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OSCE
Background Background about OSCEabout OSCE
Definition of Definition of OSCEOSCE
Harden’s12 tips Harden’s12 tips for organizing for organizing OSCEOSCE
AdvantagesAdvantages
DisadvantagesDisadvantages Examples of Examples of
OSCEOSCE Station profileStation profile Reflections Reflections Summary Summary
Abbasid era in Baghdad in 931 AD
Caliph Al-Muqtadir, ordered his chief physician to examine all healers
Licensing Boards The chief physician License for
practicing
Miller’s Pyramid of Clinical Miller’s Pyramid of Clinical
CompetenceCompetence
What is OSCEWhat is OSCE ? ?
The candidates rotate through a The candidates rotate through a series of stations at which they are series of stations at which they are asked to carry out a (usually clinical) asked to carry out a (usually clinical) tasktask
Background about OSCEBackground about OSCE
Started in 1972 Dundee, Scotland by R. Harden and F.Glesson
First literature about OSCE 1975, BMJ Used in undergraduate as well as
postgraduate Formative & summative Used in many disciplines
MODIFICATION OF OSCEMODIFICATION OF OSCE
OSLER:objective structured long examination OSLER:objective structured long examination recordrecord
OSPE: objective structured practical OSPE: objective structured practical examinationexamination
OSVE: objective structured video OSVE: objective structured video examinationexamination
OSTE: objective structured teaching OSTE: objective structured teaching evaluationevaluation
OSPRE: objective structured performance-OSPRE: objective structured performance-related examinationrelated examination
OSSE: objective structured selection examOSSE: objective structured selection exam..
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 Characteristics of the OSCE (Cont.)(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
Harden’s 12 Tips for Harden’s 12 Tips for Organizing an OSCEOrganizing an OSCE
What is to be assessed? Duration of station Number of stations Use of examiners Range of approaches New stations
Harden’s 12 Tips for Harden’s 12 Tips for Organizing an OSCE (Cont.)Organizing an OSCE (Cont.)
Organization of the examination Assigning priority Resource requirements Plan of the examination Change signal Records
Exam VenueExam Venue
Changing StationsChanging Stations
Advantages of the OSCEAdvantages of the OSCE Valid examination The examiners can control the
complexities of the examination Used as summative as well formative Can be used with larger number of
students Reproducible
Advantages of the OSCE (cont)Advantages of the OSCE (cont)
The variable of the examiner and the patient are to a large extent removed
Fun activity within the department or college, which promotes team work
Disadvantages of the OSCEDisadvantages of the OSCE
Knowledge and skills are tested in compartments
The OSCE may be demanding for both examiners and patients
More time in setting it upMore time in setting it up Shortage of examinersShortage of examiners Might be quite distressing to the Might be quite distressing to the
studentstudent
A student from Newcastle, UKA student from Newcastle, UK
New meanings for OSCE: Obligatory sweepingly crushing
experience Obnoxiously stupefying celebration
of the evil A collection of “ overwhelmingly
significant clinical errors”
Station descriptionStation description EquipmentsEquipments Simulated patient/StdSimulated patient/Std
History from a History from a patient with patient with
schizophreniaschizophrenia
NoneNone YesYes
History from a History from a patient with affective patient with affective
disorderdisorder
NoneNone YesYes
Video of patients Video of patients with EPS signswith EPS signs
Video player and Video player and televisiontelevision
NoNo
History from an History from an alcoholic patientalcoholic patient
NoneNone YesYes
Checking for Checking for symptoms of symptoms of
anticholinergic s.e. anticholinergic s.e. from a patient, who from a patient, who is on Amitryptillineis on Amitryptilline
NoneNone YesYes
OSCE stations-Dec 2002OSCE stations-Dec 2002
Simulated Patient (Hx Simulated Patient (Hx taking)taking)
Simulated Simulated Patient(examination)Patient(examination)
Video station
TaskTask Content Content areaarea
Type Cognitive Psychomotor Type Cognitive Psychomotor AttitudeAttitude
Abdominal Abdominal examinationexamination
GIGI SPSP++ +++ + ++ +++ +
Discharge Discharge summarysummary
GeneralGeneral EssayEssay+++ +++
SuturingSuturing GeneralGeneral PracticalPractical+++ +++
Interview Interview relativerelative
GeneralGeneral SPSP+++ ++ +++ ++
Scientific Scientific appraisalappraisal
ResearchResearch EssayEssay+++ +++
Post graduate surgical OSCEPost graduate surgical OSCE
OSCE in PeadiatricsOSCE in Peadiatrics
OSPE in Pharmacology OSPE in Pharmacology (Nepal)(Nepal)
(I :)Spotter section: A student identifies a drug among the choices displayed for a particular condition and then answers one or two questions related to the drug.
