MedEdWorld Updates highlight useful and easily accessible sources of information on key and important topics in medical education contributed by leading experts from around the world. UPDATE ON THE OSCE Useful resources on MedEdWorld Dr Catherine Kennedy, AMEE Projects Officer GLOSSARY Objective Structured Clinical Examination (OSCE): Introduced by Harden in 1972, the OSCE provides a standardised means to assess clinical competencies, including physical examination and history-taking skills, communication skills with patients and family members, breadth and depth of knowledge, ability to summarise and document findings, and ability to make a differential diagnosis or plan treatment. The examiners carefully plan the tested areas and objectives of the test are identified and recorded. The clinical competency to be tested is broken down into its various components such as taking a history, auscultation of the heart, interpretation of an ECG, or making a conclusion on a basis of findings. Candidates rotate through a series of “stations”, usually 10-20, and in a specified time perform a standardised task. The format of individual OSCE varies significantly. Real patients, clinical mannequins and standardised patients or simulated patients can be used and large numbers of students can be tested on the same clinical problem. Direct or indirect observations as well as checklists and rating scales measure the performance against predetermined standards resulting in a more objective examination than with traditional methods. This provides a more valid and more reliable examination permitting the move away from testing factual knowledge to testing a wide range of skills. The variables of the examiner and the patient are, to a large extent, removed. The OSCE is particularly suited to situations where a pass/fail decision has to be taken and where a decision has to be made as to whether a student has reached a prescribed standard. It is cost- effective when many candidates are examined at once. It requires resources and expertise to administer. Reference: Adapted from Wojtczak, A. (2003) Glossary of Medical Education Terms. AMEE Occasional Paper No 3. Dundee: AMEE. The MedEdWorld Glossary can be accessed at www.mededworld.org/Glossary.aspx WEBINARS Measurement and improvement of the OSCE: Recognition and remediation of station level problems (part 1) Date: 2013 Presenters: Richard Fuller and Godfrey Pell Host Institution: School of Medicine, University of Leeds, UK www.mededworld.org/Webinars/Webinar-Items/Webinar-70-Fuller-Pell-23-02-13-0900hrs-N.aspx Part 1 in this Webinar mini-series concentrates on common OSCE standard setting techniques, with special reference to the borderline methods, and discusses the use and interpretation of a variety of psychometric indicators using ‘real’ data. Measurement and improvement of the OSCE: Recognition and remediation of station level problems (part 2) Date: 2013 Presenters: Richard Fuller and Godfrey Pell Host Institution: School of Medicine, University of Leeds, UK www.mededworld.org/Webinars/Webinar-Items/Webinar-71-Fuller-Pell-05-03-13-0900hrs-N.aspx Part 2 of the mini-series uses a range of ‘diagnostic’ exercises to assist participants to gain confidence in interpreting station level metrics and remediation of station level problems. MedEdWorld A global online medical education community www.mededworld.org www.amee.org A database of the expanding vocabulary used in medical education Hour-long interactive presentations with experts in medical education
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MedEdWorld Updates highlight useful and easily accessible sources of information on key and important topics in medical education contributed by leading experts from around the world.
U P D AT E O N
THE OSCEUseful resources on MedEdWorld
Dr Catherine Kennedy, AMEE Projects Offi cer
GLOSSARYObjective Structured Clinical Examination (OSCE): Introduced by Harden in 1972, the OSCE provides a standardised means to assess clinical competencies, including physical examination and history-taking skills, communication skills with patients and family members, breadth and depth of knowledge, ability to summarise and document fi ndings, and ability to make a diff erential diagnosis or plan treatment. The examiners carefully plan the tested areas and objectives of the test are identifi ed and recorded. The clinical competency to be tested is broken down into its various components such as taking a history, auscultation of the heart, interpretation of an ECG, or making a conclusion on a basis of fi ndings. Candidates rotate through a series of “stations”, usually 10-20, and in a specifi ed time perform a standardised task.
The format of individual OSCE varies signifi cantly. Real patients, clinical mannequins and standardised patients or simulated patients can be used and large numbers of students can be tested on the same clinical problem. Direct or indirect observations as well as checklists and rating scales measure the performance against predetermined standards resulting in a more objective examination than with traditional methods. This provides a more valid and more reliable examination permitting the move away from testing factual knowledge to testing a wide range of skills. The variables of the examiner and the patient are, to a large extent, removed. The OSCE is particularly suited to situations where a pass/fail decision has to be taken and where a decision has to be made as to whether a student has reached a prescribed standard. It is cost-eff ective when many candidates are examined at once. It requires resources and expertise to administer.
