OBJECTIVE STRUCTURED CLINICAL EXAMINATION OSCE OBJECTIVE STRUCTURED PRACTICAL

OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE) & OBJECTIVE STRUCTURED PRACTICAL EXAMINATION (OSPE) Dr. Jatin Bhatt Professor & Head, Surgery Dr. G. U. Kavathia Asso. Professor in Microbiology P. D. U. Govt. Medical college, Rajkot.

LEARNING OBJECTIVES OF THIS SESSION: : Ø Ø Definition of OSCE/OSPE. General outline of OSCE/OSPE Station profile of OSCE/OSPE Advantage & disadvantage of OSCE/OSPE

DEFINITION: OSCE is basically an organized framework consisting of multiple stations around which student rotates and at which student performs and are assessed on specific tasks.

OSCE 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 Examination: the tasks are representative of those faced in real clinical situations

PURPOSE OF OSCE To make the Evaluation System as Reliable & Valid as possible Ø To Eliminate Variability (Examiners & Patients) Ø

OSCE 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

Does Shows how Knows Performance assessment in vitro: OSCEs OSPE

GENERAL OUTLINE : 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

CONDUCTING OSCE / OSPE v. Student rotates round a number of stations – about 20 v. Spends specified time on each station (45 minutes) v. On a signal (e. g. bell) moves to the next.

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. 10

e. g. 1 History taking / Examining a patient - Examiner is present - Examiner Uses a check list to record the performance of the students. e. g. 2 Chest X-Ray/CT Scan inspection etc. . - No examiner - Student asked about his findings & interpretation at the next question station. 11

PROCEDURE STATION: HISTORY TAKING Station : Roll No: This patient complains of ‘Stomach Pain”. Obtain a history from him (Time : 5 Minutes)

PROCEDURE STATION: HISTORY TAKING Station : Examiners check list : Roll No: This patient complains of ‘Stomach Pain”. Obtain a history from him (0. 5 Marks for each key point in history) Key points in History Marks Key points in History Mark s Patients name Patients Age Appetite Nausea, Vomiting Occupation Pain type Site Radiation of pain Relieving factor Exacerbating Malena Family history Drug history Smoking Weight loss Alcohol

PROCEDURE STATION: HISTORY TAKING Station : Examiners check list : History taking technique Made the Pt comfortable Establish Rapport Proper phrasing Pace of the questions Total Roll No: Marks Alloted 1 2 1 1 5 Obtained

QUESTION STATION: AFTER HISTORY TAKING Station: Roll No: Answer the following questions about the patient whose history you have just taken. (Time: 5 Minutes) (Write in response box) No. Y for Yes, N for No. Question a The patient’s name is Sunil Kumar b He is a salesman c He is married d He smokes around 30 cigarettes daily e He complains of stomach pain for 1 week f He has had stomach pain like this in the past. g During Day time it is present constantly. h His brother had an ulcer Response Marks 15

KEY FOR QUESTION STATION NO: No. Question Response Marks a The patient’s name is Sunil Kumar Y 0. 5 b He is a salesman Y 0. 5 c He is married N 0. 5 d He smokes around 30 cigarettes daily Y 0. 5 e He complains of stomach pain for 1 week Y 0. 5 f He has had stomach pain like this in the past. Y 0. 5 g During Day time it is present constantly. Y 0. 5 h His brother had an ulcer N 0. 5 i He has lost about 3 -4 kg weight recently. N 0. 5 Total 16

PROCEDURE STATION: ABDOMINAL EXAMINATION Station: Roll No: Carry out the abdominal examination of patient (Time: 5 Minute) (Write Y for Yes, N for No in response box) 17

PROCEDURE STATION: ABDOMINAL EXAMINATION Station : Examiners check list : Roll No: ( 0. 5 marks for each point of examination) Abdominal examination Made the Pt comfortable Marks Abdominal examination Mark s Percussion: Establish Rapport Liver Inspection: Spleen Position of doctor Shifting dullness Backside Auscultation Hernial sites Palpation: Starting point Gentle Total

QUESTION STATION: AFTER PHYSICAL EXAMINATION Station: Roll No: Answer the following questions regarding the abdominal examination you have performed in station No: (Write Y for Yes, N for No in response box) No. Question Response Marks a The flanks of abdomen were full b The abdomen is diffusely protuberant c There is a scar mark in right iliac fossa d Prominent veins are present on the back e The right kidney is palpable f The left kidny is palpable g The spleen is palpable h There is a bruit heard in the epigastrium i The liver is palpable 19

