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OBJECTIVE STRUCTURED CLINICAL /PRACTICAL EXAMINATION
INTRODUCTION:
An Objective Structured Clinical Examination (OSCE) is a modern type of examination often used in
health sciences. It is designed to test clinical skill performance and competence in skills evaluation and
interpretation of results.
Objective structured clinical examination (OSCEs) is a form of performance –based testing used to
measure candidates ‘clinical competence. During an OSCE, candidates are observed and evaluated as they
go through a series of station in which they interview, examine and treat standardized patients who
present with some type of medical problem.
DEFINITION:
 ‘The OSCE is an approach to the assessment of clinical competence in which the components of
competence are assessed in a planned or structured way in attention being paid to the objectivity of
the examination "Harden ,1988.
 OSCE is a full form of multi- station examination of clinical subjects first described by Harden et
al at from Dundee. It was first reported from Dundee & Glasgow (Harden and Gleeson, 1979). It
was firstly adopted in North America in widespread manner. Then adopted in the UK in the 90s.
 The principle method for clinical skills assessment in medical schools and licensure bodies across
USA, Canada, UK, New Zealand and other countries, is now the OSCE.
 Objective structured clinical examination has proved to be so effective that it is now being adopted
in disciplines other than medicine, like dentistry nursing midwifery, pharmacy even engineering
and law.
 An OSCE usually compromises a circuit of short( the usual is 5-10 minutes although some use
up to 15 minutes) station in which each candidate is examined on a one to one with one or two
impartial examiners and either real or stimulated patients (actors).

AN OSCE IS DESIGNED TO BE:
OBJECTIVE:
 All candidates are assessed using exactly the same station (although if real patients are used, their
signs may vary slightly) with the same marking scheme.
 In an OSCE, candidates get marks for each step on the mark scheme that they perform correctly,
which therefore makes the assessment of clinical skills more objective, rather than subjective ,
which is where the examiners decide whether or not the candidate fails based on their subjective
assessment of their skills.
METHODOLOGY:
 The OSCE examination consists of about 15-20 stations.
 Each of which requires about 4-5 minutes of time.
 Each station is designed to test a component of clinical competence
 All stations should be capable of being completed in the same time.
 The students are rotated through all stations and have to move to the next station at the signal.
 Since the stations are generally independent students can start at any of the procedure stations and
complete the cycle.
 At all such stations there are observers with agreed check lists to score the student's performance.
 At other stations called "response stations", students respond to questions of the objective type or
interpret data or record their findings of the previous procedure station.
FEATURES OF OSCE
 Both the process and the product are tested giving importance to individual competencies.
 The examination covers a broad range of clinical skills much wider than a conventional
examination.
 The scoring is objective, since standards of competence are preset and agreed check lists are used
for scoring.
 Where questions are asked in response stations, these are always objective.
 Simulations can be used for acute cases and there is scope for immediate feedback.
 Patient variability and examiner variability are eliminated thus increasing the validity of the
examination.

STRUCTURED:
 Station in OSCEs have very specific task. Where simulated patients are used, detail scripts are
provided to ensure that the information that they give is the same of all candidates, including the
emotions that the patients should use during the consultation .
 Instructions are carefully written to ensure that the candidate is given a very specific task to
complete.
 The OSCE is carefully structured to include parts from all elements of the curriculum as well as a
wide range of skills.
CLINICAL EXAMINATION:
 The OSCE is designed to apply clinical and theoretical knowledge is required, for example
answering questions from the examiner at the end of the station, then the questions are
standardized and the candidate is only asked questions that are on the mark sheet and if they are
asked any other then will be no marks for them.
ADVANTAGES OF OSCE / OSPE
 OSCE ensures integration of teaching and evaluation.
 Variety maintains student's interest.
 There is increased faculty-student interaction.
 OSCE is adaptable to local needs.
 A large number of students can be tested within a relatively short time.
LIMITATIONS
The process is, however, not without limitations.
 There is risk of observer fatigue if the observer has to record the performance of several
candidates on lengthy check lists.
 All stations must invariably demand only equal time. Ensuring this, therefore, requires careful
organization.
 Also, it is considered by many that breaking clinical skills into individual competencies is artificial
and not meaningful

