Objective structure clinical examination is an established and multistation test used for the assessment of practical skills of the student.

2. Introduction
 OSCE means Objective Structured Clinical
Examination. It is a form of multi-station
examination of clinical subject. It was first
described by Harden et al. in 1975. V Objective
structured clinical examination (OSCE) is a
modern type of examination often used in health
sciences (e.g, medicine, dentistry, nursing,
pharmacy and physiotherapy) to assess clinical
skill performance and competence in skills such
as communication, clinical examination, medical
and nursing procedures/ prescription, exercise
prescription and interpretation of results.

3. Cont…
 A framework for the development of clinical
competence has been described (Miller
1990) which outlines four levels at which a
learner can be assessed: knows, knows how,
shows how and does (Fig. 5.2). The OSCE
conforms to the third shows how the level of
the Miller's pyramid (Fig. 5.1) which focuses
on assessment of performance of specific
skills in a controlled setting. This makes it
particularly relevant for the early stages of
undergraduate curricula, where assessment
comprises compartmentalized exercises.

4. The development of clinical
skills/competence/performance
(adapted from Miller) 1990

5. Meaning of OSCE
 Objective: Because examiners use a checklist for evaluating
trainers.
 Structured: - The marking scheme for each station is
structured.
- A clinical skills or procedure is typically
broken down into component parts in a very structured way.
- Structured interactions between an examiner
and student.
- Stations are short, numerous, highly focused.
 Clinical: Because the tasks are representative of those faced
in real clinical situations.
 Examination: Because the skills are assessed in the form of
examination

6. Definitions of OSCE
 Objective Structured Clinical Examination (OSCE) is a form of
performance-based testing used to measure candidates' clinical
competence. During an OSCE, candidates are observed and
evaluated as they go through a series of stations in which they
interview, examine and treat standardized patients who present with
some type of medical problem.
 According to Harden 1988, The OSCE or objective structured
clinical examination is an approach to the assessment of clinical
competence in which the components are assessed in a well planned
or structured way with attention being paid to the objectivity of the
examination.
 ‘An exam whereby ‘students demonstrate their competence under a
variety of simulated conditions’.
- Waston,2002
 “Examinations in which the student is required to perform specific
skills and behaviors in a simulated clinical or patient care
environment”.

7. Structure of Objective Structured
Clinical Examinations
 In an objective structured clinical assessment, a
series of stations in an examination room is set up
to examine the students. At each station, students
may be asked to carry out a procedure, which may
involve taking history, performing preset clinical
tasks and diagnosing patients' problems. When
performing the clinical tasks, students may often
interact with 'patients', who may be healthy
volunteers or mock patients. Students also have to
answer questions based on their findings and their
interpretation. Students are observed and scored at
some stations by examiners with checklists.

8. Types of stations
There are two
types of stations
in this assessment
method:
Practice-based: Students are
given a written instruction and
have to carry out a procedure.
Question-based: Students have
to answer questions about their
findings at the previous station
and interpret these findings. The
questions may be open-ended or
of multiple choice type.

9. Purposes of OSCE
Used in both formative and
summative assessment in
health professional
education
Identify objective
performance criteria for the
skill being examined
Structure the performance
criteria in a checklist to
facilitate the identification of
desired clinical skills.
A requirement for
accreditation in many
health professional
programs.

10. The components of the OSCE
 The Examination Coordinating Committee
 The Examination Coordinator
 Lists of Skills, Behaviours and Attitudes to be Assessed
 Criteria for Scoring the Assessment
 The Examinees
 The Examiners
 The Examination Site
 Examination stations
 Patient (Real/ Simulated)
 Time keeper/ Time clock and time signal
 Contingency plan
 Assessment of the performance of the OSCE

11. OSCE DESIGN
 An OSCE usually comprises a circuit of short (usual is 5 to
10 minutes although some use up to 15 minute) stations, in
which each candidate is examined on a one-to-one basis with
one or two impartial examiner(s) and either real of simulated
patients (actors). Each station has a different examiner, as
opposed to the traditional method of clinical examinations
where a candidate would be assigned to an examiner for the
entire examination. Candidates rotate through the stations,
completing all the stations on their circuit. In this way, all
candidates take the same stations. It is considered to be an
improvement over traditional examination methods because
the stations can be standardized; enabling fairer peer
comparison and complex procedures can be assessed without
endangering patients’ health.

12. ORGANISATION OF OSCE
Advance
planning
The day
before
examination
The day of
examination
After the
examination

13. Cont…
A) Advance Planning :
Time ideally 6 months for major examination 8 weeks
for formative.
B) The Day Before The Examination
Final check for preparations & arrangement in ward
Final documentation to be given to each examiner
C) The Day Of Examination
Coordinator 1 hour prior
Final check for arrangement
Staff member brief the student
All examiners have arrived and are at their correct
station
D) After The Examination
Give feedback to students by showing checklists &
questions scored by examiners.

