osce

OSCE, which stands for Objective Structured Clinical examination, was developed as an evaluation tool, in Dundee, Scotland in the early 1970’s by Dr. Harden and colleagues. This was probably an attempt to overcome some of the problems faced in the conventional practical examination in a clinical setting. The OSCE is now used in over 50 countries world-wide.

As the name suggests, it is a method of evaluating student’s clinical competence in a planned, structure with well defined objectives, which may be a small component of a larger clinical competence eg history taking , examining the pulse or even interpretation of a laboratory investigation.

Its other variant which is called OSPE stands for Objective Structured Practical Examination which focuses on all aspects other than clinical skill. Collectively it may be called Objective Structured Performance Examination.

The important components of OSCE/OSPE are-

· First identify the skills which need to be assessed.

· Convert them into specific questions or task that can be answered in 4 to 5 minutes.

· Each question or task assigned is identified as an OSCE/OSPE station.

· Station can be a procedure station or question station.

· Procedure station can be an observed station, where you want the students to perform some specific task to accomplish the set objective under observation eg examination of the knee reflex.

· Unobserved station is usually a question station. Here student is expected to give answers to some specific and structured question to make the concepts and understanding of the subject clear eg report the microscopic findings of a focused smear.

· Third type of station is a rest station where student is given time to relax and refresh himself.

· Prepare a checklist with consensus from other members of the department.

· Checklist is the most important component of OSCE/OSPE. This contains the vital steps which we want the students to follow to accomplish the identified procedure to fulfill the set objective.

· Each step in the checklist is given some marks depending upon the significance of that step.

· The number of stations can be variable but on an average 15 to 20 stations serve the purpose.

Thus OSCE is a form of multi-station examination where each student needs to answer all the stations. It can be used for assessment of all possible competencies that you want your students to acquire. It is one of the most versatile methods of assessment that nearly fulfills all the criteria of an ideal assessment method i.e. it is valid, reliable as well as feasible method.

The most commonly appreciated advantages of OSCE/OSPE is that it provides a opportunity to test a student’s ability to integrate knowledge, clinical skills, as well as communication with the patient which is a must for any student aspiring to become a successful clinician. This method removes the subjectivity responsible for bias on the part of examiner simultaneously providing opportunity to provide constructive feedback to students for improvement.Just like all methods one of the limitations experienced in OSCE/OSPE is that this method requires extensive planning and preparation on the part of examiners. It is difficult without team effort and administrative support. Some people also feel that it breaks the clinical competence into fragments and we tend to evaluate our students in a fragmented manner.

Text compiled by Dr Praveen Singh and Dr Suman Singh