The implementation of OSCE in Nursing colleges

1. Objective Structured
Clinical/ Practical
Examination ( OSCE/ OSPE)
Presented By:
Dr Latha Venkatesan
Principal
Apollo College of Nursing
Chennai- 600 095
Email:
drlatha_Venkatesan@apollohospitals.com

2. Introduction
• Providing fair and reasonable clinical evaluation is
one of the most important and most challenging
faculty roles.
• Objective structured clinical/ practical examination
(OSCE/OSPE) was designed to test the clinical
competence while simultaneously improving
objectivity and reliability.

3. OSCE
Objective : examiners use a checklist for
evaluating the trainees
Structured: trainee sees the same problem
and performs the same tasks in the same
time frame
Clinical: the tasks are representative of
those faced in real clinical situations

4. What is OSCE/ OSPE
OSCE OSPE is a method of clinical/practical
Examination where predetermined decisions are
made on the competencies to be tested with the use
of checklists incorporating important skills.
The candidates rotate through a number of stations
at which they are asked to carry out a specific task.

5. Background of OSPE
Considering the drawbacks of TPE ,
OSPE Started in 1972 Dundee,
Scotland by R. Harden and F.Glesso
First literature about OSCE in 1975,
BMJ
First introduced in Medicine.

6. Cont….
Used in undergraduate as well as
postgraduate programs.
Formative & summative
Evaluation.
Now used in many disciplines

7. Abbreviations
OSCE: Objective structured clinical
examination
OSPE: Objective structured practical
examination
OSVE: Objective structured video
examination
COSPE: Computer assisted OSCE

8. The Objective Structured Long
Examination Record (OSLER)
OSLER was introduced by Gleeson in 1992
An attempt to remodel and improve the
long case examination
He suggested modifications to improve the
long case examination

9. OSLER..
• The long case is divided into 10 items or more
on which each candidate is assessed
• The 10 items cover all aspects of working up a
long case
• The process of history taking, examination and
management of the patients is observed
• In addition to observation during history taking,
communication skills are also evaluated

10. Use of OSPE in India
• Commonly used in Medicine in Undergraduate and
postgraduate students.
• Introduced in Tamil Nadu Dr MGR Medical University
recently.
• Used in Manipal College Of Nursing, CMC Vellore ,
Apollo College of Nursing
• In Tamil Nadu – used as a part of Formative
Evaluation.

11. Purposes of OSPE
1. To test each component of clinical competence
uniformly and objectively for all students
2. To assess the extent of achievement of each
student in every practical skill
3. To improve the objectivity and reliability of clinical
evaluation.
4. To evaluate set of predetermined clinical
competencies.
5. To reduce patient and examiner variability.

12. Difference between
OSCE/OSPE
OSPE OSCE
Domain Higher level of knowledge Psychomotor
Testability Identifies structures on
images, specimens, radio
graphs and relate it with
clinical scenario
Apply structural knowledge
to perform examination and
procedures
Time 2-4 min per station >4 min per station
Space One big hall Isolated small class rooms
close to each other
Examiner Non specific 2-3 persons
per hall
Expert examiner for wach
station
Checklist Nor required Required
Standardized patients Not required Required
Observers Not required Required

13. Traditional practical examination
& OSPE
• Evaluation Proformas of existing pattern
are modified with addition of OSCE marks
• 10 % of marks are for OSCE (i.e.20/100,
10/50)
• UG and PG exams included

14. S.No
Register No.
ASSESSMENT (8) PLANNING (5) IMPLEMENTATION (18) EVALUATION (4)
VIVA
INTERNALEXAMINER
EXTERNALEXAMINER
OSPE
TOTAL
Healthhistory
Physicalassessment
NursingDiagnosis
Planofaction
Nursingcare
Implementation
ScientificPrinciples
HealthEducation
Reassessment
Documentation
4 4 3 2 12 3 3 2 2 5 40 40 20 100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
SAMPLE EVALUATION PROFORMA FOR PRACTICAL EXAMINATION
FUNDAMENTALS OF NURSING – B.Sc (N) I YEAR

