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S tructured O bjective C linical E xamination SOC E
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S tructured O bjective C linical E xamination
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What is OSCE ? series of stations with tasks series of stations with tasks planned planned marking form marking form examiner examiner patient : SP patient : SP organization > examination organization > examination
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Why OSCE ? before OSCE (1975) before OSCE (1975) viva (oral), long case, short case viva (oral), long case, short case valid ? know how NOT show how know how NOT show how reliable ? different patients different patients different examiners different examiners
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Why OSCE ? more valid more valid show how more reliable more reliable same task | patient same examiner or same structured marking sheet
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Basic Structure 12348765
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12348765 12435687
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Basic Structure : Parallel 12348765 A B CD
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Basic Structure : Double 2 123 7654
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How to start ? blueprint of the whole OSCE blueprint of the whole OSCE design the station design the station design the mark sheet design the mark sheet
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Blueprint reversed table of classification reversed table of classification
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Station & Marking learning by doing learning by doing 8 groups : name list 8 groups : name list 8 stations 8 stations 2(p) - 4(x) - 4(d) 2(p) - 4(x) - 4(d) signal signal materials & ID materials & ID task (flexible) task (flexible) lunch : 3rd floor lunch : 3rd floor
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Station Design station time 4-15 min. station time 4-15 min. total time < 2 hrs total time < 2 hrs focus task focus task examiner used : Y | N, who? examiner used : Y | N, who? pilot pilot
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Type of Stations static | written static | written practical : technique practical : technique clinical clinical
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Marking Sheet Design checklist checklist rating scale rating scale score score
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Checklist dichotomous : Yes | No dichotomous : Yes | No Pros Pros high objectivity high reliability easy to feedback Cons Cons only quantity check
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Checklist How to improve? How to improve? stem clear clear observable observable not too long not too long overall not too long not too long
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Rating Scale rating rating quality concern quality concern lower objectivity lower objectivity lower reliability
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Rating Scale How to improve? How to improve? 3-7 scale more clarification of each scale more raters rater training common errors of rating scale common errors of rating scale
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Rating Scale common errors common errors leniency error central tendency error halo effect logical error proximity error contrast error
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Examiner station developer station developer non station developer non station developer teacher not teacher other staff other staff SP SP participation => reliability participation => reliability
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Observation direct direct indirect indirect one-way mirror monitor video
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Getting Feedback: How? verbal verbal marked checklist & be the subject marked checklist & be the subject marked checklist & watch video marked checklist & watch video printed answer printed answer relevant papers relevant papers
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Getting Feedback : When? during the exam during the exam intra-station in another station stress? NB: too much information! after the exam after the exam end of all stations
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Setting an OSCE learning by doing | 8 groups learning by doing | 8 groups structured task | medical student V structured task | medical student V time time 7 min. test (without feedback) 5 min. test + 2 min. with feedback available tools : pls ask available tools : pls ask draft of test and marking sheet : ~ 4 p.m. draft of test and marking sheet : ~ 4 p.m. preparation 8 - 9 a.m. preparation 8 - 9 a.m.
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Minimal Passing Score criterion-referenced ( อิงเกณฑ์ ) criterion-referenced ( อิงเกณฑ์ ) holistic modified Angoff norm-referenced ( อิงกลุ่ม ) norm-referenced ( อิงกลุ่ม ) borderline method relative method
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Holistic Method medical school’s faculty-wide pass mark medical school’s faculty-wide pass mark e.g. 60% e.g. 60%
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Modified Angoff Method group of experts group of experts get the OSCE get the OSCE “Think of a group of borderline candidates” “Think of a group of borderline candidates” decide the passing score decide the passing score expert discussion is acceptable in original Angoff expert discussion is acceptable in original Angoff
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Minimal Passing Score criterion-referenced ( อิงเกณฑ์ ) criterion-referenced ( อิงเกณฑ์ ) holistic Modified Angoff norm-referenced ( อิงกลุ่ม ) norm-referenced ( อิงกลุ่ม ) borderline method relative method
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Borderline Method marking form : checklist + global rating marking form : checklist + global rating all categorized ‘borderline’ students all categorized ‘borderline’ students mean scores of ‘borderline’ group mean scores of ‘borderline’ group
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Borderline Method Mean borderline score = (72+70+80) / 3 = 74
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Relative Method 1st method : Wijnen Mothod 1st method : Wijnen Mothod Passing mark = mean -1.96SE 2nd method 2nd method 60% of the 95th percentile rank score
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Minimal Passing Stations criterion-referenced criterion-referenced
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Staff & OSCE : Like emotional comfort emotional comfort validly assess validly assess consistent consistent
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Staff & OSCE : Dislike too compartmentalized too compartmentalized no opportunity to observe the complete patient evaluation of the student no opportunity to observe the complete patient evaluation of the student repetitive nature => boring repetitive nature => boring
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Students & OSCE fairer than other methods fairer than other methods less stressful less stressful unsure whether the important aspects tested unsure whether the important aspects tested
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Limitations of OSCE lengthy preparation lengthy preparation need more observational skill of the staff need more observational skill of the staff costly costly low inter-station correlation low inter-station correlation test security? test security?
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What’s next? evaluation => learning evaluation => learning summative => formative summative => formative
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Innovation senior student as SP and examiner in OSCE senior student as SP and examiner in OSCE study sheet listing Dx that might appear on the OSCEs study sheet listing Dx that might appear on the OSCEs add structured oral exam into OSCE add structured oral exam into OSCE GOSCE GOSCE
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GOSCE : Group OSCE Pros Pros economy mutual teaching mutual support opportunity to examine social skill Cons Cons lack of individual assessment different participants do different tasks
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Potential Use of GOSCE formative assessment formative assessment end-of-course assessment end-of-course assessment exploring interpersonal relationship exploring interpersonal relationship teaching method for short course teaching method for short course
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Re-using OSCE stations across rotation in the same academic year across rotation in the same academic year statistically OK from year to year from year to year statistically not OK
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Conclusion : OSCE What ? What ? stations + tasks + checklist Why ? Why ? more valid, more reliable How ? How ? How to organize? How to analyze?
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