OSCEOSCE ….….

In The Name Of God

BackgroundBackground

Traditional assessment methods useful for evaluation of knowledge, but not Traditional assessment methods useful for evaluation of knowledge, but not

necessarily of skillsnecessarily of skills

Clinical skills represents amalgam of clinical knowledge and Clinical skills represents amalgam of clinical knowledge and

communication/interpersonal and problemcommunication/interpersonal and problem--solving skillssolving skills

Performance based assessment provides unique vehicle for measurement of Performance based assessment provides unique vehicle for measurement of

clinical skillsclinical skills

What is OSCE?What is OSCE?

TheThe OSCEOSCE cancan bebe highlyhighly successfulsuccessful asas anan instrumentinstrument toto assessassess

competencecompetence inin medicinemedicine andand thethe approachapproach hashas manymany advantagesadvantages overover

moremore traditionaltraditional methodsmethods..

TheThe candidatescandidates rotaterotate throughthrough aa seriesseries ofof stationsstations atat whichwhich theythey areare

askedasked toto carrycarry outout aa (usually(usually clinical)clinical) tasktask

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OSCE ....OSCE ....

Objective

Structured

Clinical

Examination

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OOSCESCE -- OObjectivebjective

All the candidates are presented with the same test

Specific skill modalities are tested at each station

History taking

Explanation

Clinical examination

Procedures

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OOSSCE CE -- SStructuredtructured

The marking scheme for each station is structured

Structured interaction between examiner and student

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OSOSCECE –– CClinical linical EExaminationxamination

Test of performance of clinical skills

candidates have to demonstrate their skills, not just describe the theory

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History of OSCEHistory 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.

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Characteristics of the OSCECharacteristics of the OSCE

It is an assessment approach primarily used to measure clinical competence

Should be planned or structured (predetermined clinical competences)

Examination format or framework

Different types of test method can be incorporated into it

Characteristics of the OSCE (Cont.)Characteristics of the OSCE (Cont.)

In most stations students are observed (by one or more examiners)

Scored as they carry out the task or interpret clinical materials (e.g.

laboratory data, X-rays), write notes or answer question

WhyWhy OSCE?OSCE?

Provides a opportunity to test a student’s ability to integrate knowledge,

clinical skills, and communication with the patient

Renders an occasion for individualized instruction and feedback

Safety of patients

Standardized assessment

Uniquely capable of evaluation of clinical skills in simulated real-world

environment

Not efficient for assessment of knowledge alone

Logistics issues

Expense issues

Development is time-consuming and costly; maintenance of stations requires on-going commitment

Why not OSCE?Why not OSCE?

What OSCEs assess?What OSCEs assess?

• History-taking skills.

• Performance of physical examination.

• Interpretation of data and complementary exams.

• Communications skills.

• Counseling.

• Dealing with particular situations (e.g.: Breaking

bad news, dealing with anger, substance abuse, etc).

• Ethics.

THE KEY TO A SUCCESSFUL OSCE ISTHE KEY TO A SUCCESSFUL OSCE IS

CAREFULE PLANNINGCAREFULE PLANNING

How to prepare OSCE ?How to prepare OSCE ?

ONE:ONE:Selection the examination committeeSelection the examination committee

Responsibility of the examination committee determined the

content of the examination, development and implementation.

committee should prepare An Exam Blueprint

TWO:TWO:The Examination CoordinatorThe Examination Coordinator

The functions of the examination coordinator are the catalyst that

facilitates the smooth working of the committee in developing,

implementing and assessing the performance of the OSCE.

Lists of Skills, Behaviors and Attitudes to be Assessed

Three:Three:

How to develop case/scenario?How to develop case/scenario?

Define the purpose of the station

Candidate instructions

Scoring checklist

Standardized patient instructions

Instruction for station set-up

Four: Four: The ExamineesThe Examinees

The examinee is the student, resident, or fellow in training or at the end

of training of a prescribed course

Five: Five: The ExaminersThe Examiners

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: Six: The Examination Site

Seven :Seven :Examinations StationExaminations 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.

The number of stations in an examination refer the time allocated for

each station determines the time required to complete the whole

examination.

Duration of stationDuration 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.

Observer Assessment MethodObserver Assessment Method

Checklist

Rating scale

Factor leading to lower reliabilityFactor 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)

Running The ExamRunning The Exam

Space requirements

Signaling station change

Exam day

Collecting result

Budget and dedicated

Changing StationsChanging Stations

Simulated PatientSimulated Patient

The standardized patient (SP)The standardized patient (SP)

The SP is a person who is trained to portray a specific clinical

problem.

Participates in evaluating the candidate’s communications skills.

The main objective is to assess the candidate’s ability to obtain a

focused history and physical examination while interacting effectively

with a patient.

Video stationVideo station

When used correctly, the OSCE can be highly successful as an

instrument to assess competence in medicine

Ronald HardenRonald Harden

Above allAbove all