Reference: Adapted from Wojtczak, A. (2003) Glossary of Medical Education Terms. AMEE Occasional Paper No 3. Dundee: AMEE.
The MedEdWorld Glossary can be accessed at www.mededworld.org/Glossary.aspx
WEBINARSMeasurement and improvement of the OSCE: Recognition and remediation of station level problems (part 1)Date: 2013 Presenters: Richard Fuller and Godfrey Pell Host Institution: School of Medicine, University of Leeds, UKwww.mededworld.org/Webinars/Webinar-Items/Webinar-70-Fuller-Pell-23-02-13-0900hrs-N.aspx Part 1 in this Webinar mini-series concentrates on common OSCE standard setting techniques, with special reference to the borderline methods, and discusses the use and interpretation of a variety of psychometric indicators using ‘real’ data.
Measurement and improvement of the OSCE: Recognition and remediation of station level problems (part 2)Date: 2013 Presenters: Richard Fuller and Godfrey Pell Host Institution: School of Medicine, University of Leeds, UKwww.mededworld.org/Webinars/Webinar-Items/Webinar-71-Fuller-Pell-05-03-13-0900hrs-N.aspxPart 2 of the mini-series uses a range of ‘diagnostic’ exercises to assist participants to gain confi dence in interpreting station level metrics and remediation of station level problems.
MedEdWorldA global online medical education community
www.mededworld.org www.amee.org
A database of the expanding vocabulary used in medical education
Hour-long interactive presentations with experts in medical education
a standardised means to assess clinical competencies, including physical examination and history-taking skills, communication skills with patients and family members, breadth and depth of knowledge, ability to summarise and document fi ndings, and ability to make a diff erential diagnosis or plan treatment. The examiners carefully
interpretation of an ECG, or making a conclusion on a basis of fi ndings. Candidates rotate through a series of
TEXTBOOKSAkunjee, M., Akunjee, N., Siddiqui, S. and Mallick, A. (2010) The Easy Guide to OSCEs for Communication Skills. Milton Keynes: Radcliff e Publishing Ltd.www.mededworld.org/Publications/Textbooks/The-Easy-Guide-to-OSCEs-for-Communication-Skills.aspxSimplifi es and explains key communication theories and concepts, illustrating them through practical role plays.
Boursicot, K., Etheridge, L. Setna, Z., Sturrock, A., Ker, J., Smee, S. and Sambandam, E. (2013) “ Clinical Competence Assessment”, in McGaghie, W.C. (Ed) International Best Practices for Evaluation in the Health Professions. London: Radcliff e Publishing Ltd.www.mededworld.org/Publications/Textbooks/International-Best-Practices-for-Evaluation-in-the.aspx Contains a section discussing the OSCE, including aspects of reliability and validity.
Burton, N. (2011) Clinical Skills for OSCEs. Oxfordshire: Scion Publishing Ltdwww.mededworld.org/Publications/Textbooks/Clinical-Skills-for-OSCEs.aspxA concise and comprehensive guide of clinical skills for OSCE stations.
Etheridge, L. and Boursicot (2013) “Performance and workplace assessment” in Dent, J.A. and Harden, R.M.(Eds.), A Practical Guide for Medical Teachers (4th Ed.) London: Churchill Livingstone Elsevier.www.mededworld.org/Publications/Textbooks/A-Practical-Guide-for-Medical-Teachers-%284th-Ed-%29.aspxChapter includes discussion of the OSCE and other assessments of clinical competence.
Dornan, T. and O’Neill, P. (2006) Core Clinical Skills for OSCEs in Medicine. Philadelphia: Churchill Livingstone Elserveir.www.mededworld.org/Publications/Textbooks/Core-Clinical-Skills-for-OSCE-in-Medicine.aspxAn invaluable aid for everyone preparing for clinical practice and the associated OSCE examinations.
