Nagy Sayed-Ahmed

BREIFING ON OSCE

The Objectives of the programme

Essential to the practice of medicine –

Knowledge:

Normal and abnormal structure and function

Pathogenesis and epidemiology

Presentation and diagnosis

Prevention and management

Skills:

Clinical method

Basic clinical procedures

Attitudes and Competence needed to practice medicine

as a pre-registration house officer

The Pillars of Education

KnowledgeBiomedical

Contextual

Skills

Intellectual

Communicative

Procedural

Why to Examine?

Assurance of competency

Ranking students for competition

for posts

Educational impacts…..

Others !!!!!!

Lecture

Clinical

Seminars

Skills lab/

Clin Training/

others

Knowledge

Understanding

Skills

Attitude

Essays, SEQs,

MCQs, Viva

Clinical,

OSCE,

OSPE, WPA

Education Process:

What are you assessing?

Clinical Sems – Exams & Marks

MarksItem

60Midterm MCQs (2 or 3)

70SSC/Presentation & Active

Attendence

200Final MCQs/EMQs

200Final OSCE

120Final Short Essay

650Total

Is it a valid examination?

Is it a reliable examination?

What educational impact will it have?

Is it feasible?

OSCE/OSPE - Format

Observed Structured Clinical Examination / Objective Structured

Practical Examination

Different stations - each testing a specific clinical skill in a set time

One examiner observes and assess each candidate at each station

whilst remaining at the same station for the whole cycle

Circuit- The passage of the candidates through the carousel of the

number of stations

Cycle is the number of times the examination is run on a give diet

Candidates start the examination at a specific station, then progress

through the other stations

WHAT IS AN OSCE?

This is an assessment format in which the candidates rotate around a circuit of stations, at each of which specific tasks have to be performed, usually involving

a clinical skill, such as

History taking or

examination of a patient

Communication, Ethics & Attitude

Data interpretation

Preceedure perfection

The marking scheme for each station is structured and determined in advance.

Advantages & disadvantages

Improving standards – 1

Format

•Structured interaction between examiner and candidate

•Patients participating should have real physical signs

•Patients relate their own history (may have some details

modified to fit the scenario)

•Surrogate or simulated patients - learnt the scenario and

history to be discussed and related to the candidate

•Surrogate patients - have no abnormal physical findings

Format Examiners

Improving standards – 2

Marking

•The marking scheme for each station is structured

•Weighting

•Global vs. checklist scoring

•Discussion of marking inconsistencies

Examiners

• Examiners must understand the principles of OSCEs

Practicalities of OSCE

• Suitable venue

• Adjoining rooms

• Big hall with partitions

• Room for students to gather before exam

• Room to brief examiners

• Rest room for patients

Recruitment

• Examiners

• Patients

• Simulated patients

• Administrative support

DESIGNING A CLINICAL EXAMINATION SKILLS

OSCE Station

Consider the curriculum and assessment

objectives

Write instructions for site organisers

Write instructions for examiners

Write instructions for patients or volunteers

Write marking criteria

Matching Curriculum to Assessment:

Blueprinting

On the Day

• Admin to supervise students waiting

• Admin to check examiners all present

• Admin to look after patients/SPs -

?nurse

• Helpers for ‘emergencies’

• Timing system

• Refreshments

Preparation

• Decide running order for stations

• Prepare order for students

• Obtain equipment for each station

• Produce mark sheets

CONSIDER THE CURRICULUM /

ASSESSMENT OBJECTIVES

What are the index clinical situations relevant to

this question?

Which year group is this question designed for?

Year 4

Year 5

Year 6

WRITE INFORMATION FOR SITE

ORGANISERS

What resources are needed?

Real patient or healthy volunteer

If real, full details of condition

m or f or either?

What age range is appropriate?

Any other issues (eg ethnicity)?

Any other resources needed for this station?

Setting up the station Timing

8 minutes

Standard guidance (amend if needed)

The couch should be positioned in such a way to allow the candidate to

examine the ‘patient’ from the patient’s right side

Facilities for handwashing/alcogel will be available

Station

Number

Code(admin. use

only)

Description Required logistics

1 MHx History taking (1) Desk, 3 seats

2 MExA Clinical Examination (1) Bed, 2 seats, bed sheet, hand cleaning gel

3 MExB Clinical Examination (2) Bed, 2 seats, bed sheet, hand cleaning gel

4 MD Data interpretation Desk, 2 seats

5 SExA Clinical Examination (3) Bed, 2 seats, bed sheet, hand cleaning gel

6 SPh Photographic material (1)Desk, 2 seats, PC or laptop (windows operated,

MS office)

7 SExB Clinical Examination (4) Bed, 2 seats, bed sheet, hand cleaning gel

8 UHx History taking (2) Desk, 3 seats

9 UPh Photographic material (2)Desk, 2 seats, PC or laptop (windows operated,

MS office)

10 UEx Clinical Examination (5) Bed, 2 seats, bed sheet, hand cleaning gel

WRITE INSTRUCTIONS FOR STUDENT

This is a 5 / 10 minute station, set in the

[Specialty: ] outpatient department / ward

/A&E / general practice.