15. SAMPLE EVALUATION PROFORMA FOR PRACTICAL EXAMINATION
MIDWIFERY & OBSTETRICAL NURSING B. SC. (N) IV YEAR & PB.B.SC(N) I YEAR
S.No.
Register No.
ASSESSMENT (4) PLANNING (3) IMPLEMENTATION (6) EVALUATION (2)
VIVA
INTERNALEXAMINER
EXTERNALEXAMINER
OSPE
TOTAL
History
GeneralAssessment
SpecificAssessment
Nursing
Diagnosis
PlanofAction
NursingCare
Scientific
Principles
Communication
skills
Health
Education
Recording&
Reporting
1 1 2 1 2 3 1 1 1 2 5 20 20 10 50
1
2
3
4
5
6
7
8
9
10

17. Types of OSCE/PE stations
Interactive
Non
interactive

18. Types – Cont…
• Presence of
ExaminersManned
• Absence of
ExaminersUnmanned

19. Types – Cont…
Procedure
Response

20. 20
PROCEDURE
STATION
e.g. CPR,
Conducting
Delivery
QUESTION/
RESPONSE
STATION
Drug
Calculation
Interpretation
of lab report
etc.

21. Couplet & Double 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 of previous station

22. The key components of OSCE are
• There is a time limit for each station (5-10 min)
• An examiner/observer present with a checklist at
each station to carry out assessment
• All students are assessed according to the
same standards ( OSCE checklists)
• Student may communicate with standardized
patient via role play

23. Patients in OSCE
Standardized
patients
Simulated
Patients

24. Standardized Patients (SP)
• A standardized patient is an individual who is trained to
portray scripted patient
• These instruction must be detailed as standardized
patient playing the same role
• Standardized patients may be volunteers or paid
• Clinically stable patient can also be used as
standardized patient
• Ideally a physician will observe the standardized patients
before the examination

25. Simulated patients
Persons playing the role of
patients (i.e."simulated"
patients) can be used instead
of actual patients
But to make it more reliable use
as many actual patients as
possible 30

26. Instructors, lay-persons or students can be prepared for
the role of standardized patient.
Training of SP must stress the following:
• Inform them the purpose of the training and their role
• Directions should use patient-based language
• Specify patient’s perception of the problem
• Provide only relevant information
• Responses to all checklist items should be included
Guidelines for Conducting Examination
• Describe patient behavior and affect
• Describe symptoms to be simulated
• Provide training on signs to be simulated

27. Simulated Patient (History taking)

28. Simulated Patient(examination)

29. Video station

30. Methodology of OSCE/OSPE
STATIONS:
• The students during the examination moves around
a number of stations spending a specific amount of
time in each stations.
• On a signal, he/she moves on to the next station.
• The time allowed is the same for all the stations and
the stations must be designed accordingly. 3-10
minutes are given in each stations.

31. OSPE STATIONS

32. Where to conduct OSPE
Any area wherever there is space
and resources
• Clinical set up- OPD and other areas
• Multi Purpose Hall
• Examination Hall
• Library
• Laboratary eg : Foundation lab
• Large Class rooms etc

34. Exam Venue

35. Changing Stations

37. What is assessed by OSCE?
Various clinical
skills
History taking
Physical
examination
Technical
procedure
Communication
Interpersonal
skills
Knowledge and
understanding
Nursing
Diagnosis
Data
interpretation
Problem solving Attitudes Nursing
interventions

38. Advance Planning
The following are planned in advance:
• Blue print
• The patients have to be selected and briefed.
• The examiners and staff concerned to be briefed
• The venue for conducting the examination.
• Checklist
• Instructions to candidates, Evaluators and Simulated
patients

