Transcript Objective Structured Clinical examination (OSCE)

Objective Structured
Clinical examination
(OSCE)
Presented by
Prof. Namir G. Al-Tawil
M.B.Ch.B., F.I.B.M.S./C.M.
[email protected]
Objectives

At the end of this lecture, the
audience must know:
– Definition of OSCE
– Advantages and disadvantages of OSCE
– Components of OSCE
The essential components of
communication skills are linked
to:

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Knowledge.
Skills.
Attitudes.
OSCE is the “best” test that can really
and effectively assess communication
skills (CS) performance.
History
OSCE was developed in Dundee,
Scotland in the early 1970’s.
 Introduced by Dr. Harden and
colleagues in 1975.
 Reports in the literature
concerning its use come from
England, Scotland, Australia,
South Africa, Nigeria, the
Netherlands, Canada, and the US.

Definition of OSCE:
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“O” stands for Objective.
Every student gets the same patient
(same chance).
“S” stands for Structured.
Several skills are tested at one time.
Each skill is tested in a separate
station.
The examiner have a checklist for
doing the marking.
Definition, cont.
“C” stands for clinical.
 Testing the skills of students:
- Manual skills, like examining the
anterior chamber of the eye.
- Communication skills like taking
patient’s history.
 “E” stands for Examination.

Highlights
OSCE is designed to assess clinical
competence and communication
skills.
 No. of stations: 12-18 (5 min. each)
 Three areas have to be tested:
- Communication skills.
- Physical examination.
- Short answer stations.
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Example
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The student may be asked to take a
history of a young man patient (real or
standardized patient) presenting with
a loin pain.
The student would be assessed
according to the checklist.
A list of questions to be asked in the
next station (as MCQs or short assay
questions).
Advantages of an OSCE:
Tests the 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.
 Provides unique programmatic
evaluation.

Advantages of an OSCE,
cont.
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Objectivity and validity are highly
ensured in OSCE.
Tests in condition akin to professional
practice.
A wide range and variety of facts can
be tested at a time.
Contains detailed feedback for
students and teachers.
Disadvantages of an
OSCE:
Expensive.
 Takes long time to construct a
case and a scoring checklist.
 Technical limitations.

Components of an
OSCE
1. The examination
coordinating committee
Composed from qualified members
(appointed or volunteers) who are
devoted to the evaluative and
educational process.
 Its responsibility is to determine
the content of the examination,
development, and implementation.

2. The examination
coordinator
Facilitates the smooth working of
the committee in developing,
implementing, and assessing the
performance of the OSCE.
 Local site coordinator is needed if
the examination is carried out in
different sites.

3. List of skills, behaviors,
attitudes to be assessed
The OSCE should be able to
reliably assess clinical competence,
in history taking, physical
examination, laboratory,
radiographic, and other data
interpretation, technical and
procedural skills, as well as,
counseling and attitudinal
behavior.
4. Criteria for scoring the
assessment (Marking
scheme of checklist)
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Checklist should be concise,
unambiguous, and written to
contribute for the reliability of the
station.
The more focused the checklist, the
greater the power of the station to
differentiate effectively among the
abilities of the students.
5. The examinees
Could be: student, resident, or
fellow in training or at the end of
training of a prescribed course.
 Could be: undergraduate,
graduate, or enrolled in continuing
medical education program.
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6. The examiners
Most stations require an examiner.
 The examiner at a station where
clinical skills (history taking,
physical examination,
interviewing, and communication)
are assessed, may be either a
physician or standardized patient.
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7. Examination site:
Could be special part of the
teaching institution.
 The examination could be
conducted in an out-patient clinic
where offices are available in
close proximity to each other.
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8. Examination stations:
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Generally, fewer than 10 stations is
inadequate number, and more than 25 is
not practical or feasible.
The time per station should be uniform as
possible. It ranges from 5-20 minutes.
The skill, behavior or attitude to be tested in
a station determines whether the station
requires a real patient, simulated patient,
lab. data, X ray film, or patient’s record.
8. Examination stations,
cont.
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Specially constructed plastic models or
simulations may be used, e.g. rectal or
breast models.
Couplet station for e.g. may consist of
history-physical examination combined
with problem solving station.
Environment of the station, should be
quiet, good lighting…
Clearly marked directions leading from
one station to the next should be
displayed.
9. Patients standardized
or simulated.
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A standardized patient is an individual
with a health problem that is in a
chronic but stable condition.
Simulated patients may be volunteers.
Both must be trained, and more
training is required for patients used in
history taking than for patients used
for physical examination.
10. Timekeeper, Time
clock, and Time signal

A well-functioning time clock, and a
clearly audible time signal are
required.
11. Contingency plans

It includes reserve-standardized
patients who are trained to assume a
number of roles, and a patient trainer
who circulates to deal with any patient
problems that arise.
12. Assessment of the
performance of the OSCE
It is the responsibility of the examination
coordinating committee.
 The following points should be considered:
a) The OSCE should be tested for
appropriate measurement characteristics
such as: validity, reliability, feasibility, and
credibility.
b) Types of validity includes: predictive,
concurrent, and content validity.
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Points to be considered,
cont.
c) A valid OSCE station measures what it was
designed to measure. A reliable station
measures its consistency.
d) Item analysis should be completed for an
OSCE to provide indications concerning the
difficulty of each station in relation to the
overall exam.
e) Grading can be based on a criterionreferenced system, norm-referenced
system, or a combination of both.
Examples:
General communication skills (time: 5
minutes)
Choose the most appropriate answer

a)
b)
c)
d)
Where do you prefer to examine a patient
with abdominal pain lying in general
surgical ward?
In the same place in front of his relatives.
In the same place but not in front of his
relatives.
In a single room, opened-door.
In a single room, closed-door.
General communication skills
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How do you call an old man, his name
is Ali, and his son is called Hasan?
.‫ أهال عمي أبو حسن‬
.‫ أهال عمي علي‬
.‫ أهال عمي‬
.‫ أهال‬
General communication skills
c)
How do you prefer to let the patient to sit
in the clinical examination room?
In front of you, a table between him and
you.
Beside you about half meter distance.
Beside you, about 2 meters distance.
d)
Two meters in front of you.
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a)
b)
General communication skills
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a)
b)
c)
d)
Keeping an eye contact with your
patient while he is talking about his
complaint is:
Very bad habit may embarrass the
patient.
Very important to encourage the
patient.
Not useful.
Only useful in psychological disease.
Information giving skills:
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This patient in front of you is a 22
year old, has been newly diagnosed
yesterday as a case of diabetes
mellitus, his FBS was 300 mg/dl. His
urinalysis was (+++) positive for
glucose. He is irritable. Give him
valuable health education about the
nature of his disease, treatment, selfcare, and complications.
Thanks for listening