KEY FOR QUESTION STATION NO: No. Question Correct Response Marks a The flanks of abdomen were full Y 1 b The abdomen is diffusely protuberant N 1 c There is a scar mark in right iliac fossa Y 1 d Prominent veins are present on the back Y 1 e The right kidney is palpable N 1 f The left kidny is palpable N 1 g The spleen is palpable N 1 h There is a bruit heard in the epigastrium Y 1 i The liver is palpable Y 1 J There is a fluid in the abdomen Y 1 20

PROCEDURE STATION: HISTORY TAKING Station: Roll No: Carry out a nerological examination of lower limbs excluding sensation & coordination (Time: 5 Minutes)

PROCEDURE STATION: HISTORY TAKING Station: Examiners check list Roll No: Carry out a nerological examination of lower limbs excluding sensation & coordination Examination Marks Examination Mark s Inspection of legs Test for tone Test for clonus Test power-Ankle Test power-Knees Test power-Hips Test reflexes-Ankles Test reflexes-Knees Test reflexes -planter TOTAL Satisfactorily: 0. 5 Marks Attempted but not satisfactorily: 0. 25 Marks Not attempted: 0 Marks

QUESTION STATION: AFTER PHYSICAL EXAMINATION Station: Roll No: Answer the following questions about the patient you have just examined. (Time: 5 Minutes) (Write Y for Yes, N for No in response box) No. Question a Inspection reveals muscle wasting in left leg. b The tone in the left leg is decreased. c Flexion power at left knee is decreased d Muscle power at the left ankle is decreased e The knee jerk on left side is increased f The ankle jerk on left side is increased g Clonuses is present at the left ankle. h The left plantar reflex is flexor i The signs in the left leg are those of an Respons Mark e s 23

KEY FOR QUESTION STATION NO: No. Question a Inspection reveals muscle wasting in left leg. b The tone in the left leg is decreased. c Flexion power at left knee is decreased d Muscle power at the left ankle is decreased e The knee jerk on left side is increased f The ankle jerk on left side is increased g Clonuses is present at the left ankle. h The left plantar reflex is flexor i The signs in the left leg are those of an upper motor neuron lesion Respons Mark e s Total 24

PROCEDURE STATION: ECG EXAMINATION Station: Roll No: Read the given ECG (Time : 5 Minutes) 25

QUESTION STATION: AFTER ECG EXAMINATION Station: Roll No: Answer the following questions about ECG you have just examined (Write Y for Yes, N for No in response box) No. Question a The axis of the ECG is -45 b The patient has the heart rate of 110/min. c ECG shows atrial fibrilation d R-R interval is constant e Atrial rate is 450/min. f The patient has anterior myocardial infarction Respons e Marks 26

KEY FOR QUESTION STATION NO: No. Question Correct Response Marks a The axis of the ECG is -45 Y 1 b The patient has the heart rate of 110/min. N 1 c ECG shows atrial fibrilation Y 1 d R-R interval is constant Y 1 e Atrial rate is 450/min. Y 1 f The patient has anterior myocardial infarction Y 1 Total 6 27

QUESTION STATION: INSTRUMENT Station: Roll No: Answer the following questions about the instrument (Time : 5 Minutes) (Write Y for Yes, N for No in response box) No. Question a The tube is used for the endotracheal suction b This tube can be localized on X-ray c The mark corresponding to 40 cm indicates the tube is approximately in the pylorus d The mark corresponding to 65 cm indicates the tube is in the duodenum. e The tube is not useful in Upper GI bleeding. Response Marks 28

KEY FOR QUESTION STATION NO: (Ryles tube) No. Question Correct Response a The tube is used for the endotracheal suction N b This tube can be localized on X-ray Y c The mark corresponding to 40 cm indicates the tube is approximately in the pylorus N d The mark corresponding to 65 cm indicates the tube is in the duodenum. Y e The tube is not useful in Upper GI bleeding. Y Marks 29

2 a. Calculate the bleeding time(BT) in this case b. Give normal range of BT c. Mention ONE condition where BT is increased d. Name the method used to detect bleeding time in our laboratory

3 a. b. c. THIS IS THE PICTURE OF ABDOMINAL AREA OF AN ADULT PATIENT WITH AN ENDOCRINE DISORDER Name the clinical feature seen in this picture. Which is the hormone responsible for it ? Give physiological basis for the above feature. Name two other possible clinical features in this patient.

