OBJECTIVE STRUCTURED

CLINICAL EXAMINATION
INTRODUCTION
OSCE is a modern type of examination often
used in health sciences to assess clinical skill
performance and competence in skills such as
communication, clinical examination, medical and
nursing procedures and interpretation of results.
HISTORY OF OSCE
OSCE was developed in University of Dundee, Scotland
in early 1975 by Dr. Harden and his colleagues.
After some modifications it was described in detail on
1979.
More than 50 countries accepted it. Globally using now.
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 with
attention being paid to the objectivity of the examination
-Harden
PURPOSES
 Measure clinical skills
 Match assessment to intended constructs
 Promote structured interaction between student and
examiner
 Make structured marking scheme possible
 Present all candidates with the same test
 Promote objectivity
USES
 Interpersonal and communication skills
 History taking skills
 Physical examination of specific body systems
 Mental health assessment
 Clinical decision making, including the formation
of different diagnosis.
 Clinical problem-solving skills
 Interpretation of clinical findings and
investigations
 Management of a clinical situation, including
treatment and referral
 Patient education
 Health promotion
 Acting safely and appropriately in an urgent
clinical situation
 Basic and advanced nursing care procedure
practices.
STEPS IN IMPLEMENTING OSCE
1. Have set of objectives
2. Identify the practical aspects
3. Select the task
4. Break into sub – tasks
5. Assign scores(weights) for each sub- tasks
6. Set up stations
7. Conduct after orienting students and examiners
8. Make notes of the process and review
9. Analyze the results and use the same for student
assessment
COMPONENTS
The examination coordinating committee
The examination coordinator
Lists of skills, behaviors and attitude to be
assessed
Criteria for scoring the assessment
The examinees
The examiners
Examination site
Examination stations
Patient
Time keeper
Contingency plans
Assessment of the performance of the OSCE
Viva –Voce or Oral examination
ORGANISING THE OSCE
1. The OSCE examination consists of about 10-15
stations, each of which requires about 4-5
minutes.
2. The number of stations and time spent on each
station may vary based on needs of evaluation
3. All stations should be capable of being
completed in the same time
4. The students are rotated through all stations and
have to move to the next station at the signal
5. As the stations are generally independent,
students can start at any procedure stations and
complete the cycle.
6. Thus, using 15 stations of 4 minutes each, 15
students can complete the examination within 1
hour
7. Each station is designed to test a component of
clinical competence
8. At some stations, called the procedure stations ,
students are given tasks to perform on patients or
simulators. At all such stations there are observers
with agreed upon checklists or rating scales to score
the student’s performance
9. 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 stations.
PROBLEMS OF USING OSCE IN THE INDIAN
SCENARIO
Lack of feasibility due to time constrains
Shortage of training for use of OSCE
Shortage of observers/examiners
Lack of interest in examiners
Lack of enforced guidelines for practical
examination by universities
ADVANTAGES
 More valid than the traditional approach to clinical
examinations
 Examiners 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
 More reliable because variables of the examiner and the
patient are removed to a larger extent
 More practical because it can be used with a large numbers
of students
 The use of checklists by examiners and the use of multiple
choice questions results in a more objective examination
DISADVANTAGES
 Students knowledge and skills are tested in
compartments and they are not tested on their ability to
look at the patient as a whole
 Demanding for both examiners and patient.
 Examiners are required to pay close attention to the
students repeating the same task on a number of
occasions
 The time involved in setting up the examination is
greater than for the traditional examination
 Maintaining Uniform difficulty levels is not always
possible
CONCLUSION
 The OSCE has several distinct advantages. In view of
these, the nurse educators can adopt it is an objective
method for clinical evaluation
 This will help the students to improve their clinical
competence
 The emphasis is on assessing what students can do
rather than what they know
 Therefore, OSCE gives directions for attaining the
ultimate aim of the teaching learning process