The document discusses the Objective Structured Clinical Examination (OSCE) and its variations, aimed at assessing medical trainees' clinical competencies through structured, objective evaluation. It details the principles of OSCE, its advantages such as higher objectivity and reliability, and also mentions challenges like the need for extensive planning and potential stress for students. Moreover, it provides guidelines for organizing an OSCE, including suggestions for station design and evaluation preparation.

1. OBJECTIVE STRUCTURED CLINICAL
EXAMINATION(OSCE) & OSPE
Dr. Govardhan Vaghasiya
M.S. (surgery), FMAS, FAIS, FIAGES
Associate Professor & Head Of Surgical Unit, Dept. of Surgery, PDU Medical
College, Rajkot.

4. DEFINITION:
 OSCE is a procedure where
predetermined decisions are made on the
competencies to be tested and checklists
incorporating important evaluable skills are
prepared.

5. 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

6. MODIFICATION OF OSCE
OSLER:objective structured long examination
record
OSPE: objective structured practical
examination
OSVE: objective structured video examination
OSTE: objective structured teaching evaluation
OSPRE: objective structured performance-
related examination
OSSE: objective structured selection exam.

7. POLITICAL…….!!!!
Organization for Security and
Cooperation in Europe

8. PURPOSE OF OSCE
To Eliminet Following:
 Variability
 Defects in competencies examined
 Difficulties in conducting Exams

9. OBJECTIVE STRUCTURED
CLINICAL EXAMINATION (OSCE)
 It is a method of assessing a student’s
clinical competence which is objective rather
than subjective and in which the areas tested
are carefully planned by the examiners.
 The clinical competence is broken down in to
its various components e.g. taking a history /
auscultation of heart / interpretation of ECG
or coming to a conclusion on the basis of the
findings.
 Each component is the objective of one of
the stations in the examination

10. OBJECTIVE STRUCTURED
EXAMINATION (OSCE / OSPE)
 PRINCIPLE :
 Skill to be tested is given in form of a
specific question
• To be answered in 4-5 minutes
• Each question is a station
• For each question (station) a check list is
prepared in advance
• Check list prepared by breaking the skill to
be tested into its vital components and
precautions to be observed

11. ADVANTAGES OF THE OSCE
 All components of clinical Exams are assesed
So More
 Valid examination
 The examiners can control the complexities of
the examination
 Used as summative as well formative
 Can be used with larger number of students
 Reproducible
 Components of clinical Skills& standards of
competencies are predetermined So Objectivity
& Reliability is higher

12. ADVANTAGES OF THE OSCE (CONT)
 The variable of the examiner and the patient
are to a large extent removed
 Fun activity within the department or college,
which promotes team work

13. DISADVANTAGES OF THE OSCE
 Knowledge and skills are tested in
compartments & not tested in ability to look
at the Pt. as a whole, So long case may also
needed
 The OSCE may be demanding for both
examiners and patients
 More time in setting it up
 Shortage of examiners
 Might be quite distressing to the student

14. HARDEN’S 12 TIPS FOR ORGANIZING AN OSCE
 What is to be assessed?
 Duration of station
 Number of stations
 Use of examiners
 Range of approaches
 New stations

15. HARDEN’S 12 TIPS FOR ORGANIZING AN OSCE
(CONT.)
 Organization of the examination
 Assigning priority
 Resource requirements
 Plan of the examination
 Change signal
 Records

16. CONDUCTING OSCE / OSPE
• Student rotates round a number of
stations – about 20
• Spends specified time on each station (4-5
minutes)
• On a signal (e.g. bell) moves to the next.

17. 17
PROCEDURE STATION
e.g. Taking history of a patient
Examine eye of a patient
QUESTION STATION
•MCQs related to finding
•Interpretation of lab report etc.