This is [insert name of ‘patient’

Describe scenario if appropriate and task for

student

WRITE INSTRUCTIONS FOR PATIENT OR

ROLE PLAYER

Are there any instructions you need to

give to the patient?

eg what clothes to wear (and what

needs to be removed), how to

behave etc

Role play – Training & Briefing

DESIGN THE MARKING CRITERIA

Calibration

Examiners must review and discuss the patients prior to the examination.

This process, known as calibration, is essentially a standard setting process, and is critical to the fair and consistent conduct of the assessment.

Examiners should ensure that the problem described in each of the scenarios is correct

•Examiners should rehearse the history and check the physical signs

•Examiners should agree which parts of the physical examination they feel the candidate should undertake

•They should ensure that the patient or surrogate understands their role

•The requirements to pass each of the skills should be agreed by the examiners.

•If the station’s scenario is felt to be unworkable a the reserve scenario should be used.

What can go wrong?

• Examiners late or absent

• Patients ill or absent

• Too hot room

• Too much noise

• Candidate getting distressed

Examiner Briefing for OSCEs

Thank you!

• We appreciate your commitment

in time and effort

• Even if you have examined

many times before, we would

appreciate your attention for the

next few minutes

The objectives of the OSCE – 1

The main objective of most of the OSCE stations is

to evaluate the students skills.

Evaluate the students’ attitude, conduct, and

behaviour

Evaluate communication skills

Evaluate performance skills in history taking and

clinical examination

Proper data extraction and interpretation

The objectives of the OSCE – 2

Style of examination and/or ability to describe

clinical findings or appreciated normality

Ability of student to interpret and complement

findings to reach proper diagnosis and/or

management

Manual skills in diagnostic and therapeutic

maneuvers

Evaluation of the depth of knowledge and

information may be a 2ry but not a 1ry target

Check your station

• If your station contains patients or

simulated patients, check their story or

signs with them before the students arrive

• Do not alter the details of the simulated

patient’s story or the marking scheme as

this will impair standardisation across sites

• If your station needs equipment, check it

is all present and correct

How the station works

• Students read the instructions outside the

station

• They have 60 seconds to read them

• When they come in:

– Confirm their identity

– Let them start immediately

– Do not delay them by reading the instructions

again

• Let them leave as soon as the bell goes

The mark sheet

• These are comprehensively

prepared

• Fill in students’ names /numbers

• Fill in your own name and examiner

PIN number before the exam starts

The mark sheetThere are 3 parts:

• The ‘different sections’

• The overall global mark

• Written feedback

All sections are equally important

Marking the different sections

Based on your observation, decide how

completely the student has performed each

section

Do not adjust for difficulty of station or the

relative importance of each section; you are

recording what you observe

This information will be fed back to the

students, so it is vital each row is completed

Please use the full range of the marking

scheme

Written feedback

• There is a box at the bottom of the sheet

for written comments (please be legible!)

• This must be completed if you award a

mark of <60%

• These comments will be seen by students,

so keep them constructive and fair

Marking fairly• The student should be unknown to you

• If you do know them for any reason,

please

judge them on how they perform today

• Do not be influenced by your previous

knowledge of their skills (good or bad)

Marking fairly• Do not compare students with each

other

• Judge the student against the marking

scheme

• You are judging whether each student

is competent

• All could pass, all could fail at your

station

Judge carefully • As a medical school, we are accountable

for our assessments

• By allowing a student to pass our

examinations, we are confirming that he/she

is competent to progress to the next stage of

medical training

• If you have doubts about a student’s

competence, please help us and them by

marking them as borderline or lower

You are not the final decision!

• No student will fail because they have

failed one station

• It is their overall performance across

the exam which counts

• However, if you observe worrying

behaviour, please make notes in the

feedback box and speak to the Site

Exam Lead after the exam

What we expect of you

• Treat candidates

politely and

pleasantly

• Treat candidates

fairly and without

any discrimination

• Let them start and

finish on time

• Turn it into a

teaching session

• Give candidates

verbal feedback as

to how they are

doing (good/bad)

• Let them see your

marks

Do Don’t

Thank you!We welcome suggestions for

improving the OSCEs further

start

END

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Resting Station

Circuit Manager

And more importantly