The document provides an introduction to OSCE/OSPE examinations. It explains that the objectives of an OSCE/OSPE are to evaluate students' practical clinical skills in a valid, reliable and objective manner. It describes the 6 step process for developing an OSCE/OSPE: 1) Define clear objectives, 2) Identify practical tasks, 3) Select tasks for assessment, 4) Break tasks into sub-tasks, 5) Assign scores to sub-tasks, 6) Set up stations. It then demonstrates this process by having groups plan a history taking, procedure, communication or response station to assess the objective of diagnosing and treating coronary heart disease or diarrhea in children.

1. MEU WORKSHOP
OSCE / OSPE
An introduction

2. OSPE/ OSCE – an introduction

3. Session Objectives
At the end of this session, you must know
• WHAT the abbreviation “OSCE/OSPE” stands for
• HOW an OSPE/OSCE is organized
• The STRENGTHS/ WEAKNESSES of the
OSCE/OSPE system

4. EVALUATION of educational inputs
Evaluation consists of finding out, or measuring
the extent to which educational objectives have
been attained

5. Objectives
Educational objectives in the medical setting
usually aim at improving ability in THREE areas
• COGNITIVE, aiming at increasing
KNOWLEDGE, also the ability to SOLVE a
PROBLEM using the INTELLECT
• AFFECTIVE, aiming at the ability to develop,
use and convey the right ATTITUDE in a given
setting

6. Objectives
• PSYCHOMOTOR, aiming at enhancing the
SKILLS of the student in order that he or she
should be able to DO, or PERFORM a TASK

7. Evaluation
EVALUATION of an objective in the COGNITIVE
domain is done by measuring the change in the
KNOWLEDGE of the student
This is done by administering
• Essay questions,
• MCQs,
• Short notes ……
in the THEORY examination

8. Evaluation
EVALUATION of an objective in the
PSYCHOMOTOR domain is done by measuring
the SKILL of the student, in his ability to perform
a given TASK

9. Evaluation
TASKS in a medical setting can be of various
types, but are generally
A. Tasks related to clinical or practical
PROCEDURES and EXAMINATIONS, like
drawing blood from a patient, or examining for
the presence of hepatomegaly, or performing a
surgical operation, or staining a slide
B. Tasks related to COMMUNICATION,
like taking a history or counselling a patient

10. Evaluation
C. Tasks related to INTERPRETATION and
ANALYSIS, like reading and interpreting an
X Ray picture, or a laboratory report – partly
knowledge based, partly skill based

11. Evaluation
These abilities are generally assessed in the
PRACTICAL or CLINICAL examination
This afternoon’s session
will focus on this

12. Evaluation
As it exists currently, the PRACTICAL or
CLINICAL examination in a medical college
usually comprises bedside clinical examinations,
laboratory based examinations and other forms of
test and exercises
We will now OBSERVE a typical bedside clinical
examination of two students

13. Evaluation
Watch the ensuing role play closely and answer
some questions after it is over…...

14. Evaluation
The role play…..

15. Evaluation
In the examination you witnessed, the aspects of
the objective being tested (probably) were
a. Ability to take a history (Communication/
Knowledge)
b. Ability to check for the presence of icterus
(Skill/ Knowledge)

16. Evaluation
The QUESTIONS which arise are:
Q1. If the student HAS ATTAINED the objective,
is there a good chance that this test/exam/method
will recognize this ?
Is the method VALID ?

17. Evaluation
Q2. If two students have attained the objective to
the same extent, does the test/exam/method give
the SAME RESULT on repeated measurement ?
Is the method RELIABLE ?

18. Evaluation
Q3. Is it ONLY the extent of attainment of
objective that is being measured, or do other things
influence the result of the test /exam /method ?
Is the method OBJECTIVE ?

