Osce Grand Round

osce test
OSCE TESTS
(Experience of the local Orthopaedic Unit)
DR. NARESH KUMAR
MBBS, MS, DNB, FRCS Ed,

FRCS (Orth), DM (Orth Spinal Surgery)
Consultant Orthopaedics & Spine
Surgeon
National University of Singapore.
Department of
Orthopaedic Surgery
osce test
Extent of the talk

What is assessment?
What are recent trends in assessment
in Orthopaedics?
Why OSCE?
History of OSCE in the local
Orthopaedic department?
What is the present status of OSCE in
Orthopaedics.
Recent trends in the other departments
Department of
Orthopaedic Surgery
osce test
To help the student learn

This is called Formative Assessment
To assess the mission of
the institution
This is called Values
Assessment
Reasons
for
Assessment
To assess course outcomes
This is called Programme
Assessment
Department of
Orthopaedic Surgery
To test
competence
This is called
Summative
Assessment
osce test
What needs assessing?

Cognition or the processing of
information
Knowledge
Skills
What are other 3 things?
Attitude
Communication
Department of
Orthopaedic Surgery
osce test
Reliability
The assessment must measure the
students performance consistently
Characteristics
of
Assessment
Every time the student is assessed a similar mark must be
obtained
Strong students must score highly every time they take the
examination and poor students must score low consistently
Department of
Orthopaedic Surgery
osce test
There are 4 other characteristics of

assessments...
What are they?
What do they measure?
Department of
Orthopaedic Surgery
osce test
Acceptability
It must be
acceptable to
patients, students
and examiners
This refers to privacy,

examination duration,
patient fatigue, and
marking time
Reliability
The assessment must measure the
students performance consistently
Characteristics
of
Assessment
Educational Impact
The assessment must drive
learning
If students are required to have

clinical skills, then these must be
tested by an assessment which will
motivate the student to acquire
these skills
Validity
Assessment
must measure
what you want
to measure
Feasibility
It must be feasible
in terms of resources
There must be sufficient

numbers of examiners with
sufficient time and training to
make the examination feasible
Department of
Orthopaedic Surgery
osce test
Millers triangle
From Simple to
Complex
From Basic to
Abstract
Does
Shows how
Knows how
Knows
Department of
Orthopaedic Surgery
osce test
Selection of the assessment

technique
Can be based on Millers Triangle
Department of
Orthopaedic Surgery
osce test
Assessment of knows
Knows
= straight factual recall of knowledge

Multiple choice question
A variety of formats
True/False
Single best answer
Extended matching questions
Only trivial knowledge tested
As active generation of knowledge is

avoided
Department of
Orthopaedic Surgery
osce test
Assessment of knows how

Knows how
application of knowledge to problem

solving and decision making
Essays & Oral Tests
Problems in standardizing
Inconsistency in marking
Despite this oral test are popular in UK
Ability to recall & synthesise best assessed
Short answer written formats

Department of
Orthopaedic Surgery
osce test
Assessment of shows how and

does
Mini CEX format
Observation of history taking
physical examination
Part management of case
OSCE
Globally well established.
Department of
Orthopaedic Surgery
osce test
OSCE
Addresses problem of:
Adequate sampling
Standardisation
Each case with same examiner
Improves reliability
Loss of validity
Cannot address complex skills
requiring integrated judgement
Department of
Orthopaedic Surgery
osce test
OSCE
OSCE is proving less objective
than initially thought:
Scoring against checklist is not ideal
Global rating may be ideal for
judging performance.
Rater training is essential

Ensure consistency
Department of
Orthopaedic Surgery
osce test
OSCE
Standardised patient
Vs
Real patient
Simulated patient
extensive training
For reproducibility
Consistency of scenarios
OSCE Real life performance

Department of
Orthopaedic Surgery
osce test
Local History of OSCE.

1984
Interaction
with
educators
from
Canada
PBL &
OSCE
Department of
Orthopaedic Surgery
osce test
Past Examination
Pathology Museum
NUH Level 3
75 students were examined at

one time
5 clinical cases
Foot drop
History taking
5 stations
Projection
Pathology specimen
Department of
Orthopaedic Surgery
osce test
Examples Radiographs
Department of
Orthopaedic Surgery
osce test
Examples clinical cases
Department of
Orthopaedic Surgery
osce test
Example Photographs
Department of
Orthopaedic Surgery
osce test
Reintroduction
Reintroduced OSCE test end of posting
assessment as of July 2007.
I had 5 years experience of taking part in
OSCE in Orthopaedics and for last 4
years has been an examiner for the
General Medical Council (GMC) United
Kingdom for writing clinical scenarios
for OSCE.
The idea is to use this as an end of
posting assessment tool.
Department of
Orthopaedic Surgery
osce test
Present Examination
Spine
Hip
Knee
Hand
Shoulder
Department of
Orthopaedic Surgery
osce test
Methods
The first OSCE exam conducted on a
Saturday morning over 3 hours
80 students
four circuits of five stations each.
Time required for student to complete a cycle of
five stations was 40 minutes (6 minutes per station
& 2 minute between each patient which included
transfer time and time for student to read the
scenario).
Survey was then conducted on the

