Taking The Sting Out of  the Objective Structured  Clinical Examination

For Both The Program AdministratorAnd The Trainee

Tracy MitchellDept of ObGyn

University of Ottawa

History of the OSCE• Prof Ronald Harden• Prof Ian Hart• Developed in Dundee, Scotland • Early 1970’s

The OSCE Defined

A form of performance-based testing used to measure candidates’

clinical competence

Candidates are observed and evaluated as they go through a series of stations in which they interview, examine and treat standardized patients (SP) who present with some type of medical problem.

Broken Down

Objective• Not influenced by personal feelings or

opinions in considering and representing facts.

Structured• Construct or arrange according to a plan; give

a pattern or organization to.

Clinical Examination• Involving or based on direct observation of

the patient

The OSCE Is Designed To Be

Objective•all candidates are assessed using exactly the same stations•All candidates are marked using the same marking scheme•Assessment is therefore objective rather than subjective

Objective vs SubjectiveObjective is the factual

Subjective is the opinion

The sky is blue (objective)The sky is beautiful (subjective)

The OSCE Is Designed To Be

Structured• Instructions are carefully written to ensure

that the candidate is given a very specific task to complete

• Includes parts from all elements of the curriculum as well as a wide range of skills

The OSCE Is Designed To Be

A Clinical Examination• Designed to apply clinical and theoretical

knowledge• Traditional assessment methods useful for

evaluation of knowledge, but not necessarily of skills

• Mixture of clinical knowledge, communication/interpersonal skills and problem-solving skills

• Performance based assessment

Developing the OSCE• Administrative Structure

• Faculty Co-ordinator• Administrative Co-ordinator• MCQ/SAQ Exam Proctor

• Examiners• Station authors (content)• Station bank

Developing the OSCE• MCQ/SAQ• Location

• http://www.med.uottawa.ca/medweb/uossc

_simulation_centre_map/

• Equipment/Set Up• Budget

Exam Set Up

Mental map or actual map

Exam schedule

Station Instructions

Direction arrows

Door signs

Exam Rooms

Marking sheets

Envelopes

Schedule

Equipment

Exam Set Up

Marking sheets

envelopes

Elements of the OSCE

• Schedule• Stations• Scoring• Results• Reporting• Recording

The Schedule

Station Grid

Number of Candidates

Number of Stations

Excel Format

Colour Coded

Consider Trainee Schedule When Scheduling OSCE Exam

Example of Station Grid –

Two Tiered

Example of Station Grid –

Multiple Tiered

The Stations

Number of Stations

Varied Types/Content of Stations

Door Sign

Marking Sheet

Time Allotment

Standardized Patient

Equipment, Diagrams, Pictures, Lab Results

Room

The Door Sign

Door SignSTATION 1

A 30 y.o primigravida is seen for the first time for antenatal care at your office. She is at 10 weeks gestational age. She had an ultrasound done earlier this morning, which revealed a dichorionic twin pregnancy.

She is surprised at the result of the scan. She has many concerns about the pregnancy and wishes to be advised about what to expect. Please be prepared to answer questions about twin pregnancy.

Marking SheetStation 1: MFM Resident Name: _______________________

1) Screening /10

a) Prenatal screening – id individuals at risk /1

b) Nuchal translucency (NT) /1

c) Serum markers – limited usefulness in 1st trimester /2

d) AFP screening in 2nd trimester /2

e) Elevated AFP =

Neural tube defect (NTD) /1

Abdominal wall defects /1

foetomaternal haemorrhage /1

f) U/S at 18 to 20 wks GA can detect NTD and

abdominal wall defects /1

2) Complications /10

Maternal

a) PTL/ Pre-term Delivery /1

b) Anaemia /1

c) Hypertensive Disorders (PIH/Pre-eclampsia) /1

d) GDM /1

e) Polyhydramnios /1

Fetal

a) Growth discordance /1

b) Malpresentation /1

c) Higher risk for aneuploidy /1

d) co-twin demise /1

e)? risk of placental abruption /1

3) Antenatal Management /10

a) Cervical length measurement via U/S /1

b) Morphology scan at 18 to 20 wks GA /1

c) Serial U/S scans for growth /1

d) GCT test at 24 weeks /1

e) Rhogam if Rhesus negative /1

f) Corticosteroids /1

g) surveillance depending on type of twins /1

h)

risk of intra-operative delivery /1

i)

risk of PPH /1

4) Any additional relevant point /1

TOTAL: / 30

Simulation

Real patients are replaced with realistic but artificial experiences

Trainee interacts with recreations

Judgments are made about their performance

Standardized Patients

Actor/actress “trained”

to play the role of a

patient

Scripted and standardized

Conducting The Exam

Exam Materials Are In Place

Examiners Are in Place

Standardized Patients are in Place

Examinees To Their Pre-Assigned Stations

Distinct Sound Starts the Exam

Timed Intervals

MCQ/SAQ Runs Simultaneously With The OSCE

Collecting Marking Sheets

Envelopes In Each Station

Confirm Total Number Received

Examinees Name Clearly Stated On Each Marking Sheet

Confirm Scores

MCQ/SAQ

The Results

Based on Marking Sheets

Document on Excel Spreadsheet

Use Specific Formulas

Percentage Mark

Average Mark

Individual (OSCE/Written)

PGY Year

Station

Group Examinees By PGY Level

Example of Result Spread Sheet

The Record

Station Databank

File

Hard Copy (Binder)

Electronic

Resident File

Potential Glitches

Schedule Changes

Candidate dismissed or no show

Examiners no show/cancellations

Standardized patient no show/cancellation

Marking Sheets

No score

Missing sheet

No name

Equipment failures

Prepare A Stress Free Zone

Gentle reminders to all players

Specify times

Rest stations

Washrooms

Windows

Location –

away from exam

Water

Soft drinks

Coffee/tea

Snacks and/or lunch

Desserts

Written Exam

Quiet please

Prepare A Stress Free Zone

Exam Rooms

Clear Hallways

Comfortable Shoes

Stress Free Exam Day

Pens/Pencils and Pads

Review Test Times

Review Station Locations

Review Rest Stations

Simulated Patients

OSCE Exam ‐

Videohttp://www.youtube.com/watch?v=aeLzpmu0

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k&playnext=1&list=PLE6F37479B08C0FFF&f

eature=results_video

“The real power of this type of examination lies in the ability of those responsible for

teaching and testing to examine their trainees with imagination and forethought, in a reliable way, in areas seldom or never tested before.”

Dr. Ian Hart, 2001