Osce by c. shekhar karmakar

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  • 1. Objectivestructured clinical examination(OSCE) Dr.Chandra Shekhar Karmakar Dept. of Anaesthesiology ShSMCH,Dhaka.
  • 2. It is an assessment approach to measure clinical competence of trainee
  • 3. The OSCE can be highly successful as an instrument to assess competence and the approach of the examinee & has many advantages over conventional methods.
  • 4. What is an OSCE? • Objective : Examiners use a checklist for evaluating the trainees. • Structured: Trainee sees the same problem and perform the same tasks in the same time frame. • clinical: The task are representative of those faced in real clinical situation.
  • 5. The OSCE has offered a striking way of making valid assessment of clinical performance of medical student, resident, and fellows .
  • 6. History of OSCE OSCE was developed in Dundee , Scotland in the early 1975 by Dr.Harden and his colleagues.  After some modification it was described in greater detail in 1979. This method was the subject of an international conference in Ottawa in 1985 and experience were exchanged about OSCE & OSPE. More than 50 countries accepted it.
  • 7. What is assessed by OSCE? • Various clinical skills – history taking , physical examination, technical procedure, communication, interpersonal skills. • Knowledge and understanding. • Data interpretation. • Problem solving. • Attitudes.
  • 8. How to prepare OSCE ?
  • 9. Harden 12 tips for organizing an OSCE • What to be assessed? • Duration of station • Number of stations • Use of examiners. • Range of approach • New station
  • 10. Continued... • Organization of the examination • Assigning priority • Resource requirement • Plan of examination • Change signal • Records
  • 11. The key to a successful OSCE is careful planning
  • 12. The Examination Coordinator • The functions of the examination coordinator is crucial • Who is the catalyst that facilitates the smooth working of the committee in developing, implementing and assessing the performance of the OSCE.
  • 13. Selection of the examination committee • An examination coordinating committee is made up of members who are committed to the evaluative and educational process • The number of members who make up this committee is not as important as the intensity of the investment of each member.
  • 14. Continued... • The examination committee determines the content of the examination, development and implementation. • It is important that this committee has the capacity and personnel to address decisions related to reliability and validity
  • 15. Lists of Skills, Behaviors and Attitudes to be Assessed • The examination will measure objectively the competencies in specific areas of behavior, techniques, attitudes and decision-making strategies based on the objectives of the course or the requirement of the licensing body.
  • 16. How to develop case/scenario? • Define the purpose of the station • Candidate’s instructions • Scoring checklist • Standardized patient instructions • Instruction for station set-up
  • 17. Define the purpose of the station • State the skill and domain to be tested Skill –Physical examination . Domain – Anaesthesiology, Internal medicine, Cardiology etc.
  • 18. Candidate instructions • Candidate instruction must be clear and concise. • Before examination a briefing about whole system is very much effective for a successful OSCE.
  • 19. Scoring checklist • The checklist should be complete and include the main components of the skill being assessed. • Any unnecessary or exaggerated stem must be avoided.
  • 20. Instruction for station set-up • List of all equipments required for the station
  • 21. The Examinees • The examinee is the student, resident, or fellow in training or at the end of training of a prescribed course
  • 22. The Examiners • Most stations will require an examiner, although some stations do not. • The examiner at the station where clinical skills (history-taking, physical examination, interviewing and communication) are assessed, preferably be either a physician or a standardized patient.
  • 23. The Examination Site • The examination site is part of a special teaching facility in some institutions. When such facilities are not available, the examination may be conducted in an outpatient facility .
  • 24. Examinations 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.
  • 25. Stations.. • The number of stations in an examination refer the time allocated for each station determines the time required to complete the whole examination.
  • 26. Duration of station • Duration of stations has been fixed • Make sure that the task expected of the student can be accomplished within the time • If necessary some stations which are allocated double the standard time. Such double stations will require to be duplicated in the examination.
  • 27. Duration 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.
  • 28. Couplet Station • Some competencies may best be assessed by coupled or linked stations. – The use of linked stations extends the time available to complete a task. Examination Of a patient with Poor mouth opening Findings Interpretation Plan of management For GA
  • 29. Observer Assessment Method • Checklist • Rating scale
  • 30. Check list for assessment of physical finding • Mr.C. presents with a sore swollen ankle for 6 weeks Don’t Do 1-introduces self to patient 2-Explain to the patient what will be do 3-Demonstrate concern for patient.i.e.is not excessive rough 4-Inspectin for any of swelling , erythema ,deformity 5-Inspection: Standing From anterior Posterior 6- Inspection pt Gait
  • 31. Communication skills checklist (rating scale) Poor 1 Fair 2 Good 3 V Good 4 Excellenc e 5 1- Interpersonal skill: Listen carefully 2-Interviwing skill: Uses words patient can understand organized
  • 32. Standardized patient(SP) • A standardized patient is an individual who is trained to portray scripted patient. • Standardized patients may be volunteers or paid employee • Clinically stable patient can also be used as standardized Patient e.g.. fundoscopic changes ,goiter , skin change,cardiac murmur , abdominal organomegaly etc.
  • 33. Standardized patient instructions • These instruction must be detailed enough to guarantee standardized patient playing the same role.
  • 34. Continued.. • Ideally a physician will also observe the standardized patients demonstrating their scenario before the examination. • Several encounters are required to obtain a reliable estimate of a persons competence.
  • 35. Question to ensure validity • Are the patient problem relevant and important to the curriculum? • Will the station assess skill that have been taught? • Have content experts reviewed the station ?
  • 36. Factor 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)
  • 37. Continued.. • Research has shown that an acceptable level of reliability can be achieved with either a physician or standardized patient as the examiner • Harden recommends using examiners from a range of specialist and disciplines
  • 38. Running The Exam • Space requirements • Signaling station change • Collecting result • Budget
  • 39. Advantages of OSCE • Provides an opportunity to test a student’s ability to integrate knowledge, clinical skills, and communication with the patient • Less complexity. • Valid examination. • Summative and well formative. • Time limit for each station.
  • 40. Advantages • Can be used with large number of students. • Reproducible. • Provides unique programmatic evaluation. • More objective. • Test not only skills and knowledge but attitudes also.
  • 41. Disadvantage • Development and administration are time consuming and costly. • Provides assessment of case-specific skills, knowledge, and/or attitudes • Knowledge and skills are tested in compartments
  • 42. Disadvantage • Rely on task specific checklists and scoring. • Needs more observation skills of stuff. • Standardization of simulated patients and examiners. • Repetitive and boring.
  • 43. Some pearls ... • Have spare standardized patients and examiners available for the exam • Have back-up equipment ,such as view box , batteries • Have staff available during the examination to maintain exam security • Make sure the bells or buzzers can be heard from all location with closed door • For each examination prepare an extra station which can be setup with minimal effort
  • 44. At last.. • In conventional examination marks awarded is on candidates global performances not for individual competencies. • The final score indicating his overall performance gives no significant feedback to the candidate. • OSCE overcome most of those obstacles but it should be remembered that no single examination system is completely perfect.
  • 45. Thank you all