(II :)communication skills: A student communicates with and prescribes a drug
for a simulated patient .
Station ProfileStation Profile
A) A) Instruction to students:Instruction to students: . .
Mr.Mohammed is a 22-year-old Mr.Mohammed is a 22-year-old working in Thumrith base, presented working in Thumrith base, presented to our clinic with headaches, to our clinic with headaches, generalized loss of interest in life, generalized loss of interest in life, poor social performance, chest poor social performance, chest discomfort. .discomfort. .
Station Profile (cont)Station Profile (cont)
A) A) Instruction to students:(cont)Instruction to students:(cont) You have 8 minutes to assess the You have 8 minutes to assess the
affective state of this patient, by affective state of this patient, by taking the proper and relevant taking the proper and relevant historyhistory
An observer, using a checklist, will An observer, using a checklist, will assess your performance while you assess your performance while you interact with the patientinteract with the patient
Station Profile (cont)Station Profile (cont)
B) B) Briefing to the Observer:Briefing to the Observer: The student is required to assess the The student is required to assess the
affective state of Mr. Salim, by affective state of Mr. Salim, by taking the proper and relevant taking the proper and relevant history.history.
Observe your students using the Observe your students using the following checklist, without any following checklist, without any probing or interference from you.probing or interference from you.
Station Profile (cont)Station Profile (cont)
C) C) Briefing to the patientBriefing to the patient:: Don not give more information than Don not give more information than
asked for.asked for. Try to answer the questions as Try to answer the questions as
clearly as possible.clearly as possible. Try to be consistent with all the Try to be consistent with all the
students as the interview you.students as the interview you.
ChecklistChecklist Student greeted Student greeted
the patientthe patient Introduced Introduced
her/himselfher/himself Asked the Asked the
patient’s namepatient’s name Mood stateMood state Duration of mood Duration of mood
disturbancedisturbance
Interest & Interest & enjoyment of lifeenjoyment of life
Diurnal swings of Diurnal swings of moodmood
Recent change in Recent change in sleep patternsleep pattern
Change in appetiteChange in appetite Suicidal thoughts/& Suicidal thoughts/&
or attemptsor attempts
AnecdotesAnecdotes
•Using the whistle
•Tuning the video!
•Shortage of patients
•Staff as SP’s
•Preparing the equipment
•Choosing the number of stations
Key PointsKey Points
StaffStaff developmentdevelopment
Dynamic processDynamic process
StimulationStimulation
BankBank
Videos & simulatorsVideos & simulators
EnjoyableEnjoyable
FeedbackFeedback
Feedback from Students Feedback from Students (positive)(positive)
To assess our performance in actionTo assess our performance in action To detect our weaknessesTo detect our weaknesses To assess our abilities in solving To assess our abilities in solving
clinical problemsclinical problems To assess our clinical skills, skills in To assess our clinical skills, skills in
communication and communication and approaching approaching patientspatients
Feedback from Students Feedback from Students (positive)(positive)
The student The student isis made to organize made to organize hishis/her/her thoughts thoughts
IncreaseIncreasess self confidence self confidence Fair to all studentsFair to all students Clinically orientedClinically oriented To train the students because OSCE To train the students because OSCE
is an international examinationis an international examination
Feedback from Students Feedback from Students (negative)(negative)
Might be exhausting for the real Might be exhausting for the real patientpatient
ItIt’s’s humiliating humiliating toto patients patients Needs extra preparation time Needs extra preparation time burden on the studentburden on the student Only 10 stations!!!Only 10 stations!!! No need for the presence of an No need for the presence of an
observer observer Some stations require more time than Some stations require more time than
the othersthe others
Examiners after the OSCEExaminers after the OSCE
When used correctly, the OSCE When used correctly, the OSCE can be highly successful as an can be highly successful as an instrument to assess instrument to assess competence in medicinecompetence in medicine
Ronald HardenRonald Harden
THANK YOUTHANK YOU