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