The development of an oral assessment of clinical reasoning in osteopathy / Symposium C

Clinical Reasoning (CR) is “a context-dependent way of thinking and decision making on professional practice to guide practice actions” and a vital skill in healthcare. It is a core capability in accreditation standards of osteopathic programmes internationally. A benchmarking project to compare methods of assessing CR in osteopathic training institutions in Australia, New Zealand and the United Kingdom was completed in 2013, revealing that oral case based exams with a number of variations are a common component of the clinical assessment of final year students.

This project aimed to develop an oral case exam that specifically tests clinical reasoning, and to trial this exam using students in their osteopathic clinical training at Southern Cross University and Victoria University (Australia) and Unitec (New Zealand). A group of clinical educators developed authentic case scenarios, as well as an innovative assessment rubric based on current evidence and adapted for osteopathic education and practice. Examiners external to each institution were trained, and clinical educators observed the process. Students were presented two unique cases within 30 minutes. Internal consistency of the assessment rubric was calculated along with inferential statistics to investigate whether there were any differences between case difficulty and examiner stringency.

The results demonstrated that the exam was consistent both internally and with regards to case difficulty and examiner stringency. Feedback from observers pointed to potential improvements, and further reliability and validity testing is required. In conclusion, a trial oral exam of clinical reasoning in osteopathy has performed strongly and could be used across institutions as a benchmarking process and for accreditation purposes.


PAUL J ORROCK ND DO MAppSc GradCertHEd PhD (candidate) is an osteopathic academic and clinician. He has lectured in osteopathic courses at three Australian universities, and is Senior Lecturer and inaugural head of the osteopathic programme at Southern Cross University. Paul has a Masters degree by research where he investigated the relationship between pelvic dysfunction and gait, and is currently studying for a PhD looking at pragmatic clinical trial methodology for complex interventions. Paul completed a major workforce study of osteopathy in Australia, the results of which have been published internationally. Paul also has had a private practice as an Osteopath for over 25 years integrating the use of osteopathy into family health care.