Harden, R.M. and Laidlaw, J.M. (2012) Essential Skills For A Medical Teacher. Edinburgh: Churchill Livingstone Elsevier.www.mededworld.org/Publications/Textbooks/Essential-Skills-for-a-Medical-Teacher-An-Introduc.aspxChapter 30 provides an overview of the OSCE and other approaches to clinical assessment.
Hodges, B. (2009) The Objective Structured Clinical Examination: A Socio-History. Saarbrücken: Lambert Academic Publishing.www.mededworld.org/Publications/Textbooks/The-Objective-Structured-Clinical-Examination-A-So.aspxThis Foucauldian socio-history explores how discourses of performance, psychometrics and production have legitimised the widespread adoption of OSCEs.
Hurley, K.F. (2011) OSCE and Clinical Skills Handbook (2nd Ed.). Toronto: Elservier Saunders.www.mededworld.org/Publications/Textbooks/OSCE-and-Clinical-Skills-Handbook-%281%29.aspx Summarises important history and physical examination skills, presenting the information in a Q & A format.
Zabar, S., Kachur, E., Kalet, A. and Hanley, K. (2012) Objective Structured Clinical Examinations: 10 Steps to Planning and Implementing OSCEs and Other Standardized Patient Exercises. New York:Springer.www.mededworld.org/Publications/Textbooks/Objective-Structured-Clinical-Examinations-10-Step.aspx This book serves as a comprehensive how-to manual for planning and implementing OSCEs and addresses the need for best practice guidelines.
JOURNAL ARTICLESBurgess, A., Clark, T., Chapman, R. and Mellis, C.(2013) Senior medical students as peer examiners in an OSCE. Medical Teacher, 35:1, pp. 58-62.www.mededworld.org/Publications/Articles/Senior-medical-students-as-peer-examiners-in-an-OS.aspx Reports on the use of peer assessment using a practice OSCE at Sydney Medical School.
Gormley, G.J., Johnston, J., Thomson, C. and McGlade, K. (2012) Awarding global grades in OSCEs: Evaluation of a novel eLearning resource for OSCE examiners. Medical Teacher, 34:7, pp. 587-589.www.mededworld.org/Publications/Articles/Awarding-global-grades-in-OSCEs-Evaluation-of-a-no.aspx Reports on a novel online resource developed to aid OSCE examiner training, involving a series of videos of OSCE performances that allow inter-examiner comparison of global grade decisions.
A selection of key articles recommended by the MedEdWorld Community
Including reports, websites, video clips,images and diagrams.
Harden, R.M., Stevenson,M., Downie,W.W. and Wilson, G.M. (1975) Assessment of clinical competence using objective structured examination. British Medical Journal, 1975:1, pp.447-451.www.mededworld.org/Publications/Articles/Assessment-of-clinical-competence-using-objective.aspx Seminal article introducing the OSCE as a method of clinical assessment.
Homer, M. and Pell, G. (2009) The impact of the inclusion of simulated patient ratings on the reliability of OSCE assessments under the borderline regression model. Medical Teacher, 31:5, pp. 420-425.www.mededworld.org/Publications/Articles/The-impact-of-the-inclusion-of-simulated-patient-r.aspxAnalyses whether and how exactly SP data can be best used to enhance the robustness of the formal standard setting process.
Patrício, M.F., Julião, M., Fareleira, F. and Vaz Carneiro, A. (2013) Is the OSCE a feasible tool to assess competencies in undergraduate medical education? Medical Teacher, 35:6, 503-514. www.mededworld.org/Publications/Articles/Is-the-OSCE-a-feasible-tool-to-assess-competencies.aspx This article reviews the evidence on the technical and economic feasibility of the OSCE in undergraduate medical studies.
Pell, G., Fuller, R., Homer, M. and Roberts, T. (2012) Is short-term remediation after OSCE failure sustained? A retrospective analysis of the longitudinal attainment of underperforming students in OSCE assessments. Medical Teacher, 34:2, pp. 146-150.www.mededworld.org/Publications/Articles/Is-short-term-remediation-after-OSCE-failure-susta.aspx Investigates the longitudinal performance of the UK undergraduate medical degree students, with a particular focus on comparing the poorly performing with the main cohort of students.
