Objective Structured

Clinical
Examination(OSCE) &
OSPE
 It is a method of assessing a student’s clinical
competence which is objective rather than subjective and
in which the areas tested are carefully planned by the
examiners.
 The clinical competence is broken down in to its various
components e.g. taking a history / auscultation of heart /
interpretation of ECG or coming to a conclusion on the
basis of the findings.
 Each component is the objective of one of the stations in
the examination
 OSCE is a procedure where predetermined
decisions are made on the competencies to be
tested and checklists incorporating important
evaluable skills are prepared.
Objective : examiners use a checklist for
evaluating the trainees

Structured: trainee sees the same problem and

performs the same tasks in the same time frame

Clinical Examination: the tasks are representative

of those faced in real clinical situations
 History-taking skills.
 Physical examination of specific body system.
 Mental health assessment.
 Clinical decision making.
 Clinical problem solving skills.
 Interpretations of clinical findings & investigations.
 Patient education.
 Health promotion.
 Basic and advanced nursing care procedure practices.
 
 
 Process and products are tested giving
importance to individual competency.
 Examination covers a broad range of clinical
skills.
 Scoring is objective.
 Standard of competence are preset and
checklist is use to measure it.
 Scope for immediate feedback.
 Patient variability and examiner variability are
eliminated thus increasing the validity of the
examination.
 It has a detailed mark scheme & standard set of
questions.
 Points are awarded for specific action performed safely
and accurately.
 The examiner can often vary marks depending upon the
quality of task performed.
 At the end the examiner has to rate the candidates as:
Pass/ borderline / fail / excellent / good / pass
 The sum of the pass marks of all the stations determines
the overall pass marks for OSCE.
 Clinical skills are tested rather than pure
theoretical knowledge.
 It is essential to learn correct method and then
practice them repeatedly until one perfect the
method.
 Each step is awarded marks.

 Method is dissected with various steps; each step

is made to learn in sequence
 Registration
 Orientation
 Escorting to exam position
 Station instruction
 Encounter
 Post encountered period
 Escorting to the dismissal area
 More valid than the traditional approach to
clinical examination.
 Examiner can decide in advance what is to be
tested and can then design the examination to test
these competencies.
 Examiners can have better control on the content
and complexities.
 Can be used with larger number of students
 More reliable because variables of the examiner
and patient are removed to a large extent.
 It is more practical.

 The use of checklists by examiners and the use of

multiple choice questions results in a more
objective examination.
 Knowledge and skills are tested in compartments & not
tested in ability to look at the Pt. as a whole, So long
case may also needed
 The OSCE may be demanding for both examiners and
patients
 More time in setting it up
 Shortage of examiners
 Might be quite distressing to the student
• Student rotates round a number of
stations – about 20
• Spends specified time on each station (4-5
minutes)
• On a signal (e.g. bell) moves to the next.
 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.
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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)16
ent’s Name :………………………………………………
uctions to students Examiners
Checklist
patient complains of ‘Stomach Pain”. Obtain a history from him
ey points in history
ark with a tick) (2) History taking technique
nt’s Name Nausea, vomiting
Allocate a mark taking into account : Scale
nt’s age
Dates established 8-10 Distinction
pation Bowel habit
Type Melena Correct pace of questions 7 Very good
Family history
Correct phrasing of question 6
tion Drug History
ving Factors Smoking Attention paid to answer 5 Bare pass

erbating factors Alcohol Answer followed up appropriately 4

dicity Previous medical history
Total
ion e.g. perf. Hemetemesis
ity Bonus ( +1 or +2)
tite

Total
tudent’s Attitude to Patient
llocate a mark taking into account : Scale
onsideration of Patients Feeling 8-10 Distinction
ttempts to Establish a rapport 7 Very good pass
with the patient 6 Pass Total
5 Bare pass
17
4 Fail
Question : “ Which of the following statement is / are true
about the patient whose history you have just taken ?

1. A) The patient’s name is RAHUL

B) He is a salesman
C) He is married with one child.
D) He smokes around 30 cigarettes per day
E) He travels a lot.
2. A) His present complaint is of stomach pain present for 2
weeks.
B) He has had stomach pain like this in the past.
C) The pain is localized in the epigastria.
D) During Day time it is present constantly.
E) The pain often wakes him up at night.
3. A) The pain is relieved with milk and food
B) His brother had an ulcer
C) He is worried about his work
D) He complaints of diarrhea
E) He has lost about 3-4 kg weight recently. 18
 ’s Name :………………………………………………
ions to students
Examiner’s
ut a neurological examination of the lower limbs
ng sensation and coordination Checklist
(3)
ection of legs Mark for attitude to patient
for tone Taking into account, for
for clonus example Scale
power – Ankle Use of patient’s name 8-10
power – Knee Distinction
power – Hip Explanation to patient 7 Very good
pass
reflexes – Knee
reflexes – Ankle Discomfort to patient 6 Pass

reflexes – Plantar 5 Bare Pass

Total 4 Fail
k for general proficiency 0-3 Bad Fail
ng into account, for
mple Scale Total
edure carried out 8-10 Distinction
uence of procedures 7 Very good pass
dent has tendon hammer 6 Pass
5 Bare Pass
4 Fail
0-3 Bad Fail

Total 19
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

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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
8. Fundus examination -
21
 EXAMINE ANS.-Q. EXAMINE ANS.-Q
ABDOMEN ON ST.1 CHEST ON ST.3
1 2 3 4

5 HISTORY
SPOT 20

SLIDE
6 QUE. ON
ST. 5
(SPOT) 19
EXAMPLE
QUE.ON OF 7 HISTORY
ST.17 18 OSCE
NEURO QUE.ON
EXAM. 17 8 ST. 7

QUE.ON
ST.15
16 9CT SCAN
14 13 12 11
CVS LAB INSTRU. QUE.ON ANS.-Q
EXAM. 15 DATA
ECG 1
& QUE. ECG ON CT22
0
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

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QUESTION : You are provided with an oxygen-filled
spirometer. Determine your
vital capacity.
EXAMINER’S CHECKLIST:
YES NO
1. Does he check the spirometer for leakage ? 0.4 0
2. Mouth piece inserted properly 0.3
0
3. Nose clipped properly 0.3
0
4. Does he take a few normal breaths before
determining vital capacity ? 0.5 0
5. Takes a deep inspiration 1.0 0
6. Exhales maximally 1.0 0
7. Takes more than one reading 0.5
0
8. Takes the highest reading as the vital
capacity Total-
0.5 /50
9. Also determines two-stage vital capacity 0.5
0 25
A.Advance Planning

B.Organization The Day Before Examination

C.The Day Of Examination

A.After The Examination

27
(A) Advance Planning :

Time ideally 6 months for major examination

8 weeks for formative.

1) Examiners decided
- What is to be examined.
- Minimum standard to pass.

2) Briefing the examiners and concerned

staff

28
3) Preparing the ward (venue) and
ward staff

4) Selection and briefing Patients

5) Preparation of documentation
including checklist, instructions for
examiners and questions.

29
B) The Day Before The Examination:
1)Final check for preparations &
arrangement in ward

2)Final documentation to be given to

each examiner

30
C) The Day Of Examination
 Coordinator -1 hour prior
 Final check for arrangement
 Staff member brief the student
 All examiners have arrived and are
at their correct station

31
D) After The Examination:
1) Give feedback to students by
showing checklists &
questions scored by
examiners.

32
 Each participant to prepare 1 station
with check list & material required
Group 1: Procedure station-OSCE
Group 2: Question station- OSCE

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