This document provides information about objective structured clinical examinations (OSCEs) and objective structured practical examinations (OSPEs). It defines OSCEs as practical exams that assess clinical skills using standardized patients or models, structured tasks, and detailed checklists. The document outlines the history, purpose, development, administration and advantages/disadvantages of OSCEs. Key steps in preparing an OSCE include defining the purpose of each station, writing instructions, developing checklists, and training standardized patients or examiners. OSCEs aim to objectively and reliably evaluate clinical competencies.

2. Setting Rules
No cross talks
Cell phone on silent
Hand raise if any question

3. OSCE / OSPE
Developing, Checklist &
Scoring
Dr. Sindhu Almas
Lecturer Community Medicine
Department, LUMHS Jamshoro.

4. Objectives
Define objective structured clinical/ practical examination
Identify the ways in which OSCE/ OSPE differs from conventional
practical examination
Realize the circumstances that necessitated introduction of
OSCE/ OSPE
Identify the Advantages and Disadvantages of OSCE/OSPE
Plan and organize the conduction of an OSCE/ OSPE

5. 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

6. Definition- OSCE
A multidimensional practical
examination of clinical skills, as a tool
for assessing clinical competence

7. OSCE/OSPE Is A Platform
• ‘‘The OSCE is not a test method in the same way as an essay
or multiple choice question. It is basically an organization
framework consisting of multiple stations around which
students rotate and at which students
perform and are assessed on specific tasks’’ .
• Hodder (1989) and van der Vleuten and Swanson (1990)
support this view that many different types of test
methods can be incorporated within the OSCE format.
Clinical skills, Practical skills, Procedural skills, Lab. Tests,
Communication skills.

8. Objective Structured Practical
Examination (OSPE)
 A method of practical examination, assessment tool
 Subjects and materials are used instead of patients

9. Purpose Of OSCE
 Problems in routine clinical examination
 Variability
 Global assessment
 Marks awarded by overall impression
 Many abilities are ignored
 Difficulty in terms of time, money and number of patients and
examiners required
 “Tests the product not the process”
 OSCE is designed to overcome these deficiencies 6

10. History Of OSCE
 OSCE was developed in University of Dundee (Dundee, Scotland) in the
early 1975 by Dr. Harden and his colleagues
 After some modification it was described in detail on 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
 Globally used now

11. 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

15. How To Prepare
OSCE?

17. The Key To A Successful OSCE/ OSPE Is Careful
Planning

18. How To Develop Case/Scenario?
Define the purpose of the station
Candidate’s instructions
Scoring checklist
Standardized patient instructions
Instruction for stations set-up

19. Define The Purpose Of The Station
The examination will measure objectively the
competencies based on the objectives of the
course or the requirement of the licensing body
State the skill and domain to be tested
Skill – Elicit signs of Anemia
Domain – Knowledge, Psychomotor

20. Candidate Instructions
Candidate instruction must be clear
and concise
Before examination a briefing about
whole system is very much effective for
a successful OSCE

21. Scoring Checklist
The checklist should be complete and
include the main components
Any unnecessary or exaggerated
term must be avoided

22. Instructions For Station
Set-up
List the equipment required for the station
Instructions or questions to be performed by the candidate, for
example “Record the ankle jerk response for this patient”
Materials -Table/chair/couch and other materials as required for the
task e.g. Knee Hammer
Patient or subject (OSPE)
An assessor or examiner
Time frame and changing signal

23. The Examinees
The examinee is the student,
resident or fellow in training or at
the end of training of a prescribed
course

24. The Examiners
The examiner is needed in where
clinical skills (history-taking, physical
examination, interviewing and
communication) are assessed

25. Examinations Station
A “station” is the site at which the student is
assessed on a particular ability
The total number of stations will vary based the
number of skills, behaviors and attitudinal items
to be tested
For most clerkships or courses, the total will vary
from 10-25 (Usually 20)

26. Set Up “Stations”
Stations are of different types
History Taking stations: e.g. “This patient complains
of abdominal pain. Take a history pertaining to
abdominal pain”
Examination stations: Student’s ability to perform a
clinical examination is assessed, e.g. “Record ankle
jerk response”
Skill stations: Student’s are tested on their ability to
perform a skill eg. Provide CPR, Start IV line