14. Uses of OSCE
Interpersonal and communication skills.
History-taking skills.
Physical examination of specific body system.
Mental health assessment.
Clinical decision making, including the formation of differential diagnosis
Clinical problem solving skills.
Interpretation of clinical findings and investigations.

15. Advantages of OSCE
 It provides a uniform marking scheme for examiners and consistent
examination scenarios for students.
 It provides an authentic way to assess nursing students, including
pressure from patients
 Generates formative feedback for both the learners and the teaching
program. Immediate feedback collected may improve students'
competency at subsequent stations and even enhance the quality of
the learning experience.
 Minimizes the effect of cueing: When students go to a station, they
will need to diagnose patients' problems or carry out some clinical
procedures. When they go to a subsequent station, they have to
answer some questions relevant to their diagnosis or clinical tasks.
However, students cannot go back to correct any mistakes or
omissions on what they did in the previous station

16. Cont…
 More students can be examined at any one time. When
a student is carrying out a procedure, another student
who has already completed that stage is answering the
question at another station.
 In the Objective Structured Clinical Examination, the
setting is more controlled (only two variables exist: the
patient and the examiner) and a more objective of the
student's clinical competency can be made
 Provides more insights about students' clinical and
interactive competencies
 It can objectively assess other important aspects of
clinical expertise, such as physical examination skills,
interpersonal skills, technical skills, problem- solving
abilities, decision-making abilities, and patient treatment
skills

17. Cont…
 More valid than the additional approach to clinical
examinations
 The examiner can decide in advance what is to be treated and
can then design the examiner to test competencies
 Emphasis can be moved away from testing factual knowledge
to testing factual knowledge to testing a wide range of skills
including advanced clinical skills.
 More reliable because variables of the examiner and the
patient are removed to a large extent.
 The use of checklist by examiners and the use of multiple
choice questions result in a more objective yon examination
 More practical because it can be used with a large number of
student

18. Disadvantages of OSCE
 Students' knowledge and skills are tested in
compartments and they are not tested on their ability to
look at the patient as a whole
 Demanding for both examiners and patients Examiners
are required to pay close attention to students repeating
the same task on a number of occasions
 The time involved in setting up the examination is
greater than for the traditional examination
 Maintaining uniform difficulty level is not always
possible

19. Cont…
 It is expensive in terms of manpower, resources and time
(such as number of examiners, patients, and even the
space of examination room)
 It may discourage students from looking patient as a
whole because the students' knowledge and skills are
being put into compartments.
 The assessment examines a narrow range knowledge
and skills and does not test for history- taking
competency properly. Students only examine a number
of different patients in isolation at each station instead of
comprehensively examining single patient
 It requires an extensive amount of organizing

20. OSCE Methodology
 The OSCE examination consists of about 15-20 stations,
each of which requires about 4-5 minutes of time.
 All stations should be capable of being completed at the
same time.
 The students rotate through all stations and moves to the
next station at the signal.
 Each candidate is examined on a one to one basis with
one or two impartial examiners on each station.
 They are marked by the examiner on standardized mark
sheet.
 Using 15 stations of 4 minutes each, 15 students can
complete examination within 1 hour.

21. Steps in developing an OSCE
 Decide the types of skills to be examined
 Decide the types of assessment (such as a
uniform checklist)
 Consider the number of skill assessment
stations needed (it is recommended to have 10
to 15 stations, and six minutes for each station)
because the length of the examination is
determined by the number of assessment
stations and the time each candidate will spend
at each station.

22. What are common OSCE
stations?
1. Clinical examination:
Performing a clinical examination on a real or simulated patient.
2. Objective Structured Clinical Exam (OSCE) -
Assessment Criteria
An OSCE comprises a series of stations, usually between 5-10
minutes, in which all candidates rotates through the different stations.
At each station, the candidates are assigned a written, oral practical task
to be solved within a given timespan, no aid is allowed.
Before the exam, the students will be given the number of minutes
available at each station. Between each station, there will be a short
break to allow time for transferal. The circuit also contains resting
stations.

23. Cont…
 OSCE tests medical knowledge and clinical skills such
as clinical judgment, clinical examination, ability to
reason, and problem-solving.
 Communication skills including attitude/behavior
towards the patient, and linguistic dissemination and
perceptiveness are also tested as well as the candidates'
competence in diagnosing and treatment of diseases.
 The questions can be integrated or related to clinical
situations from any medical subjects which has been
taught, but the questions should be aligned with learning
outcomes.

24. Cont…
 At each station, an examiner assesses the
candidate according to certain criteria. The
assessment emphasizes the following elements of
the candidate:
i. Clinical judgment.
ii. Clinical examination.
iii. Ability to reason, as well as problem solving.
iv. Communication skills including behavior towards the patient.
v. Linguistic dissemination and perceptiveness.
vi. Diagnosing and treatment of diseases.

