Objective Structured Clinical

Examination (OSCE)

History of OSCE

• First described by Harden & Gleeson (1975)

• Using OSCE for the Canada Medical Licensing

Examination (1990)

• Using OSCE by the Education Commission for

foreign Medical Graduate (ECFMG) in USA (1994)

• Medical students have to pass OSCE before entering

clinical practice in Japan (2003)

• United State Medical Licensing Examination

(USMLE) step 2 clinical skill examination (2004)

Taiwan?

• Medical Licensing Examination step 2 clinical skill

examination in 2010

• Nursing licensing examination from 2016?

Objective

• All the candidates are presented with the

same test.

• Clear goals

• Specific criteria for evaluation

Structured

• The marking scheme for each station is structured.

• Specific skill modalities are tested at each station

- History taking

- Explanation

- Clinical examination

- Procedures

Clinical

•Use case scenarios

•Test of performance of clinical skills

•Not a test of knowledge

•The candidates have to demonstrate their skills

Examination

•Direct observation by raters

–Formative examination

–Summative examination

–High stake examination

Learning Assessment

• Pre-assessment

• Formative assessment

• Summative assessment Pre-

assessment

Formative

assessment

Summative

assessment

High Stake Testing

• When the outcome of a standardized test is used as

the sole determining factor for making a major

decision.

OSCE-3

• Usually used to assess performance

• Mostly using standardized patients

– “Standardized” refers to the fact that the person is

specifically trained to model the “real” patient’s

condition, including symptoms and emotional

states, and to do so consistently over time.

Model of Competence

Knowledge

performance

Competence

actions

Harden, R., Stevenson, M.,

Wilson Downie, W., Wilson, G.

(1975). Assessment of clinical

competence using objective

structured examination. British

Medical Journal, 22, 447–451.

Harden et al.

(1975)

Harden et al.

(1975)

Harden et al.

(1975)

Approaches to nursing OSCE/

simulated examination

• Multi station OSCE

• Scenario based OSCE (sometimes called objective

structured clinical assessment (OSCA))

• ‘Top to Toe’ assessment

• OSCE/simulated assessment with random allocation

– Not all students assessed on same scenarios/

systems

Rushforth, H. E. (2006). Objective structured clinical examination (OSCE): Review of

literature and implications for nursing education. Nurse Education Today, 27, 481–490.

Example 1

• 5 min for each

station

• Stations one and

two on

psychomotor and

communication

skills.

• Station three on

knowledge

Brosnan et al. (2006). Implementing objective structured clinical skills evaluation (OSCE)

in nurse registration programmes in a centre in Ireland: A utilisation focused evaluation.

Nurse Education Today, 26, 115–122

Example 2

Alinier, G. (2003).

Nursing students’ and

lecturers’ perspectives of

objective structured

clinical examination

incorporating simulation.

Nurse Education Today,

23, 419–426.

Benefits of OSCE-1

• Greater objectivity than in most assessment of

practice.

• Wide range of different examiners, hence reduced

risk of examiner bias.

• Reduced risk of different students being assessed by

different assessors.

• Positively viewed by students and lecturers.

Rushforth, H. E. (2006).

Benefits of OSCE-2

• Broader range of skills tested.

• Reduced ‘luck of the draw’/increased consistency of

experience between students.

• Motivation for learning.

• High level of reliability and validity.

• Flexibility is one of the OSCE’s major advantages

and a reason for adoption.

Rushforth, H. E. (2006).

Patri´cio, M. F., Julia˜o, M., Fareleira, F., & Carneiro,

A. V. (2013). Is the OSCE a feasible tool to assess

competencies in undergraduate medical

education? Medical Teacher, 35, 503–514.

Disadvantages of OSCE

• Organizational training

• The idealized ‘textbook’ scenarios may not mimic

real life situations

• Expensive

Zayyan, M. (2011). Objective structured clinical examination: The assessment of

choice. Oman Medical Journal, 26(4), 219-222.

Issues Regarding OSCE Testing

• Reliability

• Validity

• Scoring

• Practical Issues and Feasibility

Turner, J. L. & Dankoski, M. E. (1975). Objective structured clinical exams: A critical

review. Family Medicine, 40(8), 574-8.

The basic steps in modelling an OSCE

• Determination of the OSCE team.

• Skills to be assessed (OSCE Stations).

• Objective marking schemes

• Recruitment and training of the standardized patients.

• Logistics of the examination process.

Zayyan, M. (2011). Objective structured clinical examination: The assessment of

choice. Oman Medical Journal, 26(4), 219-222.

Standardized Patient Training

• Recruiting, auditioning, hiring, training, mentoring

SP actors for simulation programs

• Character and scenario development

• Realistic enactments

• Actor contributions to debriefing

• Actor retention, compensation, and development

Pascucci, R. C., Weinstock, P. H., O’Connor, B. E., Fancy, K. M., & Meyer, E. C. (2014).

Integrating actors into a simulation program. Simulation in Healthcare, 9(2), 120-126.

SP Patient

• SP candidates must be intelligent, flexible, quick

thinking, and reliable.

• SP’s understanding of the concept of the OSCE and

the role given to them is critical to the overall process.

Zayyan, M. (2011). Objective structured clinical examination: The assessment of

choice. Oman Medical Journal, 26(4), 219-222.

Writing for Scenarios and Associated

Materials

• Design scenario and evaluation form

• Guide to students

• SP instruction/training guide

• Rater checklist

• SP checklist

• Errors of OSCE

Write a scenario

with a script for

SP training

Station: B

Subject: CV system

Situation: Sudden onset of chest pain

Instructor: Hsing-Mei Chen

B

SP Training • Date and Time for the training

• Date and Time for the exam

• Location

• Stations A-F

• Musculoskeletal system

• Cardiovascular system

• Neurological system

• Female reproductive system

• Abdominal system

• Newborn assessment

• List the requirement for SP and

their names

Informed consent

for SP

SP instruction/training guide-1

Background information and

history

SP instruction/training guide-2

Script for training SP

to answer students’

questions

Student Guideline

Location: OPD ER Ward other____

Scenario:

Your task is to

History taking

PE

Communication to the patient

Time: 17 minutes for skills,

3 minutes for feedback

During the OSCE

Checklist History

taking

Physical

examination

Feedback

SP Evaluation by Rater

Student Satisfaction Evaluation

Open questions

Report the Outcome

Mid-term score

90 and above 13

80-89 12

70-79 4

60-69 0

50-59 0

Total 29