19. Evaluation
Since the answer to these questions, most of the
time, is variable, there is a need for an alternate
test/exam/system which is VALID, RELIABLE
and OBJECTIVE

20. Presenting….
The
Objective O
Structured S
Practical / Clinical P/C
Examination E

21. OSCE/ OSPE
What is an OBJECTIVE, STRUCTURED
CLINICAL EXAMINATION ?
Let us understand the answer to this question in
the following steps:

22. OSCE/ OSPE
STEP ONE - Clarity on OBJECTIVES
Since an evaluation is a measurement of the extent
to which an objective has been attained, it follows
that we must have clear OBJECTIVES in order to
have clear EVALUATIONS
Example of an objective:
The Student must be able to diagnose and treat a
case of Hypothyroidism

23. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
STEP TWO – Identify the PRACTICAL aspects
of the objective
If the objective is to be attained, the student needs
to have KNOWLEDGE, which will be tested in
the THEORY examination.

24. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
STEP TWO – Identify the PRACTICAL aspects
of the objective
But in the domain of SKILLS required, we ask
the question
“If this objective is to be attained, what are the
PRACTICAL/CLINICAL tasks the student must
be able to do ?”

25. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
Using the same example..
In diagnosing and treating hypothyroidism, the
student must be able to do the following tasks

26. a. Take history from a person who presents
with symptoms suggesting hypothyroidism
b. Perform a clinical examination, including
interpreting response to the ankle jerk
c. Investigate appropriately to confirm the
diagnosis
d. Counsel the patient regarding appropriate
treatment
among other tasks…….
“The Student must be able to diagnose and treat a case of Hypothyroidism”

27. STEP THREE – Select which of the tasks will be
assessed in the PRACTICAL/ CLINICAL
examination.
In the example, out of the four practical tasks,
the task
“Recording response to the ankle jerk”
may be considered suitable for assessment
“The Student must be able to diagnose and treat a case of Hypothyroidism”

28. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
STEP FOUR – Taking each selected task, break
the task down into its constituent units
In the example of “Recording response to the
ankle jerk”, examiners may agree upon the
following:
“ If the student is able to record ankle jerk
response correctly, then he/she must be able to do
the following :

29. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
• Introduce herself, explain the procedure to the
patient, take his consent
• Ask the person to lie down, making sure that the
lower limb is exposed below the knee,
•Position the lower limb, flexed at the knee, everted
and slightly dorsi-flexed at the foot
• Expose the achilles tendon
• With one hand, slightly dorsi-flex the foot

30. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
• Strike the achilles tendon with the rubber
hammer
• Interpret the response appropriately
• Take leave of the patient, thanking him for his co
operation

31. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
This list constitutes the sub components, or
CHECKLIST for assessment of that particular
task.
Every broad task, like
- Recording temperature, or
- Performing a peripheral smear of blood from a
patient suspected to be having malaria,
can be broken down into a series of steps which
make up the task, when correctly performed

32. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
STEP FIVE – Assign scores (weights) for each of
the sub components of the checklist,
In our “response to ankle jerk..” example, if the
student introduces himself and takes consent, he
gets some marks, if he then positions the foot, he
gets some marks.. and so on
Certain sub tasks may be considered more
important than others, and are given a greater
score (weight)

33. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
For example
making sure that the “ Position of the lower limb,
flexed at the knee, everted and slightly dorsi-
flexed at the foot ”
may be considered more important than
“Expose the achilles tendon”

34. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
Hence “:position …” may be given a maximum
score of 5, while “expose the …” may be given
a score of 2
That is, if the student positions the lower limb
correctly, he is given 5, or 4.5
If he exposes the tendon correctly before
striking it, he is given a score of 2
So, the checklist may look like this ….

