Examination design, confidentiality, and objectivity
TCM syndrome, TCM
All trainees took two-station final examinations– a systematic online knowledge test and an offline clinical performance examination. The exam was scheduled for two days. On the first day, a systematic knowledge test was conducted, whereby all trainees completed 50 objective questions online within 60 min. On the next day, the clinical performance examination lasted 60 min—there was a 20 min patient encounter wherein trainees completed a medical interview, performed a physical examination, and gave medical advice. The evaluation of student performance was immediately completed by OSP-TCMs and TCM specialists using checklists. Subsequently, the trainees had 40 min to write a summary report on the simulation encounter, including a presentation of the medical records, making a diagnosis, and giving TCM syndrome differentiation and therapeutic regimen.To ensure confidentiality and objectivity, new cases were selected from the clinical case database for testing. To eliminate evaluation bias, another group of senior OSP-TCMs and TCM specialists with no exposure to any trainee served as examination evaluators. All the OSP-TCMs and TCM specialists in the exam received evaluation training to ensure consistency. To maintain high fidelity and consistency in performance, the eligibility of OSP-TCMs was determined again 10 days before the final examination. The clinical performance examinations were conducted in a clinical skills center with three waiting areas and six examination areas, separated by appropriate distance and supervised by video to ensure no communication among the staff and trainees. The entire exam process was audiotaped and videotaped. The items needed for clinical performance examination were prepared in advance, and trainees were not allowed to take anything out of the examination area. For trainees not meeting clinical competency for the assessment, a double-check was conducted—another TCM specialist and senior OSP independently reviewed the video, and both evaluators met to discuss and regrade the trainee’s performance.