puntuaci&#243;n global del ECOE y se evalu&#243; su desempe&#241;o&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En 2013&#44; la media &#177; DE del ECOE fue de 7&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6&#41; y ning&#250;n aspirante tuvo calificaci&#243;n reprobatoria &#40;CR&#41;&#59; la media de la ET fue de 6&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6 y 7 aspirantes &#40;21&#44;9&#37;&#41; tuvieron CR &#40;&#60;<span class="elsevierStyleHsp" style=""></span>6&#41;&#46; En 2014&#44; la media del ECOE fue de 6&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6&#41; y 3 aspirantes &#40;7&#44;9&#37;&#41; tuvieron CR&#44; de los cuales 2 reprobaron la ET&#59; la media de la ET fue de 6&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5&#41; y 7 aspirantes &#40;18&#44;5&#37;&#41; tuvieron CR&#44; 2 de los cuales reprobaron el ECOE&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En 2013&#44; la correlaci&#243;n entre el ECOE y la ET fue de r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;44&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#46; En ambos a&#241;os&#44; los reumat&#243;logos certificados obtuvieron mejores calificaciones en el ECOE que los residentes&#46; El porcentaje de aprobados en la ET fue mayor entre quienes aprobaron el ECOE que entre quienes lo reprobaron&#58; 86&#37; vs&#46; 67&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se aplicaron 9 estaciones en ambos a&#241;os y sus puntuaciones mostraron correlaci&#243;n de 0&#44;81 a 0&#44;95&#44; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El ECOE es una herramienta adecuada para evaluar las competencias cl&#237;nicas de los aspirantes a la certificaci&#243;n&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pascual Ramos V&#44; Medrano Ram&#237;rez G&#44; Sol&#237;s Vallejo E&#44; Bernard Medina AG&#44; Flores Alvarado DE&#44; Portela Hern&#225;ndez M&#44; et al&#46; Desempe&#241;o del examen cl&#237;nico objetivo estructurado como instrumento de evaluaci&#243;n en la certificaci&#243;n nacional como reumat&#243;logo&#46; Reumatol Clin&#46; 2015&#59;11&#58;215&#8211;220&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0220" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0100"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1448
            "Ancho" => 2822
            "Tamanyo" => 245365
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Timeline of the design strategy of the objective structured clinical examination&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1068
            "Ancho" => 3152
            "Tamanyo" => 224411
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Correlation between the two tests&#44; the theory evaluation and objective structured clinical examination in 2013 and 2014&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;07&#44; Wilcoxon test&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First quartile 5&#46;47 to 6&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Second quartile 6&#46;19 to 6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Third quartile 6&#46;51 to 6&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fourth quartile 6&#46;73 to 7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">OSCE Score<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">OSCE Score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab851779.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Validity of Concurrency of the Theory and the Clinical Objectively Structured Examination&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Station&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score OSCE-2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score OSCE-2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pearson correlation coefficient &#40;<span class="elsevierStyleItalic">r</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4&#177;1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;8&#177;1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;941&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&#177;1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;6&#177;4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;818&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&#177;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0&#177;2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;809&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&#177;1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;869&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&#177;1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;937&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;1&#177;1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;5&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;845&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0&#177;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;6&#177;2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;926&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;9&#177;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;4&#177;2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;942&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0&#177;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;8&#177;1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;947&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab851780.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparison of the Scores of the Stations Implemented in the Objective Structured Clinical Examination in 2013 and 2014 &#40;<span class="elsevierStyleItalic">P</span>&#8804;0&#46;01&#41;&#46;</p>"
        ]
      ]
      4 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.pdf"
          "ficheroTamanyo" => 124669
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:23 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "Educational measurement"
                        "edicion" => "4th ed&#46;"
                        "serieFecha" => "2006"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The death of the long case&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;J&#46; Norcini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2002"
                        "volumen" => "324"
                        "paginaInicial" => "408"
                        "paginaFinal" => "409"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11850375"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Objective structured clinical examination &#40;OSCE&#41;&#58; review of literature and implications for nursing education"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;E&#46; Rushforth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nedt.2006.08.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nurse Educ Today"
                        "fecha" => "2007"
                        "volumen" => "27"
                        "paginaInicial" => "481"