35. “The Student must be able to diagnose and treat a case of Hypothyroidism”
Task – Record Ankle jerk Time - 3 minutes Marks - 20
Specific sub tasks Total marks Obtained
• Introduce yourself, explain the procedure to 3
the patient, take his consent
• Ask the person to lie down, making sure 5
that the knee is flexed , foot is everted and slightly
dorsi-flexed
• Expose the achilles tendon 2
• With one hand, slightly dorsi-flex the foot 2
• Strike the achilles tendon with the rubber 2
hammer appropriately
• Record the response appropriately in the 5
scoring form provided
• Take leave of the patient, thanking him 1
for his co-operation

36. OSCE/ OSPE
STEP SIX – Set up “Stations” for assessment of
tasks
A “station” is the site at which the student is
actually assessed on a particular ability
Stations are of different types, depending on the
nature of the task to be assessed
a. History Taking stations are sites where the history
taking ability of a student is assessed. eg “This
patient complains of abdominal pain. Take a
history pertaining to abdominal pain”

37. OSCE/ OSPE
b. Procedure, or Practical stations are sites where the
student’s ability to perform a clinical procedure or
examination is assessed, eg “Record ankle jerk
response”
c. Communication stations are sites where the
communication ability of a student is assessed e.g
“This is a mother of a three year old child with
diarrhea. Advise her regarding use of ORT for her
child”

38. OSCE/ OSPE
d. Response stations are sites where the
interpretative ability of a student is assessed e.g
“ Interpret this Chest X ray of a 40 year old patient
with acute dyspnea and state 3 reasons for your
answer.”
Sometimes, REST stations are inserted in between
two task-oriented stations to give students a chance
to organise their thoughts, and to have a cup of
coffee !

39. OSCE/ OSPE
Stations must have the following items:
a. Instruction to the candidate, for example “Record
the ankle jerk response for this patient”
b. Materials - Table/chair/couch and other materials
as required for the task eg knee hammer

40. OSCE/ OSPE
c. A patient.
If the task is “Take the temperature of this 1 – year
old child”, where the emphasis is more on
performance and less on interpretation, then there
is no need to have an actual patient with fever,
though it would be good to have one.

41. OSCE/ OSPE
“SIMULATED” patients can be used.
Tasks related to communication and history taking
ability are also suited for the use of simulated
patients.
Simulated patients must be trained / informed of
the nature of the procedure prior to the examination

42. OSCE/ OSPE
However, tasks like “examine this persons
respiratory system” done in order to see if the
student can recognise an abnormal clinical finding
– eg rhonchi , or crepitations, will necessitate the
use of REAL patients with clinical problems.

43. OSCE/ OSPE
d. An Assessor. If the station is a procedure, history
or communication station then the EXAMINER
must be the assessor, since direct observation must
be done.
But in RESPONSE stations, there is generally no
need for an observer. If required, an assistant can be
present to ensure that the instruction is understood,
and to ensure that the exercise proceeds smoothly.

44. “The Student must be able to diagnose and treat a case of
Hypothyroidism”
The TIME allotted for each task is generally
uniform.
Some tasks may require shorter periods of time,
but in general, the time allotted for each task is
fixed as the time required for the task requiring
most time.

45. OSCE/ OSPE
In Summary, the steps in understanding an
OSCE/OSPE are:
1. Have a set of CLEAR OBJECTIVES, and select
those which are to be assessed
2. Identify the PRACTICAL aspects of the objective,
in terms of the tasks which the student must be able
to do if the objective is to be attained
3. Of the tasks, select the TASK for assessment in
the current examination
4. Break the task down into SUB-TASKS

46. OSCE/ OSPE
Summary
5. Assign SCORES (WEIGHTS) for each sub task,
the total marks, and the TIME required for the task
When this has been done for all tasks/skills which
will be assessed,
6. Set up STATIONS for the OSCE / OSPE, ensuring
that each station is complete in all respects
- Instruction
- Materials
- Patient/ Simulated patient
- Assessor

47. Station 1 Station 2 Station 3 Station 4 Station 5
 
 
Station 10 Station 9 Station 8 Station 7 Station 6
RestHistory Response Procedure Response
Response Commu -
nication
Response Rest Procedure
OSCE/ OSPE Stations
Observer/
assessor

