MEDICAL EDUCATION TECHNOLOGY

1. Objective Structured Clinical
Examination (OSCE) /
Objective Structured
Practical Examination (OSPE)
Dr. Dinesh T,
Asst Prof. Physiology,
Member- MEU,
DSMCH, Perambalur.
1

2. Objectives
 Define objective structured clinical/ practical
examination
 Identify the ways in which OSCE/ OSPE differs
from conventional practical examination
 Realize the circumstances that necessitated
introduction of OSCE/ OSPE
 Identify the Advantages and Disadvantages of
OSCE/OSPE
 Plan and organize the conduction of an OSCE/
OSPE
2

3. What is an OSCE?
 Objective: Examiners use a checklist for
evaluating the trainees
 Structured: Trainee sees the same problem and
perform the same tasks in the same time frame
 Clinical: The task are representative of those
faced in real clinical situation
3

4. Definition- OSCE
A multidimensional practical examination
of clinical skills, as a tool for assessing
clinical competence
4

5. Objective structured practical
examination (OSPE)
 A method of practical examination, assessment
tool
 Subjects and materials are used instead of
patients
5

6. Purpose of OSCE
Problems in routine clinical examination
 Variability
 Global assessment
 Marks awarded by overall impression
 Many abilities are ignored
 Difficulty in terms of time, money and number of
patients and examiners required
 “Tests the product not the process”
 OSCE is designed to overcome these
deficiencies
6

7. History of OSCE
 OSCE was developed in University of Dundee
(Dundee, Scotland) in the early 1975 by Dr. Harden
and his colleagues
 After some modification it was described in detail on
1979.
 This method was the subject of an international
conference in Ottawa in 1985 and experience were
exchanged about OSCE & OSPE
 More than 50 countries accepted it
 Globally used now
7

8. What is assessed by OSCE?
 Various clinical skills – history taking , physical
examination, technical procedure,
communication, interpersonal skills
 Knowledge and understanding
 Data interpretation
 Problem solving
 Attitudes
8

9. Miller’s Pyramid
9

10. How to prepare OSCE ?
10

11. The steps in designing and
implementing an OSCE/OSPE
Have Set of
CLEAR
OBJECTIVES
Identify the
PRACTICAL
aspects
Select the TASK
Break into SUB-
TASKS
Assign SCORES
(WEIGHTS) for
each sub task
Set up
STATIONS
CONDUCT after
orienting
students and
examiners
Make NOTES of
the process and
review
ANALYZE the
results and use
the same for
student
assessment 11

12. The key to a successful
OSCE/ OSPE
is
Careful Planning
12

13. How to develop case/scenario?
 Define the purpose of the station
 Candidate’s instructions
 Scoring checklist
 Standardized patient instructions
 Instruction for stations set-up
13

14. Define the purpose of the station
 The examination will measure objectively the
competencies based on the objectives of the
course or the requirement of the licensing body
 State the skill and domain to be tested
 Skill – Ex. Elicit signs of Anaemia
 Domain – Knowledge, Psychomotor
14

15. Candidate instructions
 Candidate instruction must be clear and concise
 Before examination a briefing about whole
system is very much effective for a successful
OSCE
15

16. Scoring checklist
 The checklist should be complete and include
the main components
 Any unnecessary or exaggerated term must be
avoided
16

17. Instructions for station set-up
 List the equipments required for the station
 Instructions or questions to be performed by the
candidate, for example “Record the ankle jerk
response for this patient”
 Materials -Table/chair/couch and other materials
as required for the task e.g. Knee Hammer
 Patient or subject (OSPE)
 An assessor or examiner
 Time frame and changing signal
17

18. The Examinees
The examinee is the student, resident or fellow in
training or at the end of training of a prescribed
course
18

19. The Examiners
The examiner is needed in where clinical skills
(history-taking, physical examination,
interviewing and communication) are assessed
19

20. Examinations Station
 A “station” is the site at which the student is
assessed on a particular ability
 The total number of stations will vary based the
number of skills, behaviors and attitudinal items to
be tested
 For most clerkships or courses, the total will vary
from 10-25 (Usually 20)
20

21. Set up “Stations”
Stations are of different types
 History Taking stations: e.g. “This patient
complains of abdominal pain. Take a history
pertaining to abdominal pain”
 Examination stations: Student’s ability to perform
a clinical examination is assessed, e.g. “Record
ankle jerk response”
 Skill stations: Student’s are tested on their ability
to perform a skill eg. Provide CPR, Start IV line
21

22. Set up “Stations”...
 Communication stations: Communication ability
of a student is assessed e.g. “Advise the mother
of a three year old child with diarrhea regarding
use of ORT for her child”
 Response stations: Interpretative ability of a
student is assessed e.g.“ Interpret this Chest X
ray of a 40 year old patient with acute dyspnea
and state 3 reasons for your answer”
 Rest stations: To give students a chance to
organize their thoughts
22

23. Couplet & Double 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
 Double stations- for providing adequate time
Examination
Of a patient with
Anemia
Findings
Interpretation
Plan of
management
23

24. Duration of station
 Duration of stations has been fixed
 Make sure that the task expected of the student
can be accomplished within the time
 Time ranging from 4 to 15 minutes. 5 minute
station probably most frequently chosen
 The time depends on the competencies to be
assessed in the examination
24

25. Movement in the Stations
25
1
2
34
5

26. Observer Assessment
Method
 Checklist or Key
 Rating scale
26

27. Procedural station Check list
 Mr. X. Presents with a swollen ankle for 6 weeks
DoDon’t
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-Inspecting for swelling , erythema and deformity if
any
5-Inspection:
Standing
From anterior
Posterior
6- Gait examination
7- palpation 27

