OSCE EXAMINATIONS

1. OSCE
PREPARED BY:
Dr. Altayeb Abdulazeem Idress
PhD , RN , CNS
altayebabdo9@gmail.com

2. COMPONENT OF
PRESENTATION

3. O
• Objective
• examiners use a checklist for evaluating the trainees
S
• Structured
• trainee sees the same problem and performs the same tasks
in the same time frame
C
• Clinical
• the tasks are representative of those faced in real clinical
situations
E
• Exam

4. MODIFICATION OF OSCE
OSVE
objective structured video examination
OSPE
objective structured practical examination
OSLER
objective structured long examination record

5. MODIFICATION OF OSCE
OSSE
objective structured selection exam
OSPRE
objective structured performance-related examination
OSTE
objective structured teaching evaluation

6. The criteria and frame
Test method
O S
C
=
EXAM
+
So the method
used to
assess the
candidate will
not change the
meaning of
exam if the
OSC system is
achieved

7. Characteristics of the OSCE
 It is an assessment approach primarily used to
measure clinical competence
 Should be planned or structured
(predetermined clinical competences)
 Examination format or framework
 Different types of test method can be
incorporated into it

8. Characteristics of the OSCE
(Cont.)
 In most stations students are observed (by one
or more examiners)
 Scored as they carry out the task or interpret
clinical materials (e.g.laboratory data, ABG),
write notes or answer question

9. Harden’s 12 Tips for Organizing an OSCE
1-What is to be assessed?
2- Duration of station
3- Number of stations
4- Use of examiners
5- Range of approaches
6- New stations

10. Harden’s 12 Tips for Organizing an OSCE
7- Organization of the examination
8- Assigning priority
9- Resource requirements
10- Plan of the examination
11- Change signal
12- Records and registration

11.  What is to be assessed?
The subject
based
Medicine , surgery ,
obs , ped , etc
System
based
Git, Resp, basic ,
etc
Skills
Taking hist,
teaching , drug,
etc

12. Number of stations
Space
In some
unprepared
areas
Approaches
Needed for
osce
Time of the
exam
Number of
Candidate

13. Use of examiners
 Sorting of them according to:
 Specialty
 Experts
 Type of station
 Scoring system
 Interest

14. Organization of the examination
Logistic
Needs
Candidates
Restriction needs
Food and need to
move
- Personal needs
- Allowed things
Exam
Timer , Change
signal & support
system
Environment &
Plan of the
examination

15. Don’t bring
 Electronic devices
 Paper and study materials
 Valuables
 Food which provided at the exam site

16. Records and registration
 Candidate patch
 Exam book
 Label
 Pencil
 Short orientation

17. Station description Equipments Simulated patient/Std
History from a patient with schizophrenia None Yes
History from a patient with chest pain None Yes
Video of patients with EPS signs Video player and
television
No
History from an alcoholic patient None Yes
Checking vital signs Yes Yes
Resource requirements

18. Exam Venue

19. Changing Stations

24. Rest station
 It designed as a
period of replacing
ideas
 Increasing the
number of
candidates involved
in same exam cycle
 Allowed for dynamic
movement without
stopping to

25. Advantages of the OSCE

26. Disadvantages of the OSCE

27. Disadvantages of the OSCE

28. Observed Stations:
clinician examiners
OSCE test design

29. Varieties of OSCEs
Patient-based Clinical task Written task
Traditional OSCE ….
SP-based test ….
Station couplets ….
Integral consultations ….

30. OSCE STATION WRITING

31. How to start
 Decide what tasks you
 want to
 can
 should
test in an OSCE format
 OSCEs test performance, not knowledge

32. Constructive alignment
 Need to know the learning objectives of your
course / programme
 Map these across :
 Subject areas
 Knowledge areas
 Skill areas

33. Blueprinting
 Content of the assessment should align with
the learning objectives of the course
 Blueprinting
 allows mapping of test items to specific
learning outcomes
 ensures adequate sampling across subject area
and skill domains

34. OSCE blueprint: systems-based
Hx taking
(incl. diag)
Phys exam
(incl. diag)
Procedures Counselling /
Education
Nursing
intervention
CVS
Endocrine
Gastro
Cardiac
Haematolgic
Musculoskl
etc

35. OSCE blueprint: discipline-based
Hx taking
(incl. diag)
Phys exam
(incl. diag)
Procedures Counseling/E
ducation
Ordering
investigs
Obstetric nursing
Clin Pharm
Comm Health
Emergency med
Family med
Paediatric nursing
etc

36.  Ensure that all parts of station coordinate
 Candidate instructions
 Marking schedule
 Examiner instructions
 Simulated patient instructions
 Equipment
Congruence

37.  This station tests the candidates ability
to …………………………
Station construct

38. Candidate instructions
 State circumstances: e.g. outpatient clinic, ward,
ICU , CCU and etc
 Specify the task required of the candidate: e.g.
take a history, perform a neurological
examination of the legs, explain a diagnosis
 Specify tasks NOT required
 Instruct on summing up: e.g. tell the patient, tell
the examiner