48. Decide on OBJECTIVE to be
assessed
Decide on PRACTICAL ASPECTS
of the objective
Select task which will be assessed in
today’s OSCE/OSPE
Break task down into subtasks, assign
scores, make checklist
Decide on resources required
Make station
Diagnose and treat
Hypertension
Take History, Record Blood
Pressure, Counsel reg. non-
drug interventions
Counselling reg. non-drug
interventions
Greet, assess, classify,
reinforce, listen,
summarise...
Well lit station, two chairs,
simulated patient, observer..
One communication
station…
SUMMARY

49. OSCE/ OSPE
We are now ready to observe a demonstration of an
OSCE/OSPE.
We will observe a demonstration of FOUR types of
assessments – History taking, Procedure,
Communication and Response
You will work in FOUR groups

50. OSCE/ OSPE
Group ONE
Assume that the educational objective being
assessed is
“The student must be able to diagnose and treat a
person with Coronary Heart Disease”
Practical aspects of this objective ?
Take History, examine CVS, Interpret ECG,
investigate, treat, counsel, follow-up

51. OSCE/ OSPE
Group One – History taking
For today’s demonstration, the task chosen will be
“This patient comes with a complaint of chest pain.
Take a history of chest pain”

52. OSCE/ OSPE
Group One
You will have to do the following:
A. Break the task down and prepare a checklist for
assessment, with scores - like the template shown
B. State all your requirements for a station, and
prepare a simulated patient if required
C. As the whole group observes, perform the
assessment of a student – you need to prepare a
simulated student too !
D. You will then make a presentation of the checklist
which you prepared

53. OSCE/ OSPE
Specific sub tasks Total marks Obtained
• Introduce yourself, explain the procedure to 3
the patient, take his consent
• Ask the person to lie down, making sure 5
that the lower limb is everted and slightly
dorsi-flexed
• Expose the achilles tendon 2
• With one hand, slightly dorsi-flex the foot 2
• Strike the achilles tendon with the rubber 2
hammer appropriately
• Record the response appropriately in the 5
scoring form provided
• Take leave of the patient, thanking him 1
for his co-operation
Task – Record Ankle jerk Time - 3 minutes Marks - 20

54. OSCE/ OSPE
Specific sub tasks Total marks Obtained
•
•
•
•
•
•
•
Task – Take H/o Chest Pain Time ………. Marks…….

55. OSCE/ OSPE
Group TWO
Assume that the educational objective being
assessed is
“The student must be able to diagnose and manage a
child with diarrhea”
Practical aspects of this objective ?
Take History, examination, investigate if necessary,
counsel regarding ORT use, treat, follow-up…..

56. OSCE/ OSPE
Group Two - Communication
For today’s demonstration, the task chosen will be
“This is the parent of a 1-year old child with
diarrhea. Advise him/her regarding the use of ORT
in diarrhea”

57. OSCE/ OSPE
Group Two
You will have to do the following:
A. Break the task down and prepare a checklist for
assessment, with scores
B. State all your requirements for a station, and
prepare a simulated patient if required
C. As the whole group observes, perform the
assessment of the (simulated) student
D. You will then make a presentation of the checklist
which you prepared

58. OSCE/ OSPE
Specific sub tasks Total marks Obtained
•
•
•
•
•
•
•
Task – Counsel re ORT use Time ………. Marks…….

59. OSCE/ OSPE
Group THREE
Assume that the educational objective being
assessed is
“The student must be able to identify and correctly
interpret risk factors for Cardiovascular Disease in
adults”
Practical aspects of this objective ?
Take History, examination, ask for appropriate tests,
interpret test results, counsel patient at high risk…..

60. OSCE/ OSPE
Group Three - Response
For today’s demonstration, the task chosen will be
“This is the blood test result of a 40-year old
executive who came for a “master health check”.
The only complaint was occasional tiredness, worse
over the past 6 months. Read the report carefully
and answer the questions which follow..”