                        "paginaFinal" => "490"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17070622"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance of internal medicine house medicine officers on a short station OSCE"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Petrusa"
                            1 => "T&#46; Blackwell"
                            2 => "M&#46; Ainsworth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Further development in assessing clinical competence"
                        "paginaInicial" => "598"
                        "paginaFinal" => "608"
                        "serieFecha" => "1987"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Objective structured clinical examinations &#40;OSCEs&#41; and objective structured performance-related examinations &#40;OSPREs&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Curtis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "The CanMEDS competencies"
                        "paginaInicial" => "23"
                        "paginaFinal" => "25"
                        "serieFecha" => "2006"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of clinical competence using an objective structured clinical examination &#40;OSCE&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;M&#46; Harden"
                            1 => "F&#46;A&#46; Gleeson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Educ"
                        "fecha" => "1979"
                        "volumen" => "13"
                        "paginaInicial" => "41"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/763183"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elaboraci&#243;n de estaciones para el examen cl&#237;nico objetivo estructurado &#40;ECOE&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Trejo-Mej&#237;a"
                            1 => "G&#46; Blee-S&#225;nchez"
                            2 => "J&#46; Pe&#241;a-Balderas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Investig Educ Med"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "56"
                        "paginaFinal" => "59"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Content validity of the Quebec licensing examination &#40;OSCE&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Grand&#8217;Maison"
                            1 => "C&#46;A&#46; Brailovsky"
                            2 => "J&#46; Lescop"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can Fam Physician"
                        "fecha" => "1996"
                        "volumen" => "42"
                        "paginaInicial" => "254"
                        "paginaFinal" => "259"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9222574"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of objective structured clinical examination &#40;OSCE&#41; for evaluation and instruction in graduate medical education"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;A&#46; Sloan"
                            1 => "M&#46;B&#46; Donnelly"
                            2 => "R&#46;W&#46; Schwartz"
                            3 => "J&#46;L&#46; Felts"
                            4 => "A&#46;V&#46; Blue"
                            5 => "W&#46;E&#46; Strodel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Surg Res"
                        "fecha" => "1996"
                        "volumen" => "63"
                        "paginaInicial" => "1225"
                        "paginaFinal" => "1230"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reliability and validity of the objective structured clinical examination in paediatrics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;G&#46; Matsell"
                            1 => "N&#46;M&#46; Wolfish"
                            2 => "E&#46; Hsu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Educ"
                        "fecha" => "1991"
                        "volumen" => "25"
                        "paginaInicial" => "293"
                        "paginaFinal" => "299"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1890958"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of specialist registrars in rheumatology&#58; experience of an objective structured clinical examination &#40;OSCE&#41;"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "West Midlands Rheumatology Services and Training Committee"
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;B&#46; Hassell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2002"
                        "volumen" => "41"
                        "paginaInicial" => "1323"
                        "paginaFinal" => "1328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12422008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Musculoskeletal ultrasound objective structured clinical examination&#58; an assessment of the test"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;Y&#46; Kissin"
                            1 => "P&#46;C&#46; Grayson"
                            2 => "A&#46;C&#46; Cannella"
                            3 => "P&#46;J&#46; Demarco"
                            4 => "A&#46; Evangelisto"
                            5 => "J&#46; Goyal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2014"
                        "volumen" => "66"
                        "paginaInicial" => "2"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Plan &#250;nico de especializaciones m&#233;dicas en Reumatolog&#237;a&#44; M&#233;xico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Facultad de Medicina UNAM&#44; Divisi&#243;n de estudios de posgrado&#44; Subdivisi&#243;n de especializaciones m&#233;dicas&#44; Departamento de desarrollo curricular"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of musculoskeletal pain and rheumatic diseases in the southeastern region of Mexico&#46; A COPCORD-based community survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Alvarez-Nemegyei"
                            1 => "I&#46; Pel&#225;ez-Ballestas"
                            2 => "L&#46;H&#46; Sanin"
                            3 => "M&#46;H&#46; Cardiel"
                            4 => "A&#46; Ramirez-Angulo"
                            5 => "M&#46;V&#46; Goycochea-Robles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3899/jrheum.100954"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol Suppl"
                        "fecha" => "2011"
                        "volumen" => "86"
                        "paginaInicial" => "21"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21196595"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Setting standards on educations tests"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;J&#46; Norcini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Educ"
                        "fecha" => "2003"
                        "volumen" => "37"
                        "paginaInicial" => "464"
                        "paginaFinal" => "469"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12709190"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of clinical competence using objective structured examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;M&#46; Harden"