39. Organization-cont..
• Duration of station- 3-10 minutes
• Number of stations – depends on Number of
students and tasks to be performed, and content
covered.
• Number of examiners – depends on need and
availability.
• Use of bells - change signal

40. Organization-cont..
• Resource requirements
• Assigning priority – To include Must know
categories
• Arrangement for the examiners and other
supporting staff and simulated patients
• Direction arrows

41. Check list
Steps in sequence
Break into small steps
Outcome INDEPENDENT of previous steps
Marks based on importance
Validation
Open to suggestions and Feedback

42. Marking Scheme
Marks allotted to each item on a checklist
Marks are allotted for each stations
independently depending on the importance
of the each task.

43. Instructions
Students
Patients /
Simulated Patients
Examiners

44. Instructions for students
1. Display Roll No prominently.
2. Number of stations = N
3. Proceed in one direction
4. Time allotted = ‘t’ min (each station)
5. Start & end of time (ring of bell)
6. Clear instructions given at each station
7. No interaction with examiners
8. No negative marking

45. Patients
About Their
roles
Uniformity
in
answering
Not to give
any extra
information

46. Examiners
• Examiners must be trained in OSCE
• Clear Instructions on Time/ duration,
marking
• Avoid interacting with students unless
instructed
• Objective evaluation using Check lists

47. OSCE station requirement:
Task/scenario to be completed
Instructions for student available at the station(pasted)
Instructions for the standardized patient
Assessment tool (checklist)
Guidelines for Conducting Examination
• Resources needed for student to be able to perform –may simulate
• Uniform station time limit
• Mannequins and articles to set up the station as guided by the
examination
• superintendent/ examination coordinator

48. Before OSCE
Discuss the number of OSCE
stations, time limit for each station
and OSCE round with the student.
Ask if the student has any questions about the OSCE
This is orientation – NOT coaching

49. During OSCE
Observe and
assess the
student’s
performance
Stand where
you can see
without
intruding and
let the student
perform the
skill
Do not
interfere
(steps
performed
wrongly
which may be
dangerous for
the clients
MUST be
discussed
with student
following the
OSCE)
Feedback
MUST be
delayed until
completion of
all stations in
OSCE

50. After OSCE:
Review the
performance of the
student (student
shares what she
did well and what
could be improved)
Provide positive
feedback and offer
suggestions for
improvement
Determine if the
student is
competent or
needs additional
practice

51. Formative (Internal) assessments
Use the results (only when formative assessments done through
OSCE) to improve
students’ performance by giving an opportunity to ask questions
about steps they did not understand or they performed incorrectly
and instructing/coaching students to practice the steps that they
performed incorrectly.
If many students had trouble with the same stations, it means that
either the teaching methods or materials did not adequately cover
that learning objective

52. Scoring sheet for interactive stations
S.No Procedure steps Reg No Reg No Reg No Reg No Reg No

53. Overall scoring format for OSCE
Name
Reg No
of the
student
Station
I
Station
II
Station
III
Station
IV
Station
V
Total-
25
1 4 5 4 5 3 21
2 3 4 3 4 4 18
3 4 5 3 5 3 21
4 4 3 2 4 3 16
5 5 4 5 5 3 22
Total 20 22 17 22 16

54. Name of OSCE Station STATIONS
Total marks Percentage
Student Registration Number 1 2 3 4 5
Max Marks
Name of the Station Evaluator
Signature of the Station
Evaluator
OSCE Overall Scoring Compilation Sheet

55. Model
Stations in
Nursing

56. Fundamentals of Nursing
• Rare procedures Eg. Death care
• CPR
• Bowel wash
• Bladder irrigation

57. OSCE in Medical Surgical Nursing
• Tracheostomy care/colostomy care
• Blood transfusion
• Setting up for surgeries
• Interpretation of ECG/ABG

58. OSCE in Maternity Nursing
• Instruments names and purposes
• Management of PPH
• Management of eclampsia
• IUCD insertion
• Episiotomy suturing

59. OSCE in Child Health Nursing
• Immunization procedure
• Use of Restraints in children
• Neonatal resuscitation
• Feeding neonate with cleft lip/palate.

