 OSCE is a procedure where predetermined

decisions are made on the competencies to be

tested and checklists incorporating important
evaluable skills are prepared.
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
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.
To Eliminet Following:
 Variability

 Defects in competencies examined

 Difficulties in conducting Exams

 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
 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
 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
 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
 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
 What is to be assessed?
 Duration of station
 Number of stations
 Use of examiners
 Range of approaches
 New stations
 Organization of the examination
 Assigning priority
 Resource requirements
 Plan of the examination
 Change signal
 Records
• 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.
 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.

16
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)
17
Student’s Name :………………………………………………
nstructions to students Examiners Checklist
This patient complains of ‘Stomach Pain”. Obtain a history from him
i) Key points in history
(Mark with a tick) (2) History taking technique
Patient’s Name Nausea, vomiting
Allocate a mark taking into account : Scale
Patient’s age Weight loss
Dates established 8-10 Distinction
Occupation Bowel habit
Pain Type Melena Correct pace of questions 7 Very good pass
Site Family history
Correct phrasing of question 6 Pass
Radiation Drug History
Relieving Factors Smoking Attention paid to answer 5 Bare pass

Exacerbating factors Alcohol Answer followed up appropriately 4 Fail

Periodicity Previous medical history
Total
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
18
4 Fail
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.
19
udent’s Name :………………………………………………
structions to students
Examiner’s Checklist
arry out a neurological examination of the lower limbs
cluding sensation and coordination
(3)
) Inspection of legs Mark for attitude to patient
) Test for tone Taking into account, for
) Test for clonus example Scale
) Test power – Ankle Use of patient’s name 8-10 Distinction
) Test power – Knee Explanation to patient 7 Very good pass
) Test power – Hip Discomfort to patient 6 Pass
) Test reflexes – Knee
5 Bare Pass
) Test reflexes – Ankle
4 Fail
) Test reflexes – Plantar
0-3 Bad Fail
Total
) Mark for general proficiency
Taking into account, for Total

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 20
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

21
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 -

22
 EXAMINE ANS.-Q. EXAMINE ANS.-Q
ABDOMEN ON ST.1 CHEST ON ST.3
1 2 3 4

5 HISTORY
SPOT 20

SLIDE
6 QUE. ON
ST. 5
(SPOT) 19
EXAMPLE
QUE.ON OF 7 HISTORY
ST.17 18
OSCE
NEURO QUE.ON
EXAM. 17 8 ST. 7

QUE.ON
ST.15
16 9 CT SCAN
14 13 12 11
CVS LAB INSTRU. QUE.ON ANS.-Q
EXAM. 15 DATA
ECG 10
& QUE. ECG ON CT23
EXAM VENUE
CHANGING STATIONS
SIMULATED PATIENT(EXAMINATION)
28
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

29
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
30
31
 DEMO.
Q.ANS IDENTIFY
MOVEMENTS X RAY
ON 2 PART
1 2 3 4
VITAL
PRESCRI- 5 CAPACITY
PTION
20
6 QUE. ON
ST. 5
FDC-
19
EVALUATE.
EXAMPLE
NEURO
DOSAGE OF 7
FORM 18 EXAM.
OSPE
WITHDRAW QUE.ON
FROM VIAL. 17 8 ST. 7

QUE.ON
ST.15
16 NEUB.
9 CHAMBER
14 13 12 11
GROSS
LAB SLIDE LAB Q.ANS URINE
SPECIMEN.15 10
DATA (SPOT DATA ON10 PROTEIN
32
 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

33
34
A. Advance Planning

B. Organization The Day Before Examination

C. The Day Of Examination

A. After The Examination

35
(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

36
3) Preparing the ward (venue) and ward staff

4) Selection and briefing Patients

5) Preparation of documentation including

checklist, instructions for examiners and
questions.

37
B) The Day Before The Examination:
1) Final check for preparations & arrangement in ward

2)Final documentation to be given to each examiner

38
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

39
D) After The Examination:
1) Give feedback to students by
showing checklists & questions scored
by examiners.

40
 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.
41
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 42
When used correctly, the OSCE can be
highly successful as an instrument to
assess competence in medicine

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

45
THANK YOU