It is an assessment approach to
measure clinical competence of
The OSCE can be highly successful as an instrument
to assess competence and the approach of the
examinee & has many advantages over
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.
The OSCE has offered a striking way
of making valid assessment of clinical
performance of medical student,
resident, and fellows .
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.
What is assessed by OSCE?
• Various clinical skills – history taking , physical
examination, technical procedure,
communication, interpersonal skills.
• Knowledge and understanding.
• Data interpretation.
• Problem solving.
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
• Organization of the examination
• Assigning priority
• Resource requirement
• Plan of examination
• Change signal
The key to a successful
OSCE is careful planning
The Examination Coordinator
• The functions of the examination coordinator
• Who is the catalyst that facilitates the smooth
working of the committee in developing,
implementing and assessing the performance
of the OSCE.
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.
• The examination committee determines the
content of the examination, development and
• It is important that this committee has the
capacity and personnel to address decisions
related to reliability and validity
Lists of Skills, Behaviors and Attitudes to
• 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
How to develop case/scenario?
• Define the purpose of the station
• Candidate’s instructions
• Scoring checklist
• Standardized patient instructions
• Instruction for station set-up
Define the purpose of the station
• State the skill and domain to be tested
Skill –Physical examination .
Domain – Anaesthesiology, Internal medicine,
• Candidate instruction must be clear and
• Before examination a briefing about whole
system is very much effective for a successful
• The checklist should be complete and include
the main components of the skill being
• Any unnecessary or exaggerated stem must
Instruction for station set-up
• List of all equipments required for the station
• The examinee is the student, resident, or
fellow in training or at the end of training of a
• 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
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 .
• 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
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
Duration of station
• Times ranging from 4 to 15 minutes have been
reported in different examinations and a five
minute station probably most frequently
• This times depend to some extent on the
competencies to be assessed in the
• Some competencies may best be assessed by
coupled or linked stations.
– The use of linked stations extends the time
available to complete a task.
Of a patient with
Check list for assessment of physical
• Mr.C. presents with a sore swollen ankle for 6 weeks
1-introduces self to patient
2-Explain to the patient what will be do
3-Demonstrate concern for patient.i.e.is not excessive
4-Inspectin for any of swelling , erythema ,deformity
6- Inspection pt Gait
Communication skills checklist (rating
1- Interpersonal skill:
2-Interviwing skill: Uses
words patient can
• A standardized patient is an individual who is
trained to portray scripted patient.
• Standardized patients may be volunteers or
• Clinically stable patient can also be used as
e.g.. fundoscopic changes ,goiter , skin
change,cardiac murmur , abdominal
Standardized patient instructions
• These instruction must be detailed enough to
guarantee standardized patient playing the
• 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.
Question to ensure validity
• Are the patient problem relevant and
important to the curriculum?
• Will the station assess skill that have been
• Have content experts reviewed the station ?
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
• Examiners who score idiosyncratically
• Administrative problem (disorganized staff OR
• Research has shown that an acceptable level
of reliability can be achieved with either a
physician or standardized patient as the
• Harden recommends using examiners from a
range of specialist and disciplines
Running The Exam
• Space requirements
• Signaling station change
• Collecting result
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.
• Can be used with large number of students.
• Provides unique programmatic evaluation.
• More objective.
• Test not only skills and knowledge but
• Development and administration are time
consuming and costly.
• Provides assessment of case-specific skills,
knowledge, and/or attitudes
• Knowledge and skills are tested in
• Rely on task specific checklists and scoring.
• Needs more observation skills of stuff.
• Standardization of simulated patients and
• Repetitive and boring.
Some pearls ...
• Have spare standardized patients and
examiners available for the exam
• Have back-up equipment ,such as view box ,
• 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
• In conventional examination marks awarded is
on candidates global performances not for
• The final score indicating his overall
performance gives no significant feedback to
• OSCE overcome most of those obstacles but it
should be remembered that no single
examination system is completely perfect.