39.  Copy of candidate instructions
 Specific instructions appropriate to the task:
 e.g., do not prompt, explicit prompts, managing
equipment
Examiner instructions

40.  Give as much detail as possible so they can be
consistent
 try to leave as little as possible for them to ad things !
 Give enough information to enable them to
answer questions consistently
 Be specific about affect in each role
 Specify patient demographics
 i.e., gender, age, ethnicity, social class, etc.
Simulated patient instructions

41.  Ensure marks are allocated for tasks the
candidates are asked to perform
 Decide relative importance of diagnosis vs
process (history taking, examination)
 Separate checklist for process skills
Marking schedule

42.  Be detailed
 Think of
 Chairs + table / couch / bench
 Manikins - specify
 Medical equipment
 Stethoscope, ophthalmoscope, sphyg, suturing
materials, etc
Equipment

43.  Use your blueprint
 Be clear what you are testing: define the
construct
 Check for congruence
 Pilot for feasibility
Designing stations

44. Scoring considerations
 Global vs checklist scoring
 Weighting
 Standard setting

45. checklist scoring
DONE NOT DONE

46. Checklist scoring
 Advantages
 Helps examiner know what the station setters are
looking for
 Helps the examiner be objective
 Facilities the use of non-expert examiners
 Disadvantages
 Can just reward process/thoroughness
 May not sufficiently reward the excellent candidate
 Ignores the examiners expertise

47. Global scoring
DONE
PROPERLY
NOT DONE
PROPERLY
NOT DONE

48. Global scoring
 Advantages
 Utilises the expertise of the examiners
 They are in a position to make a (global) judgement
about the performance
 Disadvantages
 Examiners have to be expert examiners i.e. trained
 Examiners must be familiar with expected standards
for the level of the test

49. Weighting
 In a checklist, some items may be weighted
more than others
 More complicated scoring system
 Makes no difference to very good & very bad
candidates
 Can enhance discrimination at the cut score

50. Performance-based standard setting methods
 Three method to identify the passing score
 Borderline group method
 Contrasting group method
 Regression based standard method

51. Standard setting
the only thing we have to know is that
No perfect method!

52. Borderline method
Checklist
1. Hs shjs sjnhss sjhs sjs sj
2. Ksks sksmsiqopql qlqmq q q qkl
3. Lalka kdm ddkk dlkl dlld
4. Keyw dd e r rrmt tmk
5. Jfjfk dd
6. Hskl;s skj sls ska ak akl ald
7. Hdhhddh shs ahhakk as
TOTAL




Passing score
Borderline score distribution
Pass, Fail, Borderline P/B/F

Test score distribution

53. Contrasting groups method
Checklist
1. Hs shjs sjnhss sjhs sjs sj
2. Ksks sksmsiqopql qlqmq q q qkl
3. Lalka kdm ddkk dlkl dlld
4. Keyw dd e r rrmt tmk
5. Jfjfk dd
6. Hskl;s skj sls ska ak akl ald
7. Hdhhddh shs ahhakk as
TOTAL




Pass, Fail, Borderline P/B/F

Test score distribution
Passing score
Pass
Fail

54. Regression based standard
Checklist
1. Hs shjs sjnhss sjhs sjs sj
2. Ksks sksmsiqopql qlqmq q q qkl
3. Lalka kdm ddkk dlkl dlld
4. Keyw dd e r rrmt tmk
5. Jfjfk dd
6. Hskl;s skj sls ska ak akl ald
7. Hdhhddh shs ahhakk as
TOTAL




Overall rating 1 2 3 4 5

1 2 3 4 5
Checklist
Score
X
X = passing score
1 = Clear fail
2 = Borderline
3 = Clear pass
4 = v good pass
5 = excellent pass
Clear Borderline Clear v good pass excellent pass
fail pass

55. Borderline/contrasting/regression based methods
 “Panel” equals examiners
 Reliable: cut-off score based on large sample of
judgments (no. of stations x no. of candidates)
 Credible: based on expert judgment in direct
observation
 Passing score not known in advance (as with all
examinee centered methods)
 Judgments not independent of checklist scoring

56. Anecdotes
•Using the whistle
•Tuning the video!
•Shortage of patients
•Staff as SP’s
•Preparing the equipment
•Choosing the number of stations

57. Key Points
Staff development
Dynamic process
Stimulation
Bank
Videos & simulators
Enjoyable
Feedback

58. The organizer will
 Have a constant feeling of some thing wrong.
 Always think about many things and need to
recall them in same moment.
 Feel drowsy and need to sleep.
 But remember:
If you feel nothing of the previous
points that mean your out come will
fail

59. When used correctly, the OSCE can be
highly successful as an instrument to
assess competence in medicine and
paramedics .

60. 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
 Kramer A, Muijtjens A, Jansen K, Düsman H, Tan L, van
der Vleuten C Comparison of a rational and an empirical
standard setting procedure for an OSCE, Medical
Education, 2003 Vol 37 .

61. ‫جزيال‬ ‫شكرا‬