60. OSCE in Community Health
Nursing
• ORS Preparartion
• Dietary advices to Ante Natal mother
• Checking temperature of the child
• Wound dressing

61. OSCE in psychiatric Nursing
• Counseling alcoholic clients
• Managing patient with Extra Pyramidal side
effects
• Assessing memory status of the patient
• Orienting the patient after ECT

62. Advantages of the OSPE
• Valid examination
• Objectivity and reliability are increased
• The examiners can control the complexities
of the examination
• Used as summative as well formative
• Can be used with larger number of students

63. Advantages of the OSPE (cont)
• Reproducible
• The variability of the examiner and the patient
are to a large extent removed
• Variety maintains students’ interest
• Students’ satisfaction is increased.
• Fun activity within the department or college,
which promotes team work

64. Disadvantages of the OSPE
• Knowledge and skills are tested in compartments,
and wholistic patient care is not possible.
• The OSCE may be demanding for both examiners
and patients
• More time in setting it up
• Shortage of examiners
• Might be quite distressing for some students
• It requires very careful and meticulous organization.

65. Feedback from Students (positive)
• assess our performance in action
• detects our weaknesses
• assess our abilities in solving clinical
problems
• assess our clinical skills, skills in
communication and approaching patients

66. Feedback from Students (positive)
• student is made to organize his/her thoughts
• Increases self confidence
• Fair to all students
• Clinically oriented
• trains the students because OSCE is also an
international examination

67. Feedback from Students (negative)
• Might be exhausting for the real patient
• It’s humiliating to patients
• Needs extra preparation time
• Burden on the student
• Some stations require more time than the others

68. How to overcome difficulties
• Training course for teachers
• Preparation of the students from the beginning of the
course
• Proper communication with administrators
• Ensuring reliability and validity of the evaluation
• Adequate planning and organisaton
• Preparartion of OSPE Bank
• Can be conducted along with TPE

69. Research Findings
• Study was conducted in Apollo College of Nursing,
Chennai to assess the nursing students’ attitude and
satisfaction towards practical examination.
• Findings of the study revealed that, majority of the
students had negative attitude towards practical
examination( 64%), followed by uncertain attitude
( 37%).
• They also expressed ( 67%) that OSPE could be
included in the practical examination.

70. Studies reporting the strengths
of the OSPE approach
• Provides students with both formative and
summative feedback of their clinical skills.
• Provides means to work and think under
stress which helps sharpen critical
thinking, and assessment skills
• Mutual input encourages team-building
Issenberg S & McGaghie W 2002

71. Studies reporting the strengths of
the OSPE-cont…
• Measures what a student can do rather than
what he or she knows
(Humphris, G M & Kaney 2001 )
• Employs standardized objective outcome
measures with no ethnic bias
• Provides safe, supervised environment for
practicing a diversity of skills before entering the
clinical setting
( Elnicki D M, Shockcor W T, & Halbrtitter K. A
1993)

72. Studies reporting the strengths of
the OSPE-cont…
• Both faculty members and students
perceive OSCE OSPE as a valid
measure of their cognitive ability and a
vehicle of reliability
• Provides performance-based testing with
excellent test-retest reliability• [[
(Martin I G, Stark P & Jolly B 2000)

73. Studies reporting the strengths of
the OSPE-cont…
• The checklist approach reduces measurement error
because of its apparent objectivity
• The checklists are excellent feedback tools for students
and identify learner needs
• Provides a medium to access indicators of performance
and helps decrease subjectivity.
• Work can be decreased in terms of preparation time with
subsequent administrations of the identical OSCE
OSPE . (Offering the prospect of decreased cost)
(Dacre, J, Fox R, Rothman A, 1999)

