Dr. Govardhan Vaghasiya M.S. (surgery), FMAS, FAIS, FIAGES Associate Professor & Head Of Surgical Unit, Dept. of Surgery, PDU Medical College, Rajkot.

 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.

POLITICAL…….!!!! Organization for Security and Cooperation in Europe

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

ADVANTAGES OF THE OSCE  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

ADVANTAGES OF THE OSCE (CONT)  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

DISADVANTAGES OF THE OSCE  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

HARDEN’S 12 TIPS FOR ORGANIZING AN OSCE  What is to be assessed?  Duration of station  Number of stations  Use of examiners  Range of approaches  New stations

HARDEN’S 12 TIPS FOR ORGANIZING AN OSCE (CONT.)  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.

17 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.

18 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)

19 Student’s Name :……………………………………………… Instructions to students This patient complains of ‘Stomach Pain”. Obtain a history from him (i)Key points in history (Mark with a tick) Patient’s NameNausea, vomiting Patient’s ageWeight loss OccupationBowel habit Pain TypeMelena SiteFamily history RadiationDrug History Relieving FactorsSmoking Exacerbating factorsAlcohol PeriodicityPrevious medical history Duratione.g. perf. Hemetemesis SeverityBonus ( +1 or +2) Appetite Total (3)Student’s Attitude to Patient Allocate a mark taking into account : Scale Consideration of Patients Feeling8-10 Distinction Attempts to Establish a rapport 7 Very good pass with the patient6 Pass Total 5 Bare pass 4 Fail (2) History taking technique Allocate a mark taking into account : Scale Dates established 8-10 Distinction Correct pace of questions 7 Very good pass Correct phrasing of question 6 Pass Attention paid to answer 5 Bare pass Answer followed up appropriately 4 Fail Total Examiners Checklist

20 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.

21 Examiner’s Checklist Student’s Name :……………………………………………… Instructions to students Carry out a neurological examination of the lower limbs excluding sensation and coordination (1)Inspection of legs (2)Test for tone (3)Test for clonus (4)Test power – Ankle (5)Test power – Knee (6)Test power – Hip (7)Test reflexes – Knee (8)Test reflexes – Ankle (9)Test reflexes – Plantar Total (2)Mark for general proficiency Taking into account, for example Scale Procedure carried out 8-10 Distinction Sequence of procedures 7Very good pass Student has tendon hammer 6Pass 5Bare Pass 4Fail 0-3Bad Fail Total (3) Mark for attitude to patient Taking into account, for exampleScale Use of patient’s name 8-10 Distinction Explanation to patient7 Very good pass Discomfort to patient6 Pass 5 Bare Pass 4 Fail 0-3 Bad Fail Total

22 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

23 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 -

24 EXAMINE ABDOMEN ANS.-Q. ON ST.1 QUE.ON ECG ANS.-Q ON CT CT SCAN QUE.ON ST. 7 HISTORY QUE. ON ST. 5 HISTORY ANS.-Q ON ST.3 EXAMINE CHEST SPOT SLIDE (SPOT) QUE.ON ST.17 NEURO EXAM. QUE.ON ST.15 CVS EXAM. LAB DATA INSTRU. & QUE EXAMPLE OF OSCE

EXAM VENUE

CHANGING STATIONS

SIMULATED PATIENT(EXAMINATION)

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30 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

31 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 ? Mouth piece inserted properly Nose clipped properly Does he take a few normal breaths before determining vital capacity ? Takes a deep inspiration Exhales maximally Takes more than one reading Takes the highest reading as the vital capacity Also determines two-stage vital capacity Total- /5

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33 DEMO. MOVEMENTS X RAY LAB DATA Q.ANS ON10 URINE PROTEIN NEUB. CHAMBER QUE.ON ST. 7 NEURO EXAM. QUE. ON ST. 5 VITAL CAPACITY IDENTIFY PART Q.ANS ON 2 PRESCRI- PTION FDC- EVALUATE. DOSAGE FORM WITHDRAW FROM VIAL. QUE.ON ST.15 GROSS SPECIMEN. LAB DATA SLIDE (SPOT EXAMPLE OF OSPE

34  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

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36 A.Advance Planning B.Organization The Day Before Examination C.The Day Of Examination A.After The Examination

(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 37

3) Preparing the ward (venue) and ward staff 4) Selection and briefing Patients 5) Preparation of documentation including checklist, instructions for examiners and questions. 38

39 B) The Day Before The Examination: 1)Final check for preparations & arrangement in ward 2)Final documentation to be given to each examiner

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 40

D) After The Examination: 1) Give feedback to students by showing checklists & questions scored by examiners. 41

42 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.

43 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

When used correctly, the OSCE can be highly successful as an instrument to assess competence in medicine Ronald Harden Ronald Harden

    A practical guide for medical teachers,3 rd edition (Harden& Dent) 

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 46

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