Assessment tool OSCE AH Mehrparvar,MD Occupational Medicine department Yazd University of Medical Sciences

The essential components of communication skills are linked to:  Knowledge  Skills  Attitudes OSCE is the “ best ” test that can really and effectively assess communication skills (CS) performance

History  OSCE was developed in Scotland in the early 1970 ’ s  Introduced by Dr. Harden and colleagues in 1975

Definition of OSCE:  “ O ” stands for Objective Every student gets the same patient (same chance)  “ S ” stands for Structured Several skills are tested at one time Each skill is tested in a separate station The examiner have a checklist for doing the marking

Definition, cont.  “ C ” stands for clinical Testing the skills of students:  Manual skills, like examining the anterior chamber of the eye  Communication skills like taking patient’s history  “ E ” stands for Examination

Highlights  OSCE is designed to assess clinical competence and communication skills  No. of stations: (5 min. each)  Three areas have to be tested: - Communication skills - Physical examination - Short answer stations

Example  The student may be asked to take a history of a young man patient (real or standardized patient) presenting with an abdominal pain  The student would be assessed according to the checklist

Advantages of an OSCE:  Tests the student ’ s ability to integrate knowledge, clinical skills, and communication with the patient  Provides the faculty with an assessment tool that is custom- fit to the goals of a specific education program  Provides unique programmatic evaluation

Advantages of an OSCE, cont.  Objectivity and validity are highly ensured in OSCE  A wide range and variety of facts can be tested at a time  Contains detailed feedback for students and teachers

Disadvantages of an OSCE:  Expensive  Takes long time to construct a case and a scoring checklist  Technical limitations

Components of an OSCE

The examination coordinating committee  Composed from qualified members who are devoted to the evaluative and educational process  Its responsibility is to determine the content of the examination, development, and implementation

The examination coordinator  Facilitates the smooth working of the committee in developing, implementing, and assessing the performance of the OSCE  Local site coordinator is needed if the examination is carried out in different sites

List of skills, behaviors, attitudes to be assessed - The OSCE should be able to reliably assess clinical competence in: - history taking - physical examination - laboratory, radiographic, and other data interpretation - technical and procedural skills - counseling and attitudinal behavior

Criteria for scoring the assessment  Checklist should be concise, unambiguous, and written to contribute for the reliability of the station  The more focused the checklist, the greater the power of the station to differentiate effectively among the abilities of the students

The examinees  Could be: student, resident, or fellow in training or at the end of training of a prescribed course  Could be: undergraduate, graduate, or enrolled in continuing medical education program

The examiners  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 a physician or standardized patient

Examination site  Could be special part of the teaching institution  The examination could be conducted in an out-patient clinic where offices are available in close proximity to each other

Examination stations  Generally, fewer than 10 stations is inadequate number, and more than 25 is not practical or feasible  The time per station should be uniform as possible. It ranges from 5-20 minutes.  The skill, behavior or attitude to be tested in a station determines whether the station requires a real patient, simulated patient, lab. data, X ray film, or patient ’ s record

Examination stations, cont.  Specially constructed plastic models or simulations may be used, e.g. rectal or breast models  Couplet station for e.g. may consist of history-physical examination combined with problem solving station  Environment of the station, should be quiet, good lighting  Clearly marked directions leading from one station to the next should be displayed

Patients standardized or simulated  A standardized patient is an individual with a health problem that is in a chronic but stable condition  Simulated patients may be volunteers  Both must be trained, and more training is required for patients used in history taking than for patients used for physical examination

Timekeeper, Time clock, and Time signal  A well-functioning time clock, and a clearly audible time signal are required.

Contingency plans  It includes reserve-standardized patients who are trained to assume a number of roles, and a patient trainer who circulates to deal with any patient problems that arise

Assessment of the performance of the OSCE  It is the responsibility of the examination coordinating committee  The following points should be considered: a) The OSCE should be tested for appropriate measurement characteristics such as: validity, reliability, feasibility

Points to be considered, cont. c) A valid OSCE station measures what it was designed to measure. A reliable station measures its consistency d) Item analysis should be completed for an OSCE to provide indications concerning the difficulty of each station in relation to the overall exam e) Grading can be based on a criterion- referenced system, norm-referenced system, or a combination of both