61. OSCE/ OSPE
Group Three - Response
Mr X Age - 40 years Sex – Male
Hemoglobin
Fasting Blood sugar
Post Prandial blood sugar
Total Cholesterol
LDL Cholesterol
HDL Cholesterol

62. OSCE/ OSPE
Group Three
You will have to do the following:
A. Break the task down and prepare a checklist for
assessment, with scores
B. State all your requirements for a station
Make a presentation of this to the larger group

63. OSCE/ OSPE
Group FOUR
Assume that the educational objective being
assessed is
“The student must be able to diagnose and manage a
person with Hypertension”
Practical aspects of this objective ?
Take History, record blood pressure, examination,
ask for tests if required, counsel reg non drug/drug
therapy…..

64. OSCE/ OSPE
Group Four - Procedure
For today’s demonstration, the task chosen will be
“This patient has been complaining of giddiness.
Record his/her blood pressure”

65. OSCE/ OSPE
Group Four
You will have to do the following:
A. Break the task down and prepare a checklist for
assessment, with scores
B. State all your requirements for a station, and
prepare a simulated patient if required
C. As the whole group observes, perform the
assessment of the (simulated) student
D. You could then make a presentation of the
checklist which you prepared

66. OSCE/ OSPE
Specific sub tasks Total marks Obtained
•
•
•
•
•
•
•
Task – Record Blood Pressure Time ………. Marks…….

67. OSCE/ OSPE
DEMONSTRATION……..

68. OSCE/ OSPE
At the end of the demonstration, note the resources
required for the exercise
1. Stations - a large hall with cubicles ?
2. Materials - equipment/ bed/ chair/ table/ X ray
films, other situation specific material
3. Personnel
- Examiners who will directly observe,
- Patients who need to be kept motivated,
- Simulated patients who need to be trained,
- Assistants

69. OSCE/ OSPE
4. Evaluation sheets for examiners to mark on, and
for students to write on, if required.
5. Students instruction sheets
6. Time keepers and bells
……………….

70. OSCE/ OSPE
But..
What did you feel about the ADVANTAGES of
OSCE/OSPE ?
About the VALIDITY of the exercise ?
The RELIABILITY of OSE ?
Its OBJECTIVITY ?
The FAIRNESS to the student ?
The RANGE OF ABILITY which can be tested ?

71. OSCE/ OSPE
For 4 students, S1 to S4,
who were tested on 4 tasks T1 to T4,
a summary table of results of the OSE
may be as follows:

72. OSCE/ OSPE
Summary Mark sheet
TASK S1 S2 S3 S4 Total Max
History 14 15 13 13 55 80
Response 15 18 19 18 70 80
Procedure 18 17 16 19 70 80
Communication 13 12 10 11 46 80
TOTAL 60 62 58 61
Max Obtainable 80 80 80 80
Conclusions
Student S2 got the maximum marks
Task – communication performance was the worst –
do we need to do something about this ?

73. OSCE/ OSPE
What are the DISADVANTAGES of OSEs ?
1. Involves lots of planning
- Listing skills/knowledge to be tested
- Preparing checklists of sub skills
- Obtaining suitable material, cases, personnel
-Preparation of answer keys for stations
2. Tends to compartmentalise the skills tested,
rather than testing the entire range of skills at one
sitting

74. OSCE/ OSPE
•Requires time and effort on the part of the
examiners, during the examination
•The “Murphy Index” (Number of things that can
go wrong) is higher than for conventional
examinations
…. BUT….

75. OSPE/OSCE
DEFINITELY worth thinking about at your
department,
and more importantly….
the RGUHS is planning to implement OSCE/
OSPE as part of its practical examination
system !!

76. Session Objectives
At the end of this session, you must know
• WHAT the abbreviation “OSPE” stands for
• HOW an OSPE/OSCE is organized
• The STRENGTHS/ WEAKNESSES of the
OSCE/OSPE system

77. Thank You !