18. 18
e.g. 1
History taking / Examining a patient
- Examiner is present
- Uses a check list to record the performance of the
students as they pass through stations
e.g. 2
Chest X-Ray inspection
- No examiner
- Student asked about his findings & interpretation at
the next question station.
- May be given additional information and asked
about patient management (MCQs / TRUE – FALSE
type Question used)

19. 19
Student’s Name :………………………………………………
Instructions to students
This patient complains of ‘Stomach Pain”. Obtain a history from him
(i) Key points in history
(Mark with a tick)
Patient’s Name Nausea, vomiting
Patient’s age Weight loss
Occupation Bowel habit
Pain Type Melena
Site Family history
Radiation Drug History
Relieving Factors Smoking
Exacerbating factors Alcohol
Periodicity Previous medical history
Duration e.g. perf. Hemetemesis
Severity Bonus ( +1 or +2)
Appetite
Total
(3) Student’s Attitude to Patient
Allocate a mark taking into account : Scale
Consideration of Patients Feeling 8-10 Distinction
Attempts to Establish a rapport 7 Very good pass
with the patient 6 Pass Total
5 Bare pass
4 Fail
(2) History taking technique
Allocate a mark taking into account : Scale
Dates established 8-10 Distinction
Correct pace of questions 7 Very good pas
Correct phrasing of question 6 Pass
Attention paid to answer 5 Bare pass
Answer followed up appropriately 4 Fail
Total
Examiners Checklist

20. 20
Question : “ Which of the following statement is / are true about the
patient whose history you have just taken ?
1. A) The patient’s name is RAHUL
B) He is a salesman
C) He is married with one child.
D) He smokes around 30 cigarettes per day
E) He travels a lot.
2. A) His present complaint is of stomach pain present for 2 weeks.
B) He has had stomach pain like this in the past.
C) The pain is localized in the epigastria.
D) During Day time it is present constantly.
E) The pain often wakes him up at night.
3. A) The pain is relieved with milk and food
B) His brother had an ulcer
C) He is worried about his work
D) He complaints of diarrhea
E) He has lost about 3-4 kg weight recently.

21. 21
Examiner’s Checklist
Student’s Name :………………………………………………
Instructions to students
Carry out a neurological examination of the lower limbs
excluding sensation and coordination
(1) Inspection of legs
(2) Test for tone
(3) Test for clonus
(4) Test power – Ankle
(5) Test power – Knee
(6) Test power – Hip
(7) Test reflexes – Knee
(8) Test reflexes – Ankle
(9) Test reflexes – Plantar
Total
(2) Mark for general proficiency
Taking into account, for
example Scale
Procedure carried out 8-10 Distinction
Sequence of procedures 7 Very good pass
Student has tendon hammer 6 Pass
5 Bare Pass
4 Fail
0-3 Bad Fail
Total
(3)
Mark for attitude to patient
Taking into account, for
example Scale
Use of patient’s name 8-10 Distinction
Explanation to patient 7 Very good pass
Discomfort to patient 6 Pass
5 Bare Pass
4 Fail
0-3 Bad Fail
Total

22. 22
Question : “ Which of the following statement is / are true about the
patient you have just examined?
1. A) Inspection reveals muscle wasting in left leg.
B) The tone in the left leg is decreased.
C) Adduction at the left hip is decreased in power
D) Flexion power at left knee is decreased
E) Muscle power at the left ankle is decreased
2. A) The knee jerk on left side is increased
B) The ankle jerk on left side is increased
C) Clonuses is present at the left ankle.
D) The left plantar reflex is flexor
E) The signs in the left leg are those of an upper motor neuron lesion

23. 23
1. Inspection – e.g.. Inspect the hands / face of this patient.
2. Interpretation of Patient’s charts / Lab. Investigations :
Record of temperature
B.P. Chart
ECG, Chest X-Ray.
Biochemical / Hematological report
Respiratory function report…….
3. Patient education
4. Interpersonal skills
5. Instruments
6. Specimens
7. Practical procedures – on models e.g. CPR, L.P….
8. Fundus examination -

24. 24
EXAMINE
ABDOMEN
ANS.-Q.
ON ST.1
QUE.ON
ECG
ECG
ANS.-Q
ON CT
CT SCAN
QUE.ON
ST. 7
HISTORY
QUE. ON
ST. 5
HISTORY
ANS.-Q
ON ST.3
EXAMINE
CHEST
SPOT
SLIDE
(SPOT)
QUE.ON
ST.17
NEURO
EXAM.
QUE.ON
ST.15
CVS
EXAM.
LAB
DATA
INSTRU.
& QUE.
1
14
15
16
17
18
19
20
9
8
7
6
5
4
3
2
10
11
12
13
EXAMPLE
OF
OSCE

25. EXAM VENUE

26. CHANGING STATIONS

27. SIMULATED PATIENT(EXAMINATION)

29. 29

30. 30
Adaptation of OSCE to be applied for evaluation
of skills in preclinical and paraclinical subjects.
 Basic format remains same i.e. procedure
stations and question stations.
 Can be used as supplement to different
method of evaluation

