Objective structured clinical examination(OSCE)
Objective structured clinical examination(OSCE)
Providing fair and reasonable clinical evaluation is one of the most important and most challenging faculty roles.
- Objective structured clinical examination (OSCE) was designed to test the clinical competence while simultaneously improving objectivity and reliability.
- Testing, measurement and evaluation play an important role in all educational institution, including nursing educational institution. There are many method of evaluation such as short answer, assignment, rating scale and etc.
- Out of other evaluation method, OSCE also is an evaluation method which come under psychomotor domain of learning. Evaluation is the process of determining to what extent the educational objectives are being realized.
(Ralph and Tyler)
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
To evaluate basic clinical skills
To measure competencies
To provide opportunity to practice
To provide feed back on performance.
To reduce patient and examiner variability
- It comprises of short circuit stations
- Each station has a different examiner with either real or simulated patients
- The candidate rotate through the stations completing all the stations on their circuit.
- Stations can be standardized and complex procedures can be assessed without endangering patient’s health.
- 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)
- Atmosphere is active & busy
- Examination hall is a hospital ward/lab
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.
Principles followed while preparing blueprint
Blue print include following description of stations
Number of stations
Define nature of station
Define level and range of station
Ensure optimal mix of stations
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.
- Instructions to candidates, Evaluators and Simulated patients
Grading system for OSCE–
Checklist is used to assess-
-Interviewing / interpersonal
-Patient care (physical
skills, eye contact,
-Proper use of techniques
- scoring of marks and
pass/fail grade must be
Gives importance to the individual competencies
Covers broad range of clinical skills
Scoring is objective
patient variability and examiner variability are eliminated
Ensures integration of theory and practice
Adaptable to local needs
Large number of students can be tested in a short time
Knowledge and skills are tested in compartments, and holistic 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 organization
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 organizaton
COMPONENTS OF AN OSCE
EXAMINATION COORDINATING COMMITTEE
LISTS OF SKILLS, BEHAVIOR AND ATTITUDE TO BE ASSESSED
CRITERIA FOR SCORING THE ASSESSMENT
1. EXAMINATION COORDINATING COMMITTEE
- Composed of qualified members (appointed or volunteers) who are devoted to evaluative and educational process.
- Its responsibility is to determine the content of the examination, development, and implementation.
2. EXAMINATION COORDINATOR
- Facilitates the smooth working of the committee in developing, implementing, and assessing the performance of the OSCE.
3. LISTS OF SKILLS, BEHAVIOR AND ATTITUDE
TO BE ASSESSED
- It should be able to assess clinical competence, in history taking physical examination, laboratory, radiographic, and other data interpretation, technical and procedural skills, as well as counseling and attitudinal behavior
4. CRITERIA FOR SCORING THE ASSESSMENT
- Checklist should be concise, unambiguous, and written to contribute for the reliability of the station.
- All stations there are observers with agreed upon checklists or rating scales to score the student’s performance
- Examinee Could be: student,resident, or fellow in training or at the end of training of a prescribed course.
- Most stations require an examiner.
- The examiner at a station where clinical skills (history taking, physical examination, interviewing, and communication) are assessed, may be either physician or standardized patient.
- It Could be special part of the teaching institution.
- The examination could be conducted in an outpatient clinic where offices are available in close proximity to each other.
- Consists of about 10 – 15 stations is adequate number, and more than 25 is not practical or feasible.
- The students are rotated through all stations and have to move to the next station at the signal