OSCE The OSCE can be highly successful as

OSCE

The OSCE can be highly successful as an instrument to assess competence in medicine and the approach has many advantages over more traditional methods.

The OSCE has offered a strikingly new and exiting way of making valid assessment of clinical performance of medical student , resident, and fellows.

History of OSCE was developed in Dundee , Scotland in the early 1970’s by Dr. Harden and colleagues. n n The OSCE is now used in over 50 country world-wide. There is a national OSCE in Canada , taken by all medical school.

OSCE is a kind of exam not a test. p OSCE n p OSLER n p Objective structural Long Examination Record OSPE n p Objective Structural Clinical Examination Objective Structural Practical Examination TOSCE (GOSCE) n Team (group) Objective Structural Clinical Examination

Advantage Provides a opportunity to test a student’s ability to integrate knowledge, clinical skills, and communication with the patient p Provides the faculty with an assessment tool that is custom-fit to the goals of a specific education program p Renders an occasion for individualized instruction and feedback p Offers an additional parameter by which to evaluate student performance p Provides unique programmatic evaluation p

Disadvantage Development and administration are time consuming and costly. p Offers opportunity for compromised test security p Provides assessment of case-specific skills, knowledge, and/or attitudes p

What is the purpose of the OSCE? Provide feedback on performance p Evaluate basic clinical skill p Measure minimal competency p

How to prepare OSCE ?

THE KEY TO A SUCCESSFUL OSCE IS CAREFULE PLANNING

ONE: Selection the examination committee p p An examination coordinating committee is made up of members who are committed to the evaluative and educational process The number of members who make up this committee is not as important as the intensity of the investment of each member. Responsibility of the examination committee determined the content of the examination, development and implementation. It is important that this committee has the capacity and personnel to address decisions related to reliability and validity

TWO: The Examination Coordinator p The functions of the examination coordinator (M. D. or Ph. D. educator) are the catalyst that facilitates the smooth working of the committee in developing, implementing and assessing the performance of the OSCE.

Three: Lists of Skills, Behaviors and Attitudes to be Assessed p The examination will measure objectively the competencies in specific areas of behavior, techniques, attitudes and decision-making strategies based on the objectives of the course or the requirement of the licensing body.

committee should prepare An Exam Blueprint Subject area Specialist area History Taking Cardiology Pediatrics Clinical Pharmacology Lab data Interpretation Patient Management 1 1 Endocrinology Hematology Physical Examination 1 1

How to develop case/scenario? Define the purpose of the station p Candidate instructions p Scoring checklist p Standardized patient instructions p Instruction for station set-up p

Define the purpose of the station p State the skill and domain to be tested Skill –Physical examination. Domain –Internal medicine /cardiology.

Candidate instructions p Candidate instruction must be clear and concise.

Scoring checklist p The checklist should be complete and include the main components of the skill being assess.

Standardized patient instructions p These instruction must be detailed enough to guarantee standardization patient playing the same role.

Instruction for station set-up p List of all equipment required for the station

Four: The Examinees p The examinee is the student, resident, or fellow in training or at the end of training of a prescribed course

Five: The Examiners p Most stations will require an examiner, although some stations do not. The examiner at the station where clinical skills (history-taking, physical examination, interviewing and communication) are assessed, may be either a physician or a standardized patient.

Six: The Examination Site p The examination site is part of a special teaching facility in some institutions. When such facilities are not available, the examination may be conducted in an outpatient facility.

Seven : Examinations Station p The total number of stations will vary based on a function of the number of skills, behaviors and attitudinal items to be tested. For most clerkships or courses, the total will vary from 10 -25.

Number of Stations The number of stations in an examination refer the time allocated for each station determines the time required to complete the whole examination. p Twenty stations each of five minutes can be completed in I hour 40 mins p While 20 stations each of 10 minutes require 3 hrs 20 mins to complete p

Duration of station Times ranging from 4 to 15 minutes have been reported in different examinations and a five minute station probably most frequently chosen. p This times depend to some extent on the competencies to be assessed in the examination. p

Couplet Station Some competencies may best be assessed by coupled or linked stations. n The use of linked stations extends the time available to complete a task. History taking Finding Interpretation Treatment or Management

Duration of stations has been fixed p Make sure that the task expected of the student can be accomplished within the time p If necessary some stations which are allocated double the standard time. Such double stations will require to be duplicated in the examination. p

Observer Assessment Method Checklist p Rating scale p

Check list for assessment of a physical finding p Mr. C. presents with a sore swollen ankle for 6 weeks Don’t Do 1 -introduces self to patient 2 -Explain to the patient what will be do 3 -Demonstrate concern for patient. i. e. is not excessive rough 4 -Inspectin for any of swelling , erythema , deformity 5 -Inspection: Standing From anterior Posterior 6 - Inspection pt Gait 7 - palpation

Sample Communication skills checklist (rating scale) Poor 1 1 - Interpersonal skill: Listen carefully 2 -Interviwing skill: Uses words patient can understand Organized Fair 2 Good 3 V Good 4 Excellence 5

p If deemed appropriate , checklist items can be weighted to reflected the importance of one item over another

Standard patient p A standardized patient is an individual with a health problem that is in a chronic but stable condition; n p ( fundoscopic changes , Goiter , skin change, cardiac murmur , abdominal organomegaly) Standardized or simulated patient usually used when properly trained for history &physical assessment.

standardized patients may be volunteers or paid employee p Ideally a physician will also observe the standardized patients demonstrating their scenario before the examination p Training for these individuals can vary from 3 minutes to 15 hour depending on the complexity of the case p

Question to ensure validity Are the patient problem relevant and important to the curriculum? p Will the station assess skill that have been taught? p Have content experts reviewed the station ? p

Factor leading to lower reliability Too few station or too little testing time p Checklists or items that don’t discriminate (too easy OR too hard) p Unreliable patient or inconsistent portraits by standard patient p Examiners who score idiosyncratically p Administrative problem (disorganized staff OR noisy room) p

Research has shown that an acceptable level of reliability can be achieved with either a physician or standardized patient as the examiner p Harden recommends using examiners from a range of specialist and disciplines p

p Feed back stations included to provide examinee with immediate feedback on performance at previous station

Running The Exam Space requirements p Signaling station change p Exam day p Collecting result p Budget and dedicated p

Station 12 Station 10 Station 9 Station 11 Station 2 Station 8 Station 3 Station 4 Station 7 Station 5 Station 6 Example of 10 station OSCE accommodating 12 students

Enter in to station 8 min End of student interaction with SP 2 min Exit station 1 min Enter new examinee Signaling station change

Some pearls ! Have spare standardized patients and examiners available for the exam as life is unpredictable p Have back-up equipment , such as view box , batteries p Have staff available during the examination to maintain exam security p Make sure the bells or buzzers can be heard from all location with closed door p For each examination prepare an extra station which can be setup with minimal effort p