                            1 => "M&#46; Stevenson"
                            2 => "W&#46;W&#46; Downie"
                            3 => "G&#46;M&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br Med J"
                        "fecha" => "1975"
                        "volumen" => "1"
                        "paginaInicial" => "447"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/837162"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of clinical simulations in assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;W&#46; Schuwirth"
                            1 => "C&#46;P&#46; van der Vleuten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Educ"
                        "fecha" => "2003"
                        "volumen" => "37"
                        "paginaInicial" => "65"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14641641"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The objective structured clinical examination&#58; a step in the direction of competency-based evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Carraccio"
                            1 => "R&#46; Englander"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pediatr Adolesc Med"
                        "fecha" => "2000"
                        "volumen" => "154"
                        "paginaInicial" => "736"
                        "paginaFinal" => "741"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10891028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Design and validation of 2 objective structured clinical examination stations to assess core undergraduate examination skills of the hand and knee"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Raj"
                            1 => "L&#46;J&#46; Badcock"
                            2 => "G&#46;A&#46; Brown"
                            3 => "C&#46;M&#46; Deighton"
                            4 => "S&#46;C&#46; O&#8217;Reilly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2007"
                        "volumen" => "34"
                        "paginaInicial" => "421"
                        "paginaFinal" => "424"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17304661"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The assessment of clinical skills&#47;competence&#47;performance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46;E&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Acad Med"
                        "fecha" => "1990"
                        "volumen" => "65"
                        "numero" => "Suppl&#46;"
                        "paginaInicial" => "S63"
                        "paginaFinal" => "S67"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2400509"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The objective structured clinical examination&#46; The new gold standard for evaluating postgraduate clinical performance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;A&#46; Sloan"
                            1 => "M&#46;B&#46; Donnelly"
                            2 => "R&#46;W&#46; Schwartz"
                            3 => "W&#46;E&#46; Strodel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1995"
                        "volumen" => "222"
                        "paginaInicial" => "735"
                        "paginaFinal" => "742"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8526580"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of an OSCE assessment tool for abdominal ultrasound courses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Hofer"
                            1 => "L&#46; Kamper"
                            2 => "M&#46; Sadlo"
                            3 => "K&#46; Sievers"
                            4 => "N&#46; Heussen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0029-1246049"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ultraschall Med"
                        "fecha" => "2011"
                        "volumen" => "32"
                        "paginaInicial" => "184"
                        "paginaFinal" => "190"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21321843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Passing scores&#46; A manual for setting standards of performance on educational and occupational tests"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;A&#46; Livingston"
                            1 => "M&#46;J&#46; Zieky"
                            2 => "J&#46; Michael"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "1982"
                        "editorial" => "Educational Testing Service"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001100000004/v1_201507020119/S2173574315000064/v1_201507020119/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "17338"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Original Article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001100000004/v1_201507020119/S2173574315000064/v1_201507020119/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315000064?idApp=UINPBA00004M"
]

Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2015.01.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	9	10	19
2024 October	55	42	97
2024 September	62	18	80
2024 August	61	35	96
2024 July	53	36	89
2024 June	57	32	89
2024 May	73	39	112
2024 April	67	29	96
2024 March	46	41	87
2024 February	36	34	70
2024 January	42	27	69
2023 December	41	25	66
2023 November	44	41	85
2023 October	40	35	75
2023 September	74	42	116
2023 August	38	11	49
2023 July	24	35	59
2023 June	35	25	60
2023 May	54	31	85
2023 April	29	13	42
2023 March	85	16	101
2023 February	52	24	76
2023 January	37	23	60
2022 December	73	39	112
2022 November	81	40	121
2022 October	57	36	93
2022 September	88	35	123
2022 August	74	41	115
2022 July	60	34	94
2022 June	82	30	112
2022 May	80	46	126
2022 April	121	54	175
2022 March	63	52	115
2022 February	45	34	79
2022 January	53	49	102
2021 December	54	42	96
2021 November	60	42	102
2021 October	78	59	137
2021 September	57	43	100
2021 August	41	50	91
2021 July	27	35	62
2021 June	28	46	74
2021 May	53	45	98
2021 April	134	119	253
2021 March	51	33	84
2021 February	47	30	77
2021 January	36	25	61
2020 December	40	22	62
2020 November	29	31	60
2020 October	25	24	49
2020 September	33	15	48
2020 August	43	25	68
2020 July	18	15	33
2020 June	40	18	58
2020 May	47	20	67
2020 April	48	14	62
2020 March	13	8	21
2020 February	1	0	1
2018 May	5	2	7
2018 April	44	14	58
2018 March	51	9	60
2018 February	23	5	28
2018 January	21	5	26
2017 December	29	9	38
2017 November	26	9	35
2017 October	30	8	38
2017 September	25	14	39
2017 August	24	7	31
2017 July	32	15	47
2017 June	65	18	83
2017 May	54	11	65
2017 April	27	19	46
2017 March	43	8	51
2017 February	13	7	20
2017 January	28	2	30
2016 December	61	22	83
2016 November	65	16	81
2016 October	63	11	74
2016 September	67	7	74
2016 August	48	1	49
2016 July	44	9	53
2016 April	1	0	1
2015 December	2	0	2
2015 November	1	8	9
2015 October	3	21	24
2015 September	2	0	2
2015 August	6	46	52
2015 July	31	24	55

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter