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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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.
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.
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.
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
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.
When used correctly, the OSCE can be highly successful as an
instrument to assess competence in medicine
Ronald HardenRonald Harden