27. Set Up “Stations”
Communication stations: Communication ability of a
student is assessed e.g. “Advise the mother of a three year
old child with diarrhea regarding use of ORT for her child”
Response stations: 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”
 Rest stations: To give students a chance to organize their
thoughts

28. 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
Double stations- for providing adequate time
Examination Of a
patient with Anemia
Findings
Interpretation
Plan of
management

29. Duration Of Station
Duration of stations has been fixed
Make sure that the task expected of the student
can be accomplished within the time
Time ranging from 4 to 15 minutes. 5 minute
station probably most frequently chosen
The time depends on the competencies to be
assessed in the examination

30. Movement In The Stations

32. Observer Assessment Method
Checklist or Key
Rating scale

33. Procedural Station Check List
 Mr. X. Presents with a swollen ankle for 6 weeks
Do Do
n’t
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 Inspecting for swelling , erythema and deformity if any
5 Inspection: standing from anterior posterior
6 Gait examination
7 Palpation

34. Communication Skills Checklist
(Rating Scale)
S.
N
O
Poor 1 Fair 2 Good 3 V Good 4 Excellence 5
1 Interpersonal skill:
Listen carefully
2 Interviewing skill:
Uses words to
patient as
understandable

35. 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 employee
Clinically stable patient can also be used as standardized patient
Ideally a physician will observe the standardized patients before
the examination

36. 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

37. Advantages Of OSCE
More objective
Test not only skills and knowledge but
attitudes also
Test the student’s ability to integrate
knowledge, clinical skills and communication
with the patient

38. Advantages
Can be used with large number of students
Reproducible
Provides unique programmatic evaluation
Less complexity
Valid examination
Summative and well formative

39. Disadvantages
Development and administration are time
consuming and costly
OSCE involves lots of planning
The assessment of skills tends to get
compartmentalized in an OSCE, “on the whole” is
not assessed
Inadequate for Postgraduate examinations

40. Disadvantages
The reliability of OSCEs has been found to be low if there
are a small number of stations, noisy environments,
untrained patients and lack of structured checklists
Need for standardization of simulated patients and
examiners
Repetitive and boring
Requires time, effort on the part of the examiners, during
the examination

41. Watched Structured Clinical Examination
(WSCE)
Alnasir (2004) created this method
WSCE found to be more useful than OSCE
Less time-consuming, more cost-effective,
requires less supervising staff to conduct the
examination and less stressful to the students

42. 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

43. OSLER
The long case is divided into 10 items 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

44. 10 Items In OSLER
 History taking
 1. Pace and clarity of presentation
 2. Communication process
 3. Systematic approach
 4. Establishment of case facts
 Physical examination
 1. Systematic approach
 2. Examination technique
 3. Establishment of correct findings
 Management
 1. Appropriate investigations in logical sequence
 2. Appropriate management plan
 3. Clinical acumen

45. OSLER
All candidates will be assessed on same 10 items by the
examiners in the same frame Grades:
P+ (very good/ excellent)
P (pass)
P- (below pass)
Examiners and co –examiners analyze and give overall
grade

46. Conclusion
In conventional examination marks awarded is on candidates
global performances not for individual competencies
The OSCE is a highly reliable and valid clinical examination that
provides unique information about the performance of residents
OSCE overcome most of those obstacles
Combining OSCE with long cases can assess the competency
effectively

47. Exercise 1 Procedure station
Instruction to the candidate Check the Blood pressure of the
given patient accurately
Materials required Bed or couch, stool for candidate, BP
apparatus, stethoscope, patient, examiner, instructions to
candidate and checklist for the examiner
Marks allotment: 0.5+1+1+1+1+0.5 = 5 marks
Time allotment: 5 minutes

49. References
 Samira Alsenany, Amer Al Saif. Developing skills in managing
Objective Structured Clinical Examinations (OSCE), Life Science
Journal 2012;9(3); 600-602.
 Alnasir, F.A. The Watched Structured Clinical Examination (WSCE) as
a tool of assessment. Saudi Medical Journal 2004; 25(1):71-47.
 Barman A. Critiques on the Objective Structured Clinical
Examination. Ann Acad Med Singapore 2005;34 478-82.
 Patil JJ. Objective Structured Clinical Examinations; CMAJ 1993;149;
1376-78. 46

51. Reading Resources
Books
 A Practical Guide to Medical Teachers
(Ronald Harden)
 Understanding Medical Education (Tim
Swanwick)