The Integrated Direct Observation Clinical Encounter Examination (IDOCEE) - an objective assessment of students' clinical competence in a problem-based learning curriculum

Because of the well known, poor reliability and cost ineffectiveness of the traditional discipline-oriented type of long/short case clinical examination, the College of Medicine of the Arabian Gulf University in 1996 replaced this type of examination for its final MD Graduating Class by a performance-based clinical examination 'The integrated Direct Observation Clinical Encounter Examination' (IDOCEE) in which the student's clinical competence is tested during his encounter with four or five real patients having a mix of clinical problems under direct observation by a panel of between four and six examiners from different disciplines over a 2 hour period. Seventy four students were examined by 26 examiners. In order to test the students' and examiners' satisfaction with this type of examination, a structured questionnaire was used. The response was as follows: 98% of the students were satisfied by the examination structure and organization, 94% with its effectiveness in resting student clinical competence, and 97% with the examiners attitude and approach; 96% of the examiners expressed satisfaction with the examination structure and organization and 97% with its ability to test clinical competence. This experience indicates that the IDOCEE is a practical and cost-effective assessment tool of student's student's clinical competence, and it can replace the traditional discipline-based clinical examinations.