74. Studies reporting the strengths of
the OSCE-cont…
• More reliable and valid than traditional testing
methods.
• Highly adaptable to a variety of clinical
competencies (e.g., cognitive, psychomotor, self-
efficacy)
• Easily employed in assessing in a variety of
clinical competencies
(Elnicki D M, Shockcor W T, & Halbrtitter K. A
1993)

75. Studies reporting the limitations of the
OSPE approach
• It is expensive in terms of institutional resources such as
development costs and salaries of faculty, administrators and support
staff.
• Critical indicators require validation and piloting.
• Poorly trained personnel result in inconsistencies in the evaluation
process
• Checklists remove professional judgment
• Thoroughness, rather than competence, may be rewarded, thereby
failing to recognize alternative problem- solving approaches.
((Dacre, J, Fox R, Rothman A, 1999)

76. Studies reporting the limitations of the OSPE –
cont..
• May not be appropriate to meet the learning
objectives on teaching philosophies of the institution
• Objectivity may be compromised due to examiner
boredom or fatigue.
• Criteria-based learning may not be appropriate to
the students once they meet the criteria for the initial
stage
• May not be integrated into the curriculum to advance
practice of knowledge (e.g., problem-solving)

77. Studies reporting the limitations of the
OSPE –cont..
• Does not provide a means for students to engage in
self-evaluation
• Specific performance criteria discourage students
from looking at patients holistically
• May produce “simulation syndrome” that limits the
student’s ability to adapt to a diversity of different
clinical situations and settings
(Humphris, G M & Kaney 2001 )

78. Studies reporting the limitations of
the OSPE –cont..
• Inadequate as a sole method and unable to
accurately replicate all clinical and community
environments or patient situations
• Students’ scores may be increased due to Likert’s
scale effect, especially with increased fatigue and
boredom of assessors
(Elnicki D M, Shockcor W T, & Halbrtitter K. A
1993)

79. Studies reporting the limitations of
the OSCE approach- Cont..
• Poorly trained personnel (e.g., seasonal and
inexperienced instructors) result in
inconsistencies in the evaluation process
(Dacre, J, Fox R, Rothman A, 1999)
• Objectivity of evaluation process may be
compromised due to examiner boredom or
fatigue.
(Humphris, G M & Kaney 2001 )

80. Key Points- OSPE
• Reliable, valid, and objective
• Staff development
• Dynamic process
• Simulation
• OSPE Bank
• Videos & simulators
• Enjoyable
• Feedback

81. Conclusion
When used correctly, the OSCE
can be highly successful as an
instrument to assess competence
Ronald Harden

82. Bibliography
• Ananthakrishnan N, Sethuraman K R, Kumar S ( 2000 ). Medical
Education: Principles and Practice, Second edition, Alumni
Association of National Teacher Training centre, JIPMER.
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safety education for Nurses to enhance competency outcome
performance assessment ; A synergistic Approach tht promotes
patient safety and quality outcome. Jl of Nursing Education
2009. 48 ( 12), 686-693.
• Bhat, Sham M, Anana & Susan. Objective Structured Clinical
examination (OSCE OSPE). Nursing Journal of India. 2006.

83. Bibliography- Cont..
• Billings d M, Halstead J A. ( 2006 ). Teaching in Nursing. A
guide for Faculty. Second edition. Elsevier Saunders.
• Dacre, 1., Fox, R., Rothman, A. (1999). Development of a new
OSCE OSPE marking schedule based on a combination of item
scores and global judgments, Medical Education, 33, 230.
• Elnicki, D.M., Shockcor, W.T, Morris, D.K. and Halbritter, K.A.
(1993). Creating an objective structured clinical examination for
the intemal medicine clerkship: Pitfalls and benefits, American
Journal of the Medical Sciences, 306(2), 94-97.

85. Thank
You