28. Communication skills checklist
(Rating Scale)
Excellence
5
V Good
4
Good
3
Fair
2
Poor
1
1- Interpersonal skill:
Listen carefully
2-Interviwing skill: Uses
words to patient as
understandable
28

29. Standardized Patients (SP)
• A standardized patient is an individual who is
trained to portray scripted patient
• These instruction must be detailed as
standardized patient playing the same role
• Standardized patients may be volunteers or paid
employee
• Clinically stable patient can also be used as
standardized patient
• Ideally a physician will observe the standardized
patients before the examination
29

30. Simulated patients
 Persons playing the role of patients
(i.e."simulated" patients) can be used instead of
actual patients
 But to make it more reliable use as many actual
patients as possible
30

31. Advantages of OSCE
 More objective
 Test not only skills and knowledge but attitudes
also
 Test the student’s ability to integrate knowledge,
clinical skills and communication with the patient
31

32. Advantages..
 Can be used with large number of students
 Reproducible
 Provides unique programmatic evaluation
 Less complexity
 Valid examination
 Summative and well formative
32

33. Disadvantages
 Development and administration are time
consuming and costly
 OSCE involves lots of planning
 The assessment of skills tends to get
compartmentalized in an OSCE, “on the whole”
is not assessed
 Inadequate for Postgraduate examinations
33

34. Disadvantages ...
 The reliability of OSCEs has been found to be
low if there are a small number of stations, noisy
environments, untrained patients and lack of
structured checklists
 Need for standardization of simulated patients
and examiners
 Repetitive and boring
 Requires time, effort on the part of the
examiners, during the examination
34

35. Watched
Structured Clinical Examination
(WSCE)
 Alnasir (2004) created this method
 WSCE found to be more useful than OSCE
 Less time-consuming, more cost-effective,
requires less supervising staff to conduct the
examination and less stressful to the students
35

36. The Objective Structured Long
Examination Record (OSLER)
 OSLER was introduced by Gleeson in 1992
 An attempt to remodel and improve the long
case examination
 He suggested modifications to improve the long
case examination
36

37. OSLER..
 The long case is divided into 10 items on which
each candidate is assessed
 The 10 items cover all aspects of working up a
long case
 The process of history taking, examination and
management of the patients is observed
 In addition to observation during history taking,
communication skills are also evaluated
37

38. 10 items in OSLER
 History taking
1. Pace and clarity of presentation
2. Communication process
3. Systematic approach
4. Establishment of case facts
 Physical examination
1. Systematic approach
2. Examination technique
3. Establishment of correct findings
 Management
1. Appropriate investigations in logical sequence
2. Appropriate management plan
3. Clinical acumen 38

39. OSLER
All candidates will be assessed on same 10 items
by the examiners in the same frame
Grades:
 P+ (very good/ excellent)
 P (pass)
 P- (below pass)
 Examiners and co –examiners analyze and give
overall grade
39

40. Conclusion
 In conventional examination marks awarded is
on candidates global performances not for
individual competencies
 The OSCE is a highly reliable and valid clinical
examination that provides unique information
about the performance of residents
 OSCE overcome most of those obstacles
 Combining OSCE with long cases can assess
the competency effectively
40

41. Exercise 1: Procedure station
 Instruction to the candidate
Check the Blood pressure of the given patient
accurately
 Materials required
Bed or couch, stool for candidate, BP
apparatus, stethoscope, patient, examiner,
instructions to candidate and checklist for the
examiner
 Marks allotment: 0.5+1+1+1+1+0.5 = 5 marks
 Time allotment: 5 minutes
41

42. Specific sub tasks Marks
allotted
Marks
obtained
1. Greet the patient and supply proper instructions 0.5
2. Position patient sitting with arm exposed
•Arm at heart level
•Apparatus at level of observer’s eyes (0.25 each)
0.5
3. Check BP by palpatory method –
Palpates over the Radial artery
1
4. Check BP by auscultatory method –
•Positions stethoscope over Brachial artery in cubital
fossa
•Deflates by 2 mmHg every second
•Records Systolic BP
•Records Diastolic BP (0.25 each)
1
5.Records SBP/DBP accurately within 5 mmHg of
patients known BP (0.5 each)
1
6.Deflates, removes cuff & replaces equipment
carefully. Thanks patient (0.25 each)
1
42

43. EXERCISE
43

44. “If you can’t make a
mistake, you can’t
learn anything”
- M Collins
Thank you all....
44

45. References
 Harden RM, Stevenson M, Downie WW, Wilson GM.
Assessment of clinical competence using objective
structured examination. Br Med J 1975; 1:447-51.
 Sethuraman KR. Objective Structured Clinical
Examination. New Delhi: Jaypee Brothers, 1993.
 Ananthakrishnan, N. Objective structured
clinical/practical examination (OSCE/OSPE). Journal of
Postgraduate Medicine 1993; 39:82-84.
 David A. Sloan, M.D., Michael B. Donnelly, Ph.D.,
Richard W. Schwartz, M.D.and William E. Strodel, M.D.
The Objective Structured Clinical Examination.The New
Gold Standard for Evaluating Postgraduate Clinical
Performance. Annals of surgery 1995. 222 (6), 735-742.
45

46. References...
 Samira Alsenany, Amer Al Saif. Developing skills in
managing Objective Structured Clinical Examinations
(OSCE), Life Science Journal 2012;9(3); 600-602.
 Alnasir, F.A. The Watched Structured Clinical
Examination (WSCE) as a tool of assessment. Saudi
Medical Journal 2004; 25(1):71-47.
 Barman A. Critiques on the Objective Structured Clinical
Examination. Ann Acad Med Singapore 2005;34 478-82.
 Patil JJ. Objective Structured Clinical Examinations;
CMAJ 1993;149; 1376-78.
46