11 a. b. c. Identify this device. Explain the mechanism of action of this device. Name the permanent contraceptive method adopted in males and females

13 a. Identify the focused WBC b. Mention its normal count c. Mention one function of it d. Name one clinical condition where it’s count increases

15 Figure shows the recording of basal body temperature (BBT) in a woman during a menstrual cycle: a. Has the woman ovulated? Give reason. b. What is the cause for elevated BBT in the latter half of the cycle? c. Name the important physiological event that occurs at the time of ovulation. d. Name the ovarian hormone which peaks at the time of ovulation.

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. Instruments 4. Specimens 5. Fundus examination - 35

SPECIMEN & QUE. HISTORY QUE. ON ST. 1 1 2 3 ANS. -Q ON ST. 3 Rest 4 5 HISTORY 20 ON 6 QUE. ST. 5 INSTRU. & QUE. 19 QUE. ON ST. 17 EXAMINE CHEST EXAMPLE OF OSCE 18 7 EXAMINE ABDOMEN ANS. -Q. ON ST. 7 NEURO EXAM. 17 8 QUE. ON ST. 15 16 9 CT SCAN CVS EXAM. 14 15 LAB DATA 13 INSTRU. & QUE. 12 QUE. ON ECG 11 ECG 10 ANS. -Q ON CT 36

EXAM VENUE

SIMULATED PATIENT(EXAMINATION)

ADVANTAGES OF THE OSCE All components of clinical Exams are assesed So More Valid examination Can be used with larger number of students Reproducible Components of clinical Skills & standards of competencies are predetermined So Objectivity & Reliability is higher The variable of the examiner and the patient are to a large extent removed

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

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Adaptation of OSCE to be applied for evaluation of skills in preclinical and paraclinical subjects. v Basic format remains same i. e. procedure stations and question stations. v Can be used as supplement to different method of evaluation 42

OSPE : PROCEDURE STATION Station: Roll No: You are provided with an oxygen-filled spirometer. Determine your vital capacity. (Time: 5 Minutes) 43

OSPE : PROCEDURE STATION EXAMINER’S CHECKLIST Roll No: You are provided with an oxygen-filled spirometer. Determine your vital capacity. Station: No Examination Yes No 1 Does he check the spirometer for leakage ? 1 0 2 3 4 5 Mouth piece inserted properly Nose clipped properly Does he take a few normal breaths before Determining vital capacity ? 1 0 1 0 6 7 8 9 Takes a deep inspiration Exhales maximally Takes the highest reading as the vital capacity Determines two-stage vital capacity 1 0 1 0 Total 10 44

OSPE : QUESTION STATION 45

DEMO. MOVEMENTS 1 PRESCRIPTION Q. ANS ON 2 X RAY 2 3 20 ON 6 QUE. ST. 5 EXAMPLE OF OSPE DOSAGE FORM 18 WITHDRAW FROM VIAL. 17 16 GROSS SPECIMEN 15. 4 VITAL 5 CAPACITY FDC 19 EVALUATE. QUE. ON ST. 15 IDENTIFY PART 14 LAB DATA 13 SLIDE (SPOT 7 NEURO EXAM. 8 QUE. ON ST. 7 NEUB. 9 CHAMBER 12 LAB DATA 11 Q. ANS ON 10 URINE 10 PROTEIN 46

v Determining vital capacity v Charging the Neubauer chamber for doing the RBC count v Recording blood pressure by auscultatory method v Preparing the blood smear from given sample v Identification of structures in the specimen (e. g. horizontal section of brain) or a dissected part or x ray v Interpretation of histological specimen 47

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Ø Advance Planning Ø Organization The Day Before Examination Ø The Day Of Examination 49

(A) Advance Planning : 1) Examiners decide - What is to be examined. - Weightage to different components - Minimum standard to pass. 2) Briefing the examiners and concerned staff 3) Preparing the ward (venue) and ward staff 4) Selection and briefing Patients 5) Preparation of documentation including checklist, instructions for examiners and questions. 50

B) The Day Before The Examination: 1) Final check for preparations & arrangement in ward 2)Final documentation to be given to each examiner 51

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 52

GROUP WORK 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- 15 minutes 53

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