assessors and students
An audit survey was then conducted to see
the effect of changes introduced in the
examination system
Department of
Orthopaedic Surgery
Analysis of the Students response
osce test
STUDENTS RESPOSES
JULY 2007
DEC 2007
Student Factors:
Improves Psychomotor clinical skills
Fear of Unknown
12
1
9
1
Examiner Factors:
Examiner not helpful
Examiner Unaware of the examination pattern
Interference by the examiner
2
7
7
3
17
12
Scenario/ Case Related:

Lack of time per station
Inadequate time for studying the questions
8
8
2
4
Examination System Suggestions:

Well Organized
Poorly Organized
Pre-exam briefing poor
3
1
2
15
2
6
Role Player Related:

Role players did not play the part well
Recommendations:
Overall a good change
Recommended to continue in the future
Inclusion of discussion/ mini viva
Real Patients would be better
12
10
2
2
19
11
5
3
Department of
Orthopaedic Surgery
osce test
Analysis of Examiners Responses

JULY 2007
DEC 2007
Yes
No
Yes
No
Scenario related
Scenario was realistic
Task required was appropriate
Sufficient Time allowed
Improved examination skills
16
15
15
11
3
8
7
1
16
20
15
2
4
0
4
0
Role player Related

Simulated patient was consistent
Played Role Realistically
18
17
2
3
15
15
4
4
Recommendations:
Should teach in a way wanting to examine
Shorten the examination
Include Discussions
5
12
5
0
0
0
2
0
5
0
0
0
EXAMINERS RESPONSES
Department of
Orthopaedic Surgery
osce test
Discussion
OSCE well received.

The clinical stations set were similar to the
stations set for GMCs Professional and
Linguistic Assessment Board (PLAB) test,
which has been standardized as a
performance assessment test.
From the students & examiners responses
it was good overall change
improves psychomotor skills of the students.
Both students and examiners felt that

time was not adequate for the first round of
examination was a mere indication of lack of the
exposure to the assessment technique.
Department of
Orthopaedic Surgery
osce test
Students view point

There were clear indication by the
students that they would be
happy for this method of
examination to be used as a
method of assessment.
Examiners unaware of the
examination technique and were
interfering.
Department of
Orthopaedic Surgery
osce test
Examiners view point

There was an element of inertia and
resistance to change that was evident
from the responses of the examiners.
great reluctance by the examiners to
follow the newly introduced
examination technique and they
wanted to continue with their
established techniques and methods.
Department of
Orthopaedic Surgery
osce test
Conclusion of the audit

Students will find it easy to adapt.
Examiners will find it difficult to
adapt to the new method of
assessment.
Department of
Orthopaedic Surgery
osce test
University of Birmingham
Case based discussion (OSLER)
Objective structured Long
examination of record
MCQ matching type.
Department of
Orthopaedic Surgery
osce test
Future
Presently we are trialling OSCE as
method of end of posting assessment
Future we will have OSCE for end of
posting assessment:
Increase the number of stations
Include
role player station and
interactive station.
Department of
Orthopaedic Surgery
osce test
Department of
Orthopaedic Surgery

Osce Grand Round

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osce test

DR. NARESH KUMAR

MBBS, MS, DNB, FRCS Ed,

Extent of the talk

To help the student learn

What needs assessing?

There are 4 other characteristics of

This refers to privacy,

If students are required to have

There must be sufficient

Selection of the assessment

= straight factual recall of knowledge

Only trivial knowledge tested

As active generation of knowledge is

Assessment of knows how

application of knowledge to problem

Despite this oral test are popular in UK

Ability to recall & synthesise best assessed

Short answer written formats

Assessment of shows how and

Rater training is essential

OSCE Real life performance

Local History of OSCE.

75 students were examined at

Examples clinical cases

Survey was then conducted on the

Analysis of the Students response

Scenario/ Case Related:

Examination System Suggestions:

Role Player Related:

Analysis of Examiners Responses

Role player Related

OSCE well received.

Both students and examiners felt that

Students view point

Examiners view point

Conclusion of the audit

MCQ matching type.

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