Objective Structured Practical/Clinical Examination

OBJECTIVE STRUCTURED
CLINICAL/PRACTICAL
EXAMINATION(OSCE/OSPE)

INTRODUCTION:
Assessment of clinical competence is an essential
requirement of health professional education.
Since its development in the 1970’s the objective
structured clinical examination(OSCE) has
gained acceptance as a benchmark for clinical
skills assessment(Banfay,2004).
It has been widely adopted tool to assess the
student’s competence in a range of subjects.

CONTI..
It is a formal assessment of student’s clinical
procedure skills.
An OSCE requires each student to perform or
demonstrate specific skills and behaviors in a
simulated work environment with standardized
patient.

Candidates are assessed using exactly the
same stations or cues with the same marking
scheme. Candidates get marks/points for each
step that they perform/answer correctly.
This makes the assessment of clinical skills
more objective rather than subjective.

Stations/cues have specific tasks. Where
simulated patients are used, detailed scripts
are provided to all candidates, including
emotional data.
Instructions are carefully written/spoken to
ensure that candidates are given specific
tasks to complete or questions to answer. The
OSCE is carefully designed to include all
elements of the curriculum.

An OSCE is designed to apply clinical and
theoretical knowledge.
Where theoretical knowledge is required,
questions are standardized.

THERE CAN BE CLINICAL OR PRACTICAL
TASKS:

DEFINITION
According to Harden,1988; Objective Structured
Clinical Examination(OSCE) is an approach to the
assessment of clinical competence in which the
components of competence are assessed in a
well planned or structured way with attention
being paid to objectivity.

OSPE:
Objective structured practical examination is a
new pattern of practical examination in which
each component is tested uniformly and
objectivity for all the students who are taking up
a practical examination at a given place.

FEATURES:
The examiner cover a broad range of clinical skills.
A pre-set structured mark scheme is used; hence
reduced examiner input and discretion.
Emphasis on what candidates can do rather than
what they know.
Written answer sheets are observe and assessed
by using checklist.
The scoring is objective.

Full simulated of a
“real” situation
OSCES ARE BASED ON PRACTICE NOT
NECESSARILY HOW THE COMPLETE JOB IS
DONE
A discrete aspect of
a learning outcome
e.g. Taking a blood
pressure
e.G A full ALS
resuscitation

Objective Structured Practical/Clinical Examination

IMPORTANCE:
Enhance
student’s
interest.
Encourage each
student to
demonstrate
specific behaviors
in simulated work
environment.
Now being
adopted in
disciplines.
Enhance
clinical or
practical skills
performance

PRACTICAL SKILLS ARE ASSESSED IN NURSING USING
OSCE/OSPE.
Interpersonal and communication
skills.
History taking skills and physical
examination of specific body
system.
Mental health assessment.

CONTI..
Clinical decision making including the
formation of differential diagnosis.
Clinical problem-solving skills.
Patient education and health
promotion.

COMPONENTS OF OSCA:
Khattab & Ravelings (2001) report using a
two components objective structured
clinical assessment (OSCA) for student
nurses.
One for
tasks(skills
assessment)
One for
questions
(knowledge
assessment)

TIPS FOR ORGANIZING AN OSCE/OSPE
Assessment.
Duration of station.
Number of stations.
Use of examiners.
Range of approaches.
New stations.
Organization of examination.
Resource requirement.

CONTI..
Plan of examination and directions.
Change signal.
Records.

REQUIREMENT FOR CONDUCTING OSCE/OSPE:
Standardized Patient(SP):- Standardized patients
are individuals trained to portray a patient with a
particular disease or condition; thus affording
hands on testing of students.
Use of standardized patients increase reliability
across different stations.

CONTI..
Station and required Procedure articles:- Number
of stations are determined by number of
students and number of activities for which
examiners want to evaluate students.
Arrange necessary articles in advance and
prepare different stations

Making schemes:- Checklists have been
standard in many established OSCE/OSPE
programs and have intuitive value as an
assessment tool. But; checklist may have limits
when testing skilled students.
Global rating scales scored by experts show
higher inter-station reliability; better construct
validity .

CHECKLIST
Examiner to fill in box to each item that student successfully
completes
Marks
Drapes patient appropriately 2
Inspects abdomen 1
Auscultation abdomen 1
Percussion abdomen 1
Asks patient for the location of pain 1
Start to palpate abdomen from the
area which is not pain 2
Lightly palpates each quadrant 2
Deeply palpates each quadrant 2
Checks for peritoneal irritation 2
Stem

Trained observer:- Roles of trained observers in
conduction of OSCE/OSPE are:
Observes the performance of the trainee at a
particular task.
Score according to the marking scheme.
Contribute to the good conduct of the
examination.

STEPS OF CONDUCTING OSCE/OSPE
Registration :- The first step is registration.
The students must show their identification
card; and keep in mind about the exam rules.
Orientation:- Students should be oriented
initially with the format of OSCE, procedures
and policies. Keep the students informed with
the number of groups they would be divided
into and team leader assigned to them.

Escorting the students to exam position:-
Students are divided into groups e.g; if total
number of students are 25 and there are 5
stations; then each group will consist of five
each students. Exam starts with buzzer or long
bell.
Station instruction time:- Once to two minutes
will be given; students should read the
instruction about the station situation, patient,
and required tasks.

