OSCEOSCE

??

Objective Structured Objective Structured Clinical examinationClinical examination

(OSCE)(OSCE)

Presented byPresented byProf. Namir G. Al-TawilProf. Namir G. Al-Tawil

M.B.Ch.B., F.I.C.M.S./C.MM.B.Ch.B., F.I.C.M.S./C.M..namiraltawil@gmail.comnamiraltawil@gmail.com

Definition of OSCEDefinition of OSCE::

““OO”” stands for stands for Objective.Objective. Every student gets the same patient Every student gets the same patient

(same chance).(same chance). ““SS”” stands for stands for StructuredStructured..

Several skills are tested at one time. Several skills are tested at one time.

Each skill is tested in a separate station.Each skill is tested in a separate station.

The examiner have a checklist for doing The examiner have a checklist for doing the marking. the marking.

marking.marking.

Definition, contDefinition, cont..

““CC”” stands for stands for clinicalclinical.. Testing the skills of students:Testing the skills of students:

- Manual skills, like examining the - Manual skills, like examining the anterior chamber of the eye.anterior chamber of the eye.

- Communication skills like taking - Communication skills like taking

patientpatient’’s history.s history. ““EE”” stands for stands for ExaminationExamination..

The essential components The essential components of communication skills are of communication skills are linked tolinked to::

Knowledge.Knowledge. Skills.Skills. Attitudes.Attitudes.

OSCE is the OSCE is the ““bestbest”” test that can test that can really and effectively assess really and effectively assess communication skills (CS) communication skills (CS)

performance.performance.

HistoryHistory

OSCE was developed in Dundee, OSCE was developed in Dundee, Scotland in the early 1970Scotland in the early 1970’’s.s.

Introduced by Dr. Harden and Introduced by Dr. Harden and colleagues in 1975.colleagues in 1975.

Reports in the literature concerning Reports in the literature concerning its use come from England, its use come from England, Scotland, Australia, South Africa, Scotland, Australia, South Africa, Nigeria, the Netherlands, Canada, Nigeria, the Netherlands, Canada, and the US. and the US.

HighlightsHighlights

OSCE is designed to assess clinical OSCE is designed to assess clinical competence and communication competence and communication skills.skills.

No. of stations: 12-18 (5 min. each)No. of stations: 12-18 (5 min. each) Three areas have to be testedThree areas have to be tested::

- Communication skills.- Communication skills.

- Physical examination.- Physical examination.

- Short answer stations.- Short answer stations.

ExampleExample

The student may be asked to take a The student may be asked to take a history of a young man patient (real history of a young man patient (real or standardized patient) presenting or standardized patient) presenting with a loin pain.with a loin pain.

The student would be assessed The student would be assessed according to the checklist.according to the checklist.

A list of questions to be asked in the A list of questions to be asked in the next station (as MCQs or short essay next station (as MCQs or short essay questions).questions).

Advantages of an Advantages of an OSCEOSCE::

Tests the studentTests the student’’s ability to s ability to integrate knowledge, clinical skills, integrate knowledge, clinical skills, and communication with the patient.and communication with the patient.

Provides the faculty with an Provides the faculty with an assessment tool that is custom-fit to assessment tool that is custom-fit to the goals of a specific education the goals of a specific education program.program.

Provides unique programmatic Provides unique programmatic evaluation.evaluation.

Advantages of an Advantages of an OSCE, contOSCE, cont..

Objectivity and validity are highly Objectivity and validity are highly ensured in OSCE.ensured in OSCE.

Tests in condition akin to Tests in condition akin to professional practice.professional practice.

A wide range and variety of facts A wide range and variety of facts can be tested at a time.can be tested at a time.

Contains detailed feedback for Contains detailed feedback for students and teachers.students and teachers.

Disadvantages of an Disadvantages of an OSCEOSCE::

Expensive.Expensive. Takes long time to construct a Takes long time to construct a

case and a scoring checklist.case and a scoring checklist. Technical limitations.Technical limitations.