28. Cont…
 Communication skills: history taking, information
giving, breaking bad news
 Data interpretation: interpreting investigation results
(e.g. X-rays, blood tests, CSF results)
 Simulation / ABCDE assessment: assessing and
managing an acutely unwell patient
 Clinical procedures: performing a clinical skill (e.g.
venepuncture or blood cultures)

30. Cont…
 Allocate resources for the examination (such as space for
examination rooms, marking sheets and plastic models)
 Prepare the staff resources needed (including examiners,
timekeepers and patient/volunteers)
 Determine/arrange the day/period of exams.
 Conduct a review/evaluation of the arrangement of the exam after it
is over
 To design concise marking schemes that focus on actions that
distinguish To design concise marking schemes that focus on
actions that distinguish between good and poor performance
 To provide marking scheme instructions on what students would do
at each station for the examiner
 To provide instructions which outline exactly the task required at
each station for students.

31. Steps in taking OSCE as
examination for students

32. 1. Registration
 The first step is registration. In this you will
go through the following process:
 Show your roll number or identity card
 General instructions are provided regarding
examination.
 Invigilator will inspect articles and prohibit
those which are not allowed in examination.
e.g. use of mobile.
 Receive your exam envelop which contains
your ID, stickers, pencil, notebook or
clipboard.

33. 2. Orientation
The next step after registration is
orientations
 Exam format, procedures and policies
will be reviewed
 Introduce to your team and team leader.
 Instructed about your starting station and
how to proceed.
 Students can ask their queries regarding
OSCE

34. 3. Escorting to exam position
 After briefing and exam. orienting
students OSCE, students will be escorted
to stations. Students will be instructed
about time at each station and about time
buzzer. Students will start exam as soon as
long bell or buzzer announce the start of
the exam.

35. 4. Station Instruction time
 This is one or two minutes to read the
instruction about the station, the situation,
patient and required task. Students read
carefully and enter the room at the next
bell.

36. 5. The encounter
 Start your encounter with the standardize
patient. There is a 5-20 minutes encounter.
Perform the required task. Stop at the next
bell.

37. 6. Post encounter period
 Some OSCE will have no post encounter
period. Some will have 1-2 min of the
encounter period assigned to an oral question
asked by the examiner inside the
examination room. No more communication
is allowed with the patient, and then written
questions to be answered on a paper or
computer outside the exam room for 5-10
min. At the next bell, first station ends as
well as next station starts. Student proceeds
to the next station quickly.

38. 7. Repeat step 4 to 6
 Step 4-6 will be repeated until student
have been in all the stations. Some OSCE
will offer 1 or 2 short rest period

39. 8. Exam ended
 Exam is over. Student will be escorted
back to dismissal area for signing out. He
will be asked to handle back all what he
has received on signing in; he may be
asked to stay for some time for exam
security reason

40. Tips for Organizing OSCE
 Assessment: Produce a grid summarizing. What is to be tested
during OSCE. Down the left hand side list the competencies such as
history taking, physical exam, patient education, etc.
 Duration of stations: Once the duration has been fixed make sure
that the task expected of the student can be accomplished with time.
 No. of stations: Within the time constraints include in the
examination as many stations as possible as there is good evidence
that the reliability of the examination.
 Use of examiners: Make sure that examiners are fully briefed prior
to the examination, both for an examination in general and
particular with regard to the station to which they are assigned.
Provide them with a list of resources that will be available at these
stations.
 Range of approaches: When planning an OSCE for the first time,
talk with number of individuals from different settings who have
previously made use of this technique. If possible, visit and watch
examinations.

41. Cont…
 New stations: New station should be tested with one or more
student before use in the examination.
 Organizations of the examinations. There should be co-
coordinator appointed in advance of the examination that has the
responsibility for taking overall charge of the advance planning of
the exam and its implementation on that day.
 Resource requirements: It is helpful to produce a checklist of the
resources required for each station in exam.
 Plan examination and directions: After the exam is set up and the
directions in place for students that they can find their way easily
from one station to the next. Use of tape on the floor for direction
can also be used.
 Change signal: Before examination, check that the audible signal
can be heard clearly at all locations on the examination.
 Records: Keep an OSCE file into which all resources required,
such as station numbers, direction arrows, master sheet of
instruction to students, checklists, rating scales and so on.

42. Problems in Conducting OSCE
 Non-availability of many faculty
members.
 Lack of enthusiasm of the teachers to try
out new methods
 Students' apprehension for having to learn
even the smallest detail of the subject
 Lack of physical facilities and cooperation
in the clinical settings
 Controversies over the evaluation criteria.

43. Strategies to Overcome
 Training the faculty members in using OSPE.
 Preparation of the students from the
beginning of the course for this type of
examination.
 Proper communication with the
administrators of the clinical areas regarding
OSCE.
 Ensuring the reliability and validity of the
evaluation criteria.
 Adequate planning and organization of the
whole exercise.

44. Thank you….