The Encounter:- Students should execute the
skills for the period of 5-20 minutes. The period
should be fixed with accurate time for all
procedures. Perform the required tasks. Stop at
the next bell/buzzer.
Repeat steps 4 to 5:- Following the bell; the
students will go the next stations and step 4 and
5 are repeated till; the students complete all the
stations.

Post encounter period:- This is question-answer
period.
Escorting to dismissal area:- Examination has
come to end. Students will be escorted to the
dismissal area; where the identity card will be
taken back. Keeping them away in this area for
some-time; is for security reasons that is in
case another group of students have to be
evaluated on the same day.

SIMULATED PATIENT(EXAMINATION)

32
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.

33
e.g. 1
History taking / Examining a patient
- Examiner is present
- Uses a check list to record the performance of the
students as they pass through stations
e.g. 2
Chest X-Ray inspection
- No examiner
- Student asked about his findings & interpretation at
the next question station.
- May be given additional information and asked
about patient management (MCQs / TRUE – FALSE
type Question used)

37
Examiner’s ChecklistStudent’s Name :………………………………………………
Instructions to students
Carry out a neurological examination of the lower limbs
excluding sensation and coordination
(1) Inspection of legs
(2) Test for tone
(3) Test for clonus
(4) Test power – Ankle
(5) Test power – Knee
(6) Test power – Hip
(7) Test reflexes – Knee
(8) Test reflexes – Ankle
(9) Test reflexes – Plantar
Total
(2) Mark for general proficiency
Taking into account, for
example Scale
Procedure carried out 8-10 Distinction
Sequence of procedures 7 Very good pass
Student has tendon hammer 6 Pass
5 Bare Pass
4 Fail
0-3 Bad Fail
Total
(3)
Mark for attitude to patient
Taking into account, for
example Scale
Use of patient’s name 8-10 Distinction
Explanation to patient 7 Very good pass
Discomfort to patient 6 Pass
5 Bare Pass
4 Fail
0-3 Bad Fail
Total

38
Question : “ Which of the following statement is / are true about the
patient you have just examined?
1. A) Inspection reveals muscle wasting in left leg.
B) The tone in the left leg is decreased.
C) Adduction at the left hip is decreased in power
D) Flexion power at left knee is decreased
E) Muscle power at the left ankle is decreased
2. A) The knee jerk on left side is increased
B) The ankle jerk on left side is increased
C) Clonuses is present at the left ankle.
D) The left plantar reflex is flexor
E) The signs in the left leg are those of an upper motor neuron lesion

39
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. Patient education
4. Interpersonal skills
5. Instruments
6. Specimens
7. Practical procedures – on models e.g. CPR, L.P….
8. Fundus examination -

40
EXAMINE
ABDOMEN
ANS.-Q.
ON ST.1
QUE.ON
ECG
ECG
ANS.-Q
ON CT
CT SCAN
QUE.ON
ST. 7
HISTORY
QUE. ON
ST. 5
HISTORY
ANS.-Q
ON ST.3
EXAMINE
CHEST
SPOT
SLIDE
(SPOT)
QUE.ON
ST.17
NEURO
EXAM.
QUE.ON
ST.15
CVS
EXAM.
LAB
DATA
INSTRU.
& QUE.
1
14
15
16
17
18
19
20
9
8
7
6
5
432
10
111213
EXAMPLE
OF
OSCE

43
Adaptation of OSCE to be applied for evaluation
of skills in preclinical and paraclinical subjects.
 Basic format remains same i.e. procedure
stations and question stations.
 Can be used as supplement to different
method of evaluation

The OSPE is a method of objectively
testing the practical knowledge and skills
acquired during the preclinical years of a
medical curriculum. This method was
standardized by the All India Institute of
Medical Sciences. It is a modification of
Objective Structured Clinical Examination
(OSCE) used for clinical evaluation.

Objective Structured Practical Examination (OSPE)
is an assessment tool in which the competence of a
student is evaluated: For general experiments;
In terms of: Identification of equipment/accessories of
experiment, procedure of experiment, handling of
instruments, making observations/results,
interpretation of results, conclusion.

ACTIVITIES TO ENHANCE FAIRNESS IN EVALUATION:
Establish and
maintain open &
trusting student-
faculty
relationship.
Understand the
course objectives
and standards.
Explain the
subjectivity of
evaluation.
Review the
course evaluation
tool.
Explain the basis
of grading.
Provide quality
feedback.
Encourage
student-
participation in
student-
evaluation.
Avoid comparing
student’s
performance to
others.
Use multiple
sources of
evaluative data.

Legal and ethical issues of
clinical and evaluation and
grading.

Ensures integration of teaching and evaluation.
Examiners can decide in advance what is to be tested.
Examiner can have better control on the content and
complexities.
Emphasis can be move from testing factual knowledge
to testing a wide range of skills; including advance
clinical skills.
A large number of students can be tested and there is
increased faculty-student interaction.
Use of checklists and MCQ’s by examiner result in
more objective examination.

BIBLIOGRAPHY;
 Sharma Suresh K. Communication and Education Technology.
Elsevier publishers; 2012; p: 397-403.
 Mukesh Chandra. Textbook of Nursing education. 1st edn.
Jaypee Publishers; 2013; p: 274-278.
 web.squ.edu.om/med/chpe/CHPE2011/CHPE2011/11.%20
osce/ospe.

Objective Structured Practical/Clinical Examination

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