Components of an Components of an OSCEOSCE

1.1. The examination The examination coordinating coordinating committee committee

Composed from qualified members Composed from qualified members (appointed or volunteers) who are (appointed or volunteers) who are devoted to the evaluative and devoted to the evaluative and educational process.educational process.

Its responsibility is to determine Its responsibility is to determine the content of the examination, the content of the examination, development, and implementation.development, and implementation.

2. The examination 2. The examination coordinator coordinator Facilitates the smooth working Facilitates the smooth working

of the committee in developing, of the committee in developing, implementing, and assessing implementing, and assessing the performance of the OSCE.the performance of the OSCE.

Local site coordinator is needed Local site coordinator is needed if the examination is carried out if the examination is carried out in different sites.in different sites.

3. List of skills, 3. List of skills, behaviors, behaviors, attitudes to be attitudes to be assessedassessed

The OSCE should be able to The OSCE should be able to reliably assess reliably assess clinical clinical competencecompetence, in history taking, , in history taking, physical examination, physical examination, laboratory, radiographic, and laboratory, radiographic, and other data interpretation, other data interpretation, technical and procedural skillstechnical and procedural skills, , as well as, as well as, counseling and counseling and attitudinal behaviorattitudinal behavior. .

4. Criteria for scoring the 4. Criteria for scoring the assessment (Marking assessment (Marking scheme of checklist) scheme of checklist) Checklist should be concise, Checklist should be concise,

unambiguous, and written to unambiguous, and written to contribute for the reliability of the contribute for the reliability of the station.station.

The more focused the checklist, The more focused the checklist, the greater the power of the the greater the power of the station to differentiate effectively station to differentiate effectively among the abilities of the students.among the abilities of the students.

55 . .The examineesThe examinees

Could be: student, resident, or Could be: student, resident, or fellow in training or at the end of fellow in training or at the end of training of a prescribed course.training of a prescribed course.

Could be: undergraduate, Could be: undergraduate, graduate, or enrolled in graduate, or enrolled in continuing medical education continuing medical education program.program.

66 . .The examinersThe examiners

Most stations require an Most stations require an examiner.examiner.

The examiner at a station where The examiner at a station where clinical skillsclinical skills (history taking, (history taking, physical examination, physical examination, interviewing, and communication) interviewing, and communication) are assessed, may be either a are assessed, may be either a physician or standardized patient. physician or standardized patient.

77 . .Examination siteExamination site::

Could be special part of the Could be special part of the teaching institution.teaching institution.

The examination could be The examination could be conducted in an out-patient conducted in an out-patient clinic where offices are clinic where offices are available in close proximity to available in close proximity to each other. each other.

88 . .Examination Examination stationsstations::

Generally, fewer than 10 stations is Generally, fewer than 10 stations is inadequate number, and more than 25 is inadequate number, and more than 25 is not practical or feasible. not practical or feasible.

The The time per stationtime per station should be uniform as should be uniform as possible. It ranges from 5-20 minutes.possible. It ranges from 5-20 minutes.

The skill, behavior or attitude to be tested The skill, behavior or attitude to be tested in a station determines whether the in a station determines whether the station requires a station requires a real patientreal patient, , simulated simulated patientpatient, , lab. datalab. data, , X ray filmX ray film, or , or patientpatient’’s s recordrecord. .

88 . .Examination Examination stations, contstations, cont..

Specially constructed plastic models or Specially constructed plastic models or simulations may be used, e.g. rectal or simulations may be used, e.g. rectal or breast models.breast models.

Couplet station for e.g. may consist of Couplet station for e.g. may consist of history-physical examination combined history-physical examination combined with problem solving station.with problem solving station.

Environment of the station, should be Environment of the station, should be quiet, good lightingquiet, good lighting……

Clearly marked directions leading from Clearly marked directions leading from one station to the next should be one station to the next should be displayed.displayed.

9. Patients 9. Patients standardized standardized or simulated. or simulated. A standardized patient is an A standardized patient is an

individual with a health problem that individual with a health problem that is in a chronic but stable condition.is in a chronic but stable condition.

Simulated patients may be Simulated patients may be volunteers.volunteers.

