![OSCE marking
Marking in OSCEs is done by the examiner. Occasionally written stations, for example, writing a
prescription chart, are used and these are marked like written examinations, again usually using a
standardized mark sheet. One of the ways an OSCE is made objective is by having a detailed mark
scheme and standard set of questions.
For example, a station concerning the demonstration to a simulated patient on how to use a
Metered dose inhaler [MDI] would award points for specific actions which are performed safely
and accurately. The examiner can often vary the marks depending on how well the candidate
performed the step. At the end of the mark sheet, the examiner often has a small number of marks
that they can use to weight the station depending on performance and if a simulated patient is
used, then they are often asked to add marks depending on the candidates approach. At the end,
the examiner is often asked to give a "global score". This is usually used as a subjective score
based on the candidates overall performance, not taking into account how many marks the
candidate scored.
The examiner is usually asked to rate the candidate as pass/borderline/fail or sometimes as
excellent/good/pass/borderline/fail. This is then used to determine the individual pass mark for the
station.
Many centers allocate each station an individual pass mark. The sum of the pass marks of all the
stations determines the overall pass mark for the OSCE. Many centers also impose a minimum
number of stations required to pass which ensures that a consistently poor performance is not
compensated by a good performance on a small number of stations.
There are, however, criticisms that the OSCE stations can never be truly standardized and
objective in the same way as a written exam. It has been known for different patients / actors to
afford more assistance, and for different marking criteria to be applied. Finally, it is not
uncommon at certain institutions for members of teaching staff be known to students (and vice
versa) as the examiner. This familiarity does not necessarily affect the integrity of the examination
process, although there is a deviation from anonymous marking. However, in OSCEs that use
several circuits of the same stations the marking is repeatedly shown to be very consistent which
supports the validity that the OSCE is a fair clinical examination.](https://image.slidesharecdn.com/osce-220708033957-85f2743e/85/OSCE-docx-4-320.jpg)
OSCE.docx
- 1. OBJECTIVE STRUCTURED CLINICAL /PRACTICAL EXAMINATION INTRODUCTION: An Objective Structured Clinical Examination (OSCE) is a modern type of examination often used in health sciences. It is designed to test clinical skill performance and competence in skills evaluation and interpretation of results. Objective structured clinical examination (OSCEs) is a form of performance –based testing used to measure candidates ‘clinical competence. During an OSCE, candidates are observed and evaluated as they go through a series of station in which they interview, examine and treat standardized patients who present with some type of medical problem. DEFINITION: ‘The OSCE is an approach to the assessment of clinical competence in which the components of competence are assessed in a planned or structured way in attention being paid to the objectivity of the examination "Harden ,1988. OSCE is a full form of multi- station examination of clinical subjects first described by Harden et al at from Dundee. It was first reported from Dundee & Glasgow (Harden and Gleeson, 1979). It was firstly adopted in North America in widespread manner. Then adopted in the UK in the 90s. The principle method for clinical skills assessment in medical schools and licensure bodies across USA, Canada, UK, New Zealand and other countries, is now the OSCE. Objective structured clinical examination has proved to be so effective that it is now being adopted in disciplines other than medicine, like dentistry nursing midwifery, pharmacy even engineering and law. An OSCE usually compromises a circuit of short( the usual is 5-10 minutes although some use up to 15 minutes) station in which each candidate is examined on a one to one with one or two impartial examiners and either real or stimulated patients (actors).
- 2. AN OSCE IS DESIGNED TO BE: OBJECTIVE: All candidates are assessed using exactly the same station (although if real patients are used, their signs may vary slightly) with the same marking scheme. In an OSCE, candidates get marks for each step on the mark scheme that they perform correctly, which therefore makes the assessment of clinical skills more objective, rather than subjective , which is where the examiners decide whether or not the candidate fails based on their subjective assessment of their skills. METHODOLOGY: The OSCE examination consists of about 15-20 stations. Each of which requires about 4-5 minutes of time. Each station is designed to test a component of clinical competence All stations should be capable of being completed in the same time. The students are rotated through all stations and have to move to the next station at the signal. Since the stations are generally independent students can start at any of the procedure stations and complete the cycle. At all such stations there are observers with agreed check lists to score the student's performance. At other stations called "response stations", students respond to questions of the objective type or interpret data or record their findings of the previous procedure station. FEATURES OF OSCE Both the process and the product are tested giving importance to individual competencies. The examination covers a broad range of clinical skills much wider than a conventional examination. The scoring is objective, since standards of competence are preset and agreed check lists are used for scoring. Where questions are asked in response stations, these are always objective. Simulations can be used for acute cases and there is scope for immediate feedback. Patient variability and examiner variability are eliminated thus increasing the validity of the examination.
