Objective structured clinical examination(OSCE)

Objective structured clinical examination(OSCE)

Introduction
  • 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

PURPOSE

  • 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

DESIGN

  • 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.

FEATURE

  • 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

METHODOLOGY

  • 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.

BLUE PRINT
Principles followed while preparing blueprint

  1. Relevance

  2. Observable

  3. Measurable

  4. Complexity

 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

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

GRADING SYSTEM


Grading system for OSCE–
Checklist is used to assess-
-Interviewing / interpersonal
skills
-Patient care (physical
examination)
-Professionalism (listening
skills, eye contact,
compassion, organization
etc.)
-Proper use of techniques
-Clinical knowledge
- scoring of marks and
pass/fail grade must be
determined 

ADVANTAGES 

  • 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 

LIMITATION

  • 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

  1.  EXAMINATION COORDINATING COMMITTEE

  2.  EXAMINATION COORDINATOR

  3. LISTS OF SKILLS, BEHAVIOR AND ATTITUDE TO BE ASSESSED

  4. CRITERIA FOR SCORING THE ASSESSMENT

  5.  EXAMINEES

  6.  EXAMINER

  7. EXAMINATION SITE

  8. EXAMINATION STATIONS

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

5. EXAMINEES

  •  Examinee Could be: student,resident, or fellow in training or at the end of training of a prescribed course.

6. EXAMINER

  • 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.

7.EXAMINATION SITE

  • 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.

8.EXAMINATION STATIONS

  • 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

#