Both must be trained, and more Both must be trained, and more training is required for patients used training is required for patients used in history taking than for patients in history taking than for patients used for physical examination.used for physical examination.

10. Timekeeper, Time 10. Timekeeper, Time clock, and Time clock, and Time signalsignal A well-functioning time clock, and A well-functioning time clock, and

a clearly audible time signal are a clearly audible time signal are required.required.

1111 . .Contingency plansContingency plans

It includes reserve-standardized It includes reserve-standardized patients who are trained to patients who are trained to assume a number of roles, and a assume a number of roles, and a patient trainer who circulates to patient trainer who circulates to deal with any patient problems deal with any patient problems that arise.that arise.

12. Assessment of the 12. Assessment of the performance of the performance of the OSCEOSCE It is the responsibility of the examination It is the responsibility of the examination

coordinating committee. coordinating committee. The following points should be considered:The following points should be considered:

a) The OSCE should be tested for appropriate a) The OSCE should be tested for appropriate measurement characteristics such as: measurement characteristics such as: validityvalidity, , reliabilityreliability, , feasibilityfeasibility, and , and credibilitycredibility..

b) A valid OSCE station measures what it was b) A valid OSCE station measures what it was designed to measure. A reliable station designed to measure. A reliable station measures its consistency.measures its consistency.

Points to be Points to be considered, contconsidered, cont..

c) Item analysis should be c) Item analysis should be completed for an OSCE to completed for an OSCE to provide indications concerning provide indications concerning the difficulty of each station in the difficulty of each station in relation to the overall exam.relation to the overall exam.

d) Grading can be based on a d) Grading can be based on a certain reference system. certain reference system.

Examples:Examples:General communication skillsGeneral communication skills (time: (time: 5 minutes)5 minutes)Choose the most appropriate Choose the most appropriate answeranswer Where do you prefer to examine a Where do you prefer to examine a

patient with abdominal pain lying in patient with abdominal pain lying in general surgical ward?general surgical ward?

a)a) In the same place in front of his In the same place in front of his relatives.relatives.

b)b) In the same place but not in front of In the same place but not in front of his relatives.his relatives.

c)c) In a single room, opened-door.In a single room, opened-door.

d)d) In a single room, closed-door. In a single room, closed-door.

General communication skillsGeneral communication skills

How do you call an old man, his How do you call an old man, his name is Ali, and his son is called name is Ali, and his son is called Hasan?Hasan?

. حسن أبو عمي .أهال حسن أبو عمي أهال. علي عمي .أهال علي عمي أهال. عمي .أهال عمي أهال.أهال.أهال

General communication skillsGeneral communication skills

How do you prefer to let the patient to How do you prefer to let the patient to sit in the clinical examination room?sit in the clinical examination room?

a)a) In front of you, a table between him In front of you, a table between him and you.and you.

b)b) Beside you about half meter distance.Beside you about half meter distance.

c)c) Beside you, about 2 meters distance.Beside you, about 2 meters distance.

d)d) Two meters in front of you. Two meters in front of you.

General communication skillsGeneral communication skills

Keeping an eye contact with your Keeping an eye contact with your patient while he is talking about patient while he is talking about his complaint is:his complaint is:

a)a) Very bad habit may embarrass Very bad habit may embarrass the patient.the patient.

b)b) Very important to encourage the Very important to encourage the patient.patient.

c)c) Not useful.Not useful.d)d) Only useful in psychological Only useful in psychological

disease.disease.

Information giving Information giving skillsskills::

This patient in front of you is a 22 This patient in front of you is a 22 year old, has been newly diagnosed year old, has been newly diagnosed yesterday as a case of diabetes yesterday as a case of diabetes mellitus, his FBS was 300 mg/dl. His mellitus, his FBS was 300 mg/dl. His urinalysis was (+++) positive for urinalysis was (+++) positive for glucose. He is irritable. Give him glucose. He is irritable. Give him valuable health education about the valuable health education about the nature of his disease, treatment, nature of his disease, treatment, self-care, and complications.self-care, and complications.

Thanks for listeningThanks for listening