OSCE
The OSCE can be highly successful as
an instrument to assess competence in
medicine and the approach has many
advantages over more traditional
methods.
The OSCE has offered a strikingly new
and exiting way of making valid
assessment of clinical performance of
medical student ,resident, and fellows .
History of OSCE
OSCE was developed in Dundee , Scotland in the
early 1970’s by Dr.Harden and colleagues.
The OSCE is now used in over 50 country world-
wide.
There is a national OSCE in Canada ,taken by all
medical school.
OSCE is a kind of exam not a test.
OSCE
Objective Structural Clinical Examination
OSLER
Objective structural Long Examination Record
OSPE
Objective Structural Practical Examination
TOSCE (GOSCE)
Team (group) Objective Structural Clinical
Examination
Advantage
Provides a opportunity to test a student’s ability
to integrate knowledge, clinical skills, and
communication with the patient
Provides the faculty with an assessment tool that
is custom-fit to the goals of a specific education
program
Renders an occasion for individualized
instruction and feedback
Offers an additional parameter by which to
evaluate student performance
Provides unique programmatic evaluation
Disadvantage
Development and administration are time
consuming and costly.
Offers opportunity for compromised test security
Provides assessment of case-specific skills,
knowledge, and/or attitudes
What is the purpose of the OSCE?
Provide feedback on performance
Evaluate basic clinical skill
Measure minimal competency
How to prepare OSCE ?
THE KEY TO A SUCCESSFUL
OSCE IS CAREFULE
PLANNING
ONE:
Selection the examination committee
An examination coordinating committee is made up of
members who are committed to the evaluative and
educational process
The number of members who make up this committee is
not as important as the intensity of the investment of
each member.
Responsibility of the examination committee determined
the content of the examination, development and
implementation.
It is important that this committee has the capacity and
personnel to address decisions related to reliability and
validity
TWO:
The Examination Coordinator
The functions of the examination coordinator
(M.D. or Ph.D. educator) are the catalyst that
facilitates the smooth working of the committee
in developing, implementing and assessing the
performance of the OSCE.
Three: Lists of Skills, Behaviors and
Attitudes to be Assessed
The examination will measure objectively the
competencies in specific areas of behavior,
techniques, attitudes and decision-making
strategies based on the objectives of the course
or the requirement of the licensing body.
committee should prepare An Exam
Blueprint
History Physical Lab data Patient
Taking Examination Interpretation Management
Subject area Specialist area
Cardiology
1
Endocrinology
1
Hematology
1
Pediatrics
1 1
Clinical
Pharmacology 1
How to develop case/scenario?
Define the purpose of the station
Candidate instructions
Scoring checklist
Standardized patient instructions
Instruction for station set-up
Define the purpose of the station
State the skill and domain to be tested
Skill –Physical examination .
Domain –Internal medicine /cardiology .
Candidate instructions
Candidate instruction must be clear and concise.
Scoring checklist
The checklist should be complete and include
the main components of the skill being assess.
Standardized patient instructions
These instruction must be detailed enough to
guarantee standardization patient playing the
same role.
Instruction for station set-up
List of all equipment required for the station
Four:
The Examinees
The examinee is the student, resident, or fellow
in training or at the end of training of a
prescribed course
Five: The Examiners
Most stations will require an examiner, although
some stations do not. The examiner at the
station where clinical skills (history-taking, physical
examination, interviewing and communication) are
assessed, may be either a physician or a
standardized patient.
Six: The Examination Site
The examination site is part of a special teaching
facility in some institutions. When such facilities
are not available, the examination may be
conducted in an outpatient facility .
Seven : Examinations Station
The total number of stations will vary based on a
function of the number of skills, behaviors and
attitudinal items to be tested. For most clerkships
or courses, the total will vary from 10-25.
Number of Stations
The number of stations in an examination refer
the time allocated for each station determines
the time required to complete the whole
examination.
Twenty stations each of five minutes can be
completed in I hour 40 mins
While 20 stations each of 10 minutes require 3
hrs 20 mins to complete
Duration of station
Times ranging from 4 to 15 minutes have been
reported in different examinations and a five
minute station probably most frequently chosen.
This times depend to some extent on the
competencies to be assessed in the
examination.
Couplet Station
Some competencies may best be assessed by
coupled or linked stations.
The use of linked stations extends the time available
to complete a task.
Finding Treatment or
History taking
Interpretation Management
Duration of stations has been fixed
Make sure that the task expected of the student
can be accomplished within the time
If necessary some stations which are allocated
double the standard time. Such double stations
will require to be duplicated in the examination.
Observer Assessment Method
Checklist
Rating scale
Check list for assessment of a physical
finding
Mr.C. presents with a sore swollen ankle for 6 weeks
Don’t Do
1-introduces self to patient
2-Explain to the patient what will be do
3-Demonstrate concern for patient.i.e.is not excessive
rough
4-Inspectin for any of swelling , erythema ,deformity
5-Inspection:
Standing
From anterior
Posterior
6- Inspection pt Gait
7- palpation
Sample Communication skills checklist
(rating scale)
Poor Fair Good V Good Excellence
1 2 3 4 5
1- Interpersonal skill:
Listen carefully
2-Interviwing skill:
Uses words patient can
understand
Organized
If deemed appropriate ,checklist
items can be weighted to reflected
the importance of one item over
another
Standard patient
A standardized patient is an individual with a
health problem that is in a chronic but stable
condition;
( fundoscopic changes ,Goiter , skin change, cardiac murmur ,
abdominal organomegaly)
Standardized or simulated patient usually used
when properly trained for history &physical
assessment .
standardized patients may be volunteers or paid
employee
Ideally a physician will also observe the
standardized patients demonstrating their
scenario before the examination
Training for these individuals can vary from 3
minutes to 15 hour depending on the complexity
of the case
Question to ensure validity
Are the patient problem relevant and important
to the curriculum?
Will the station assess skill that have been
taught?
Have content experts reviewed the station ?
Factor leading to lower reliability
Too few station or too little testing time
Checklists or items that don’t discriminate (too
easy OR too hard)
Unreliable patient or inconsistent portraits by
standard patient
Examiners who score idiosyncratically
Administrative problem (disorganized staff OR
noisy room)
Research has shown that an acceptable
level of reliability can be achieved with
either a physician or standardized patient
as the examiner
Harden recommends using examiners
from a range of specialist and disciplines
Feed back stations included to provide
examinee with immediate feedback on
performance at previous station
Running The Exam
Space requirements
Signaling station change
Exam day
Collecting result
Budget and dedicated
Station Station
Station 12 10
1 Station
9
Station Station
2 11 Station
8
Station
3 Station
7
Station Station Station
4 5 6
Example of 10 station OSCE accommodating 12 students
Enter in to station
8 min
End of student interaction with SP
2 min
Exit station
1 min
Enter new examinee
Signaling station change
Some pearls !
Have spare standardized patients and examiners
available for the exam as life is unpredictable
Have back-up equipment ,such as view box
,batteries
Have staff available during the examination to
maintain exam security
Make sure the bells or buzzers can be heard
from all location with closed door
For each examination prepare an extra station
which can be setup with minimal effort