01.   Introduction & Basics of OSPE/OSCE


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Contents:

Homepage - OSCE and OSPE

Compiled Responses

 The Beginning

 01.   Introduction and Basics of OSPE/OSCE

 02.   Is OSPE glorified spotting.. 

  03.   How to set up OSCE and OSPE stations..

 04.   How to collect the answer-sheets in OSCE/OSPE from students.

 05.   OSCE reliability

 06.   Levels of competencies in evaluation

 07.   Practical experiences of OSPE/OSCE

 08.   OSCE in testing Communication and attitudes

  09   Should knowledge be accessed in OSCE/OSPE

 10.   Simulated patients

 11. Examiner training...a must to do...

12.   Standard setting in OSCE

 13.   Disadvantages of OSCE

 

Compiled responses from FAIMER fellows and faculty

Introduction and basics of OSPE/OSCE

What is OSPE/OSCE?

Praveen: OSPE is a method of assessment where a student’s competence is tested objectively rather than subjectively & the areas tested are carefully planned by examiners.
Can we all first discuss the definition & basics of OSPE & OSCE.
Find herewith an article on OSCE.

  David A. S, Michael B. D, Richard W. S, and William E. S. The Objective Structured Clinical Examination The New Gold Standard for Evaluating Postgraduate Clinical Performance Annals Of Surgery   222; 6: 735-42

Sajjad: OSCE is an assessment tool in which the components of clinical competence such as history taking, physical examination, simple procedures, interpretation of lab results, patient management problems, communication, attitude etc. are tested using agreed check lists and rotating the student round a number of stations some of which have observers with check lists.

Anshu: Sajjad has made a good beginning but let me also try to write a short introduction for people who are not familiar with the terms.
 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 stations in which they interview, examine and treat standardized patients (SP) who present with some type of medical problem.
The hallway of OSCE exam rooms, each occupied by a uniquely challenging patient, is a familiar milieu to the physician or other healthcare professional. When standardized patients (SPs) are utilized in OSCE exams, the linear sequence of the multiple station and skill challenges bears remarkable similarity to that real environment. 

Since the first paper written about the "programmed patient" in the mid-1960's over 1500 papers have been published that deal with teaching or assessment using standardized patients better known now as Objective Structured Clinical Examination (OSCEs).
"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, 1988 .

OSCE is a form of multi-station examination for clinical subjects first described by Harden et al from Dundee (1975). It was first reported from Dundee and Glasgow (Harden and Gleeson, 1979). It was firstly adopted in North America in a widespread manner. Then widely adopted in the UK in the 90s. The principle method for clinical skills assessment in medical schools and licensure bodies across USA, Canada, UK, Australia, New Zealand and other countries, is now the OSCE.

Objective Structured Clinical Examination (OSCEs) has proved to be so effective that it is now being adopted in disciplines other than medicine, like dentistry, nursing, midwifery, pharmacy and even engineering and law.  

"The OSCE examination tests a wide range of skills thus greatly reducing the sampling error. This very significantly improves the reliability of the examination" Harden, 1988.
"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" Hart, 2001.

Conventional practical examination suffers from certain inherent deficiencies. Although marking should depend only on student variability, patient (or in the case of practical - experiment) - variability and examiner variability significantly affect scoring. In fact, the subjectivity involved may reduce the correlation coefficient between marks awarded by different examiners for the same candidates performance to as low as 0.25. The marks awarded also reflect only the global performance of the candidate and are not based on demonstration of individual competencies. Problems in communication significantly affect the outcome. Attitudes are usually not tested at all by the conventional examination. The ability to examine a patient and arriving at that conclusion is not observed by the examiners. The final score indicating his overall performance gives no significant feedback to the candidate.

These defects of clinical and practical examinations have been realized for long and have given rise to attempts at improving the current scenario

Objective structured practical examination (OSPE) was evolved to overcome some of these problems. An OSPE consists of a circuit of stations through which each candidate must pass. These stations assess practical, communication, technical, and data interpretation skills and there is a predetermined decision on the competencies to be tested. Competence is defined as what students should be able to do at an expected level of achievement. It may be regarded as the mastery of a body of relevant knowledge and acquisition of a range of relevant skills, which would include interpersonal, clinical and technical components
Praveen : As we had been discussing the definition OSCE/OSPE as a structured objective way of assessment having high validity & reliability.
It minimizes the subjectivity bias usually involved with our assessment patterns, broadly seeing the only problem is increased number of observers required (if we have large no. of procedural stations) and increased amount of labour & effort required for careful & meticulous  planning.
Other details have been added by Sajjad.

OSCE: Objective Structured Clinical Examination

OSPE: Objective Structured Practical Examination

COSPE: Computerised Objective Structured Practical Examination

GOSCE: Group Objective Structured Practical Examination
Collectively these may also be called as Objective Structured Performance Examination, any body to comment?

Anshu: Can you please elaborate on the process of GOSCE? Haven't heard of this before.
 Praveen: I came to know about this term when I had attended a workshop on OSPE/OSCE at Ahmadabad.
In GOSPE/GOSCE there is a group activity given at the stations which is then observed. It evaluates skills of a performance in group activity. I also don't have much idea about this method.

Sanjay Bedi started discussion on Computer assisted OSPE as tool for summative assessment where some portion of questions is projected with LCD screen to make the process convenient and faster.
http://advan.physiology.org/cgi/content/full/30/1/48-b

Praveen responded on a positive note, but he was of the opinion, to begin with we can start it with the formative evaluation then only we can switch over for summative evaluation as external examiners are involved in university exam that may not be very familiar with this system.

Praveen: Also OSCE/OSPE requires very careful & meticulous planning so it’s always good to first establish with internal exams then switch over to external exams.
Anyway we can discuss more after we discuss the methodology.

Sajjad: This type of computerized OSPE/OSCE definitely is uniform for whole of the
 class and less time consuming. This can be used as an excellent tool for day today internal assessment. What about annual university exams?

Sanjay Bedi: This is a nice website from student point of view. For last nine
days it has been sending a daily newsletter on OSCE preparation.
http://oscehome.blogspot.com/

 

 

 

 

 

Discussion Summary

Introduction

Origin and evolution of OSCE

What is OSCE OSPE..

Important terminologies OSCE and OSPE

Process - OSCE and OSPE

Competencies

Advantages OSCE and OSPE

Limitation OSCE and OSPE

The final words