Pell, G., Fuller, R., Homer, M. and Roberts, T. (2010) How to measure the quality of the OSCE: A review of metrics - AMEE Guide No.49. Medical Teacher, 32:10, pp.802-811.www.mededworld.org/Publications/Articles/How-to-measure-the-quality-of-the-OSCE-A-review-of.aspxThe authors review the metrics available for measuring quality and indicate how a rounded picture of OSCE assessment quality may be constructed by using a variety of such measures, and consider which characteristics of the OSCE are appropriately judged by which measure(s).
Preusche, I., Schmidts, M. and Wagner-Menghin, M. (2012) Twelve tips for designing and implementing a structured rater training in OSCEs. Medical Teacher, 34:5, pp.368-372.www.mededworld.org/Publications/Articles/Twelve-tips-for-designing-and-implementing-a-struc.aspxThese 12 tips were developed as a result of a tailored rater training programme.
Trowbridge, R.L., Snydman, L.K., Skolfi eld, J., Hafl er, J. and Bing-You, R.G. (2011) A systematic review of the use and eff ectiveness of the Objective Structured Teaching Encounter. Medical Teacher, 33:11, pp. 893-903.www.mededworld.org/Publications/Articles/A-systematic-review-of-the-use-and-eff ectiveness-o.aspxThe Objective Structured Teaching Encounter (OSTE) has been proposed as a means of promoting and assessing the teaching skills of medical faculty. This paper describes the uses of the OSTE and the evidence supporting its eff ectiveness.
Webb, E.A., Davis, L., Muir, G., Lissauer, T., Nanduri, V. and Newell, S.J. (2012) Improving postgraduate clinical assessment tools: The introduction of video recordings to assess decision making. Medical Teacher, 34:5, pp.404-410.www.mededworld.org/Publications/Articles/Improving-postgraduate-clinical-assessment-tools-T.aspx Explores competency in the management of acutely unwell patients using an objective structured clinical examination (OSCE).
RESOURCES Resources contains over 300 images, video clips, websites and conference presentations that may be incorporated into lectures, including:
The OSCE Examiner: Training and Development www.mededworld.org/Resources/Resources-Items/OSCE-Training-website.aspx A valuable web tool for OSCE examiners from Queens University, Belfast, The OSCE Examiner features a Global Scoring Exercise, as well as a Dilemma Sorter as resources for examiners.
Simplifi es and explains key communication theories and concepts, illustrating them through practical role plays.
Boursicot, K., Etheridge, L. Setna, Z., Sturrock, A., Ker, J., Smee, S. and Sambandam, E. (2013) “ Clinical
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LEARNING TECHNOLOGY CliniQuest OSCE Software www.mededworld.org/Learning-Technology/Equipment-Items/CliniQuest-OSCE-Software.aspx CliniQuest can be used to create individual station or assessment sheets, with candidate response interpreted by Speedwell’s OSCE software CliniQuest and Optical Mark Reading (OMR) technology.
eOSCE : A three component digital OSCE processwww.mededworld.org/Learning-Technology/Equipment-Items/eOSCE-A-three-component-digital-OSCE-process.aspx The Electronic Registration of Objective Structured Clinical Examination (eOSCE) aims to create a more effi cient and entirely digital preparation, execution and analysis process of OSCEs which is less erroneous and quicker to evaluate.
mosceewww.mededworld.org/Learning-Technology/Equipment-Items/Moscee-For-OSCE-examiners.aspxmoscee is an application designed to run on mobile devices such as the Apple iPhone™.It can be used to set up an OSCE exam, mark and collate the results.
Qpercom: OSCE Solutionwww.mededworld.org/Learning-Technology/Equipment-Items/Qpercom-OSCE-Solution.aspx An OSCE Management Information System (OMIS) which allows universities to create forms, administer OSCEs and analyse results.
FORUMS
eLearning for OSCEwww.mededworld.org/Forums/f129/t2579/e-learning-for-OSCE.aspx Post you queries, ideas and suggestions about eLearning for OSCE here for discussion with colleagues.
You can also add your recommendations on topics to a forum for upload into the MedEdWorld site.
POLL
Which do you use in an OSCE: Real patients or standardised/ simulated patients?www.mededworld.org/News/News-Articles/Poll-Results-Which-do-you-use-in-an-OSCE.aspx The results of our June survey revealed that 55% of respondents reported that they used both real patients and standardised/ simulated patients for the OSCE, whilst 45% use standardised/ simulated patients only. None of the respondents used only real patients.
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