31. 31
QUESTION : You are provided with an oxygen-filled
spirometer. Determine your vital capacity.
EXAMINER’S CHECKLIST:
YES NO
1. Does he check the spirometer for leakage ? 0.4 0
2. Mouth piece inserted properly 0.3 0
3. Nose clipped properly 0.3 0
4. Does he take a few normal breaths before
determining vital capacity ? 0.5 0
5. Takes a deep inspiration 1.0 0
6. Exhales maximally 1.0 0
7. Takes more than one reading 0.5 0
8. Takes the highest reading as the vital
capacity 0.5 0
9. Also determines two-stage vital capacity 0.5 0
Total- /5

32. 32

33. 33
DEMO.
MOVEMENTS X RAY
LAB
DATA
Q.ANS
ON10
URINE
PROTEIN
NEUB.
CHAMBER
QUE.ON
ST. 7
NEURO
EXAM.
QUE. ON
ST. 5
VITAL
CAPACITY
IDENTIFY
PART
Q.ANS
ON 2
PRESCRI-
PTION
FDC-
EVALUATE.
DOSAGE
FORM
WITHDRAW
FROM VIAL.
QUE.ON
ST.15
GROSS
SPECIMEN.
LAB
DATA
SLIDE
(SPOT
1
14
15
16
17
18
19
20
9
8
7
6
5
4
3
2
10
11
12
13
EXAMPLE
OF
OSPE

34. 34
 Determining vital capacity
 Charging the Neubauer chamber for doing the RBC count
 Recording blood pressure by auscultatory method
 Preparing the blood smear from given sample
 Identification of structures in the specimen (e.g. horizontal section
of brain) or a dissected part or x ray
 Interpretation of histological specimen
 Examination and interpretation of gross specimen

35. 35

36. 36
A.Advance Planning
B.Organization The Day Before Examination
C.The Day Of Examination
A.After The Examination

37. (A) Advance Planning :
Time ideally 6 months for major examination
8 weeks for formative.
1) Examiners decided
- What is to be examined.
- Weightage to different components
- Minimum standard to pass.
2) Briefing the examiners and concerned staff
37

38. 3) Preparing the ward (venue) and ward staff
4) Selection and briefing Patients
5) Preparation of documentation including
checklist, instructions for examiners and
questions.
38

39. 39
B) The Day Before The Examination:
1)Final check for preparations & arrangement in
ward
2)Final documentation to be given to each
examiner

40. 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
40

41. D) After The Examination:
1) Give feedback to students by
showing checklists & questions
scored by examiners.
41

42. 42
Limitations
1. Knowledge and skills tested in COMPARTMENTS, not for
ability to look at the patient as a whole. Can combine
with traditional type ‘Long Case’ to overcome.
2. DEMANDING for examiners and patients – use more
patients/ simulated patient.
3. TIME taken for planning in advance greater than
traditional examination.
More effort and time are required before examination.
Can reduce with a) Experience and
b) Bank of objective test items &
checklist.

43. 43
USES:
In any situation where one has to assess a student’s clinical
competence / psychomotor/communication
1) STAGE OF STUDENT :
a) As term ending & internal examination (Formative)
b) Final (summative) examination.
2) PURPOSE :
a) Criteria reference – Pass / Fail decision
(Criteria decided in advance)
b) Formative – To find out areas where deficient & needs to
improve
- Provides Feedback
c) Selection of student for a course
3) Relation to other assessments - may be used as
- Sole assessment of clinical competence?
- Combined with a ‘long case’ or some other form of assessment

44. When used correctly, the OSCE can be
highly successful as an instrument to
assess competence in medicine
Ronald Harden

45. RESOURCES
 www.Ltsn-01.ac.uk
 www.osceskills.com
 www.oscehome.com
 A practical guide for medical teachers,3rd
edition (Harden& Dent)
 www.mededuworld.com

46. GROUP WORK
Each participant to prepare 1 station with
check list & material required
Group 1: Procedure station-OSCE
Group 2: Question station- OSCE
Group 3: Procedure station- OSPE
Group 4: Question station- OSPE
-To be presented in the plenary session
Time- 30 minutes
46

47. THANK YOU

48. CUT THE Q :TWO REGION MUST B SAME SIZE &
SHAPE