- 3. STRUCTURED: Station in OSCEs have very specific task. Where simulated patients are used, detail scripts are provided to ensure that the information that they give is the same of all candidates, including the emotions that the patients should use during the consultation . Instructions are carefully written to ensure that the candidate is given a very specific task to complete. The OSCE is carefully structured to include parts from all elements of the curriculum as well as a wide range of skills. CLINICAL EXAMINATION: The OSCE is designed to apply clinical and theoretical knowledge is required, for example answering questions from the examiner at the end of the station, then the questions are standardized and the candidate is only asked questions that are on the mark sheet and if they are asked any other then will be no marks for them. ADVANTAGES OF OSCE / OSPE OSCE ensures integration of teaching and evaluation. Variety maintains student's interest. There is increased faculty-student interaction. OSCE is adaptable to local needs. A large number of students can be tested within a relatively short time. LIMITATIONS The process is, however, not without limitations. There is risk of observer fatigue if the observer has to record the performance of several candidates on lengthy check lists. All stations must invariably demand only equal time. Ensuring this, therefore, requires careful organization. Also, it is considered by many that breaking clinical skills into individual competencies is artificial and not meaningful
- 4. OSCE marking Marking in OSCEs is done by the examiner. Occasionally written stations, for example, writing a prescription chart, are used and these are marked like written examinations, again usually using a standardized mark sheet. One of the ways an OSCE is made objective is by having a detailed mark scheme and standard set of questions. For example, a station concerning the demonstration to a simulated patient on how to use a Metered dose inhaler [MDI] would award points for specific actions which are performed safely and accurately. The examiner can often vary the marks depending on how well the candidate performed the step. At the end of the mark sheet, the examiner often has a small number of marks that they can use to weight the station depending on performance and if a simulated patient is used, then they are often asked to add marks depending on the candidates approach. At the end, the examiner is often asked to give a "global score". This is usually used as a subjective score based on the candidates overall performance, not taking into account how many marks the candidate scored. The examiner is usually asked to rate the candidate as pass/borderline/fail or sometimes as excellent/good/pass/borderline/fail. This is then used to determine the individual pass mark for the station. Many centers allocate each station an individual pass mark. The sum of the pass marks of all the stations determines the overall pass mark for the OSCE. Many centers also impose a minimum number of stations required to pass which ensures that a consistently poor performance is not compensated by a good performance on a small number of stations. There are, however, criticisms that the OSCE stations can never be truly standardized and objective in the same way as a written exam. It has been known for different patients / actors to afford more assistance, and for different marking criteria to be applied. Finally, it is not uncommon at certain institutions for members of teaching staff be known to students (and vice versa) as the examiner. This familiarity does not necessarily affect the integrity of the examination process, although there is a deviation from anonymous marking. However, in OSCEs that use several circuits of the same stations the marking is repeatedly shown to be very consistent which supports the validity that the OSCE is a fair clinical examination.
- 5. PREPARATION Preparing for OSCEs is very different from preparing for an examination on theory. In an OSCE, clinical skills are tested rather than pure theoretical knowledge. It is essential to learn correct clinical methods and then practice repeatedly until one perfects the methods whilst simultaneously developing an understanding of the underlying theory behind the methods used. Marks are awarded for each step in the method; hence, it is essential to dissect the method into its individual steps, learn the steps, and then learn to perform the steps in a sequence. For example, when performing an abdominal examination, a student is instructed to first palpate for the liver, and then to palpate for the spleen. This seemingly meaningless order becomes relevant when it is considered that those with enlarged livers often also have enlarged spleens. Most universities have clinical skills labs where students have the opportunity to practice clinical skills such as taking blood or mobilizing patients in a safe and controlled environment. It is often very helpful to practice in small groups with colleagues, setting a typical OSCE scenario and timing it with one person role playing a patient, one person doing the task and if possible, one person either observing and commenting on technique or even role playing the examiner using a sample mark sheet.
- 6. References 1. Assessment of clinical competence using objective structured examination, Harden et al., Br Med J. 1975 Feb 22;1(5955):447-51 http://www.bmj.com/cgi/content/abstract/1/5955/447 2. (Ross, M., Carroll, G., Knight, J., Chamberlain, M., Fothergill-Bourbonnais, F., and Linton, J. (1988) Using the OSCE to measure clinical skills performance in nursing. Journal of Advanced Nursing, 13, 45-56). 3. Kropmans, Thomas; Barry GG O’Donovan, David Cunningham, Andrew W Murphy, Gerard Flaherty, Debra Nestel, Fidelma P Dunne (2012-01-01). "An Online Management Information System for Objective Structured Clinical Examinations". Computer and Information Science 5 (1): 38–48. Retrieved 9 May 2013. 4. Kropmans, Thomas; Liam Griffin, David Cunningham, Winny Setyonugroho, Catherine Anne Field, Eva Flynn Kieran M Kennedy (2015-02-15). "Back to the Future: Electronic Marking of Objective Structured Clinical Examinations and Admission Interviews Using an Online Management Information System in Schools of Health Sciences". Health & Medical Informatics 6 (1): 1–6. 5. How to perform an abdominal examination in the OSCE http://www.instamedic.co.uk/osce/abdomen/