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Objective Structured Clinical examination (OSCE)


Objective Structured Clinical examination (OSCE) Presented by Prof. Namir G. Al-Tawil M.B.Ch.B., F.I.B.M.S./C.M. namiraltawil_at_yahoo.com Objectives At the end of this ... – PowerPoint PPT presentation

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Title: Objective Structured Clinical examination (OSCE)

Objective Structured Clinical examination (OSCE)
  • Presented by
  • Prof. Namir G. Al-Tawil
  • M.B.Ch.B., F.I.B.M.S./C.M.
  • namiraltawil_at_yahoo.com

  • At the end of this lecture, the audience must
  • Definition of OSCE
  • Advantages and disadvantages of OSCE
  • Components of OSCE

The essential components of communication skills
are linked to
  • Knowledge.
  • Skills.
  • Attitudes.
  • OSCE is the best test that can really and
    effectively assess communication skills (CS)

  • OSCE was developed in Dundee, Scotland in the
    early 1970s.
  • Introduced by Dr. Harden and colleagues in 1975.
  • Reports in the literature concerning its use come
    from England, Scotland, Australia, South Africa,
    Nigeria, the Netherlands, Canada, and the US.

Definition of OSCE
  • O stands for Objective.
  • Every student gets the same patient (same
  • S stands for Structured.
  • Several skills are tested at one time.
  • Each skill is tested in a separate station.
  • The examiner have a checklist for doing the
  • marking.

Definition, cont.
  • C stands for clinical.
  • Testing the skills of students
  • - Manual skills, like examining the anterior
    chamber of the eye.
  • - Communication skills like taking
  • patients history.
  • E stands for Examination.

  • OSCE is designed to assess clinical competence
    and communication skills.
  • No. of stations 12-18 (5 min. each)
  • Three areas have to be tested
  • - Communication skills.
  • - Physical examination.
  • - Short answer stations.

  • The student may be asked to take a history of a
    young man patient (real or standardized patient)
    presenting with a loin pain.
  • The student would be assessed according to the
  • A list of questions to be asked in the next
    station (as MCQs or short assay questions).

Advantages of an OSCE
  • Tests the students ability to integrate
    knowledge, clinical skills, and communication
    with the patient.
  • Provides the faculty with an assessment tool that
    is custom-fit to the goals of a specific
    education program.
  • Provides unique programmatic evaluation.

Advantages of an OSCE, cont.
  • Objectivity and validity are highly ensured in
  • Tests in condition akin to professional practice.
  • A wide range and variety of facts can be tested
    at a time.
  • Contains detailed feedback for students and

Disadvantages of an OSCE
  • Expensive.
  • Takes long time to construct a case and a scoring
  • Technical limitations.

Components of an OSCE
The examination coordinating committee
  • Composed from qualified members (appointed or
    volunteers) who are devoted to the evaluative and
    educational process.
  • Its responsibility is to determine the content of
    the examination, development, and implementation.

2. The examination coordinator
  • Facilitates the smooth working of the committee
    in developing, implementing, and assessing the
    performance of the OSCE.
  • Local site coordinator is needed if the
    examination is carried out in different sites.

3. List of skills, behaviors, attitudes to
be assessed
  • The OSCE should be able to reliably assess
    clinical competence, in history taking, physical
    examination, laboratory, radiographic, and other
    data interpretation, technical and procedural
    skills, as well as, counseling and attitudinal

4. Criteria for scoring the assessment
(Marking scheme of checklist)
  • Checklist should be concise, unambiguous, and
    written to contribute for the reliability of the
  • The more focused the checklist, the greater the
    power of the station to differentiate effectively
    among the abilities of the students.

5. The examinees
  • Could be student, resident, or fellow in
    training or at the end of training of a
    prescribed course.
  • Could be undergraduate, graduate, or enrolled in
    continuing medical education program.

6. The examiners
  • Most stations require an examiner.
  • The examiner at a station where clinical skills
    (history taking, physical examination,
    interviewing, and communication) are assessed,
    may be either a physician or standardized

7. Examination site
  • Could be special part of the teaching
  • The examination could be conducted in an
    out-patient clinic where offices are available in
    close proximity to each other.

8. Examination stations
  • Generally, fewer than 10 stations is inadequate
    number, and more than 25 is not practical or
  • The time per station should be uniform as
    possible. It ranges from 5-20 minutes.
  • The skill, behavior or attitude to be tested in
    a station determines whether the station requires
    a real patient, simulated patient, lab. data, X
    ray film, or patients record.

8. Examination stations, cont.
  • Specially constructed plastic models or
    simulations may be used, e.g. rectal or breast
  • Couplet station for e.g. may consist of
    history-physical examination combined with
    problem solving station.
  • Environment of the station, should be quiet, good
  • Clearly marked directions leading from one
    station to the next should be displayed.

9. Patients standardized or simulated.
  • A standardized patient is an individual with a
    health problem that is in a chronic but stable
  • Simulated patients may be volunteers.
  • Both must be trained, and more training is
    required for patients used in history taking than
    for patients used for physical examination.

10. Timekeeper, Time clock, and Time
  • A well-functioning time clock, and a clearly
    audible time signal are required.

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

12. Assessment of the performance of the
  • It is the responsibility of the examination
    coordinating committee.
  • The following points should be considered
  • a) The OSCE should be tested for appropriate
    measurement characteristics such as validity,
    reliability, feasibility, and credibility.
  • b) Types of validity includes predictive,
  • concurrent, and content validity.

Points to be considered, cont.
  • c) A valid OSCE station measures what it was
    designed to measure. A reliable station measures
    its consistency.
  • d) Item analysis should be completed for an OSCE
    to provide indications concerning the difficulty
    of each station in relation to the overall exam.
  • e) Grading can be based on a criterion-
    referenced system, norm-referenced system, or a
    combination of both.

Examples General communication skills (time 5
minutes) Choose the most appropriate answer
  • Where do you prefer to examine a patient with
    abdominal pain lying in general surgical ward?
  • In the same place in front of his relatives.
  • In the same place but not in front of his
  • In a single room, opened-door.
  • In a single room, closed-door.

General communication skills
  • How do you call an old man, his name is Ali, and
    his son is called Hasan?
  • ???? ??? ??? ???.
  • ???? ??? ???.
  • ???? ???.
  • ????.

General communication skills
  • How do you prefer to let the patient to sit in
    the clinical examination room?
  • In front of you, a table between him and you.
  • Beside you about half meter distance.
  • Beside you, about 2 meters distance.
  • Two meters in front of you.

General communication skills
  • Keeping an eye contact with your patient while he
    is talking about his complaint is
  • Very bad habit may embarrass the patient.
  • Very important to encourage the patient.
  • Not useful.
  • Only useful in psychological disease.

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

Thanks for listening
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