OSCE marking
 Marking in OSCEs is done by the examiner. Occasionally written stations, for example, writing a
prescription chart, are used and these are marked like written examinations, again usually using a
standardized mark sheet. One of the ways an OSCE is made objective is by having a detailed mark
scheme and standard set of questions.
 For example, a station concerning the demonstration to a simulated patient on how to use a
Metered dose inhaler [MDI] would award points for specific actions which are performed safely
and accurately. The examiner can often vary the marks depending on how well the candidate
performed the step. At the end of the mark sheet, the examiner often has a small number of marks
that they can use to weight the station depending on performance and if a simulated patient is
used, then they are often asked to add marks depending on the candidates approach. At the end,
the examiner is often asked to give a "global score". This is usually used as a subjective score
based on the candidates overall performance, not taking into account how many marks the
candidate scored.
 The examiner is usually asked to rate the candidate as pass/borderline/fail or sometimes as
excellent/good/pass/borderline/fail. This is then used to determine the individual pass mark for the
station.
 Many centers allocate each station an individual pass mark. The sum of the pass marks of all the
stations determines the overall pass mark for the OSCE. Many centers also impose a minimum
number of stations required to pass which ensures that a consistently poor performance is not
compensated by a good performance on a small number of stations.
 There are, however, criticisms that the OSCE stations can never be truly standardized and
objective in the same way as a written exam. It has been known for different patients / actors to
afford more assistance, and for different marking criteria to be applied. Finally, it is not
uncommon at certain institutions for members of teaching staff be known to students (and vice
versa) as the examiner. This familiarity does not necessarily affect the integrity of the examination
process, although there is a deviation from anonymous marking. However, in OSCEs that use
several circuits of the same stations the marking is repeatedly shown to be very consistent which
supports the validity that the OSCE is a fair clinical examination.

PREPARATION
 Preparing for OSCEs is very different from preparing for an examination on theory. In an OSCE,
clinical skills are tested rather than pure theoretical knowledge. It is essential to learn correct
clinical methods and then practice repeatedly until one perfects the methods whilst simultaneously
developing an understanding of the underlying theory behind the methods used.
 Marks are awarded for each step in the method; hence, it is essential to dissect the method into its
individual steps, learn the steps, and then learn to perform the steps in a sequence.
 For example, when performing an abdominal examination, a student is instructed to first palpate
for the liver, and then to palpate for the spleen. This seemingly meaningless order becomes
relevant when it is considered that those with enlarged livers often also have enlarged spleens.
 Most universities have clinical skills labs where students have the opportunity to practice clinical
skills such as taking blood or mobilizing patients in a safe and controlled environment.
 It is often very helpful to practice in small groups with colleagues, setting a typical OSCE scenario
and timing it with one person role playing a patient, one person doing the task and if possible, one
person either observing and commenting on technique or even role playing the examiner using a
sample mark sheet.

References
1. Assessment of clinical competence using objective structured examination, Harden et al., Br Med
J. 1975 Feb 22;1(5955):447-51 http://www.bmj.com/cgi/content/abstract/1/5955/447
2. (Ross, M., Carroll, G., Knight, J., Chamberlain, M., Fothergill-Bourbonnais, F., and Linton, J.
(1988) Using the OSCE to measure clinical skills performance in nursing. Journal of Advanced
Nursing, 13, 45-56).
3. Kropmans, Thomas; Barry GG O’Donovan, David Cunningham, Andrew W Murphy, Gerard
Flaherty, Debra Nestel, Fidelma P Dunne (2012-01-01). "An Online Management Information
System for Objective Structured Clinical Examinations". Computer and Information Science 5 (1):
38–48. Retrieved 9 May 2013.
4. Kropmans, Thomas; Liam Griffin, David Cunningham, Winny Setyonugroho, Catherine Anne
Field, Eva Flynn Kieran M Kennedy (2015-02-15). "Back to the Future: Electronic Marking of
Objective Structured Clinical Examinations and Admission Interviews Using an Online
Management Information System in Schools of Health Sciences". Health & Medical Informatics 6
(1): 1–6.
5. How to perform an abdominal examination in the OSCE
http://www.instamedic.co.uk/osce/abdomen/

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