Background: The Objective Structured Clinical Examination was designed 30 years ago by Harden. It has been thought of as a reliable and objective tool to evaluate clinical competences in structured patient encounters. Although generally accepted as a high stake assessment process, reliability, validity and reproducibility of an OSCE still are subject of discussions and concerns. These days the question urges wether a compensatory or an additional rating is advisable for the final pass-fail decision.
Aim: The hypothesis is that a yellow card system (red flagging) could help to identify the high risk future clinicians.
Method: During 8 OSCE-sessions, which included 354 GP-students, observers were asked to deal a yellow card in case of ‘alarming acts’. These acts were defined as dramatic or dangerous shortcomings on three levels: theoretical, practical and behavioral level.
Result: During three academic years, involving 354 students, and eight OSCE-sessions only 41 yellow cards were dealt. Strikingly, one single observer was responsible for one quarter of the allocations. During two sessions half of all yellow cards was dealt to poor performing students. Students remembered with a yellow card were more likely to underperform on all assessments except on the internship.
Conclusion: Flagging alarming or critical events during simulated patient encounters does not identify high risk students. Perhaps in future research the evaluation of internships should be stressed in order to guarantee an objective quotation. Finally, the idea of ‘flagging’ is not be abandoned but moved to other assessment situations.