Kazakhstan Health Technology Transfer and Institutional Reform Project The Objective Structured Clinical Examination

Kazakhstan Health Technology Transfer and Institutional Reform Project

The Objective Structured Clinical Examination


Objectives• To become familiar with OSCE format and

scoring • To explore standard setting techniques• To provide an overview of quality assurance

methods• To identify strengths and weaknesses of the

OSCE • To facilitate good design of OSCE stations


What is an OSCE?• Number of stations through which students

rotate• Demonstration of a clinical skill or respond on

paper to a series of related questions• Wide variety of skills tested: History, physical

examination, interpretation of tests, communication and interpersonal skills


Advantages• Standardization• Can test a range of skills• Can pre set standards• Flexible

• Does not rely on real patients


Disadvantages• Can seem artificial• Takes a lot of planning • Expensive

• Needs well trained patients…and examiners!


How to run an OSCE• Decide what you want to assess• Identify the Team• Decide the content• Planning the site• Patients• Examiners• Candidates• Support staff• The day before• The day• The day after• Final follow up


Is it formative or summative?


Decide what you want to assess• Communication skills• History taking• Examination technique• Ethical issues• Patient education• Emergencies• Technical skills


Identify the team• Discussion


Decide station content• Sort or long stations• Mixture of the two• Post encounter tasks eg read an x ray,

interpret data

• Rest stations may be added


Couplet Stations• Consists of patient encounters and post

encounter probe• Provides opportunity to test data

interpretation in context• Allows for an increase in test capacity without

additional costs


You MUST talk to the standardised patient coordinator early

• You need to know the age and sex of available patients in order to plan the station content

• Define a time line for recruitment, training and testing roles


Test the station• You MUST test the station to see if it works…

try to get someone else to play the role of the student


For each station you will need• Clear instructions to the candidate• A very detailed patient role• Prompts for the patient

• A scoring checklist• A list of equipment needed in the room


Instructions to the candidate

• Who are they? • Where are they?

• Eg You are a medical student working in the emergency room

• What are they to do?• Do you want to give them any other information eg

“The patient has diabetes”




Planning the site• How many students?• How many stations?• How many tracks can you run?• How long is each encounter?

• This will depend on your local site


You need– An area for registration and administration– Orientation of students, patients, examiners– Refreshment area

– Area to keep students after their examination

– Book the space early, a few months before!


Draw a map of the site• Assign stations, considering the flow of

students


Equipment lists• Blood pressure cuff• Reflex hammer etc

• Pencil for examiner• Check list• Water etc

• Clearly define who is responsible for these…or they WILL be forgotten!!




Examiners• Find your examiners early

– Faculty– Nurses?– Any other options?

• At least one per station and a small number of spares

• Send a letter explaining when they should arrive etc• Record their answers and send reminders

• You may not have time to offer much training.


Instructions to examiners• They should meet together, and with the

patient, and run through the checklist• Is it all clear to them?• Rules for interacting with the student• Rules for completing the list

• What to do with completed checklists


Candidates• Need to know day of OSCE and time of arrival• What can they bring? Eg stethoscope• What can they NOT bring? Eg Phone

• Where do they register?


Orientation• What signal will they hear?– To enter station– To leave station

• What is the time interval between stations

• Will there be an additional question whilst in the station?


Identification• Best to give the a large sticker with their name

or number on it

• Examiner MUST check it corresponds to the scoresheet they have in front of them




Support staff• Registration• Time keeper• Escorts (standing in corridor etc)

• Clerical staff….responsible for signs, catering etc


The time keeper


The Day before• Post signs…outside each room and also inside

by the door• Check signal system.• Find a spare whistle!!

• Make sure all the standardized patients have remembered to come, especially teenagers


On the Day• Have a clear schedule for when everyone

arrives and where they go• Where will orientation take place and who will

do it?• Where will the dry runs take place?

• When does the OSCE start?


Remember breaks for examiners with small bladders

• When you make the master schedule you must build in breaks…. A bigger break allows you to catch up if things are running over


Things that go wrong• Patients fail to turn up – rare• Examiners fail to turn up – common• Scoresheets turn out to be ambiguous or

confusing – common• Food does not arrive• Bell cannot be heard onside rooms - common




The day after• Evaluations from examiners and participants

are useful• Payments to patients etc

• Send thank you letters


Scoring• There is a difference between the examiners

scoring of the OSCE and the final interpretation of the score afterwards.


1. Checklist for important items - Done or Not done

2. Global rating section

3. Section to identify borderline candidates

4. Comments box – eg hurt patient, incorrect technique


• Will you have “red flag” items?

• How much will the global section be worth eg 25%

• How do you define a pass mark?• How many stations can be failed?


Group work• We will design an OSCE• We need to run through everything so far

discussed• Then we will create some roles and checklists


In groups• Decide content for an 8 station OSCE

• We will split up and develop roles and stations

Documents

Kazakhstan Health Technology Transfer and Institutional Reform Project The Objective Structured Clinical Examination