Dr. Jatin Bhatt Professor & Head, Surgery Dr. G. U. Kavathia Asso. Professor in Microbiology P. D. U. Govt. Medical college, Rajkot.

 Definition of OSCE/OSPE.  General outline of OSCE/OSPE  Station profile of OSCE/OSPE  Advantage & disadvantage of OSCE/OSPE

OSCE is basically an organized framework consisting of multiple stations around which student rotates and at which student performs and are assessed on specific tasks.

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

 To make the Evaluation System as Reliable & Valid as possible  To Eliminate Variability (Examiners & Patients)

 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

Knows Shows how Knows how Does Knows Knows howShows how Performance assessment in vitro: OSCEs OSPE Does

 Skill to be tested is given in form of a specific question To be answered in 4-5 minutes Each question is a station For each question (station) a check list is prepared in advance Check list prepared by breaking the skill to be tested into its vital components and precautions to be observed

 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.

10 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.

11 e.g. 1 History taking / Examining a patient - Examiner is present - Examiner Uses a check list to record the performance of the students. e.g. 2 Chest X-Ray/CT Scan inspection etc.. - No examiner - Student asked about his findings & interpretation at the next question station.

Station : Roll No: This patient complains of ‘Stomach Pain”. Obtain a history from him (Time : 5 Minutes) PROCEDURE STATION: HISTORY TAKING

Key points in History MarksKey points in History Marks Patients nameAppetite Patients AgeNausea, Vomiting OccupationMalena Pain typeFamily history SiteDrug history Radiation of painSmoking Relieving factorWeight loss Exacerbating factorAlcohol TOTAL Station : Examiners check list : Roll No: This patient complains of ‘Stomach Pain”. Obtain a history from him (0.5 Marks for each key point in history) PROCEDURE STATION: HISTORY TAKING

History taking technique Marks Alloted Obtained Made the Pt comfortable 1 Establish Rapport 2 Proper phrasing 1 Pace of the questions 1 Total 5 Station : Examiners check list : Roll No: PROCEDURE STATION: HISTORY TAKING

15 Answer the following questions about the patient whose history you have just taken. (Time: 5 Minutes) (Write Y for Yes, N for No in response box) Station: Roll No: No.Question Response Marks aThe patient’s name is Sunil Kumar bHe is a salesman cHe is married dHe smokes around 30 cigarettes daily eHe complains of stomach pain for 1 week fHe has had stomach pain like this in the past. gDuring Day time it is present constantly. hHis brother had an ulcer iHe has lost about 3-4 kg weight recently. Total marks QUESTION STATION: AFTER HISTORY TAKING

16 No.Question Response Marks aThe patient’s name is Sunil Kumar Y0.5 bHe is a salesman Y0.5 cHe is married N0.5 dHe smokes around 30 cigarettes daily Y0.5 eHe complains of stomach pain for 1 week Y0.5 fHe has had stomach pain like this in the past. Y0.5 gDuring Day time it is present constantly. Y0.5 hHis brother had an ulcer N0.5 iHe has lost about 3-4 kg weight recently. N0.5 Total KEY FOR QUESTION STATION NO:

17 Carry out the abdominal examination of patient (Time: 5 Minute) (Write Y for Yes, N for No in response box) Station: Roll No: PROCEDURE STATION: ABDOMINAL EXAMINATION

Abdominal examinationMarksAbdominal examinationMarks Made the Pt comfortable Percussion: Establish Rapport Liver Inspection: Spleen Position of doctor Shifting dullness BacksideAuscultation Hernial sites Palpation:Total Starting point Gentle Method Bimanual Station : Examiners check list : Roll No: ( 0.5 marks for each point of examination) PROCEDURE STATION: ABDOMINAL EXAMINATION

19 Answer the following questions regarding the abdominal examination you have performed in station No: (Write Y for Yes, N for No in response box) Station: Roll No: No.QuestionResponse Marks aThe flanks of abdomen were full bThe abdomen is diffusely protuberant cThere is a scar mark in right iliac fossa dProminent veins are present on the back eThe right kidney is palpable fThe left kidny is palpable gThe spleen is palpable hThere is a bruit heard in the epigastrium iThe liver is palpable JThere is a fluid in the abdomen Total marks QUESTION STATION: AFTER PHYSICAL EXAMINATION

20 No.QuestionCorrect Response Marks aThe flanks of abdomen were full Y1 bThe abdomen is diffusely protuberant N1 cThere is a scar mark in right iliac fossa Y1 dProminent veins are present on the back Y1 eThe right kidney is palpable N1 fThe left kidny is palpable N1 gThe spleen is palpable N1 hThere is a bruit heard in the epigastrium Y1 iThe liver is palpable Y1 JThere is a fluid in the abdomen Y1 TOTAL MARKS 10 KEY FOR QUESTION STATION NO:

Carry out a nerological examination of lower limbs excluding sensation & coordination (Time: 5 Minutes) Station: Roll No: PROCEDURE STATION: HISTORY TAKING

Examination MarksExamination Marks Inspection of legsTest power-Hips Test for toneTest reflexes-Ankles Test for clonusTest reflexes-Knees Test power-AnkleTest reflexes -planter Test power-Knees TOTAL Carry out a nerological examination of lower limbs excluding sensation & coordination Satisfactorily: 0.5 Marks Attempted but not satisfactorily: 0.25 Marks Not attempted: 0 Marks Station: Examiners check list Roll No: PROCEDURE STATION: HISTORY TAKING

23 Answer the following questions about the patient you have just examined. (Time: 5 Minutes) (Write Y for Yes, N for No in response box) Station: Roll No: QUESTION STATION: AFTER PHYSICAL EXAMINATION No.QuestionResponse Marks aInspection reveals muscle wasting in left leg. bThe tone in the left leg is decreased. cFlexion power at left knee is decreased dMuscle power at the left ankle is decreased eThe knee jerk on left side is increased fThe ankle jerk on left side is increased gClonuses is present at the left ankle. hThe left plantar reflex is flexor iThe signs in the left leg are those of an upper motor neuron lesion Total

24 KEY FOR QUESTION STATION NO: No.QuestionResponse Marks aInspection reveals muscle wasting in left leg. bThe tone in the left leg is decreased. cFlexion power at left knee is decreased dMuscle power at the left ankle is decreased eThe knee jerk on left side is increased fThe ankle jerk on left side is increased gClonuses is present at the left ankle. hThe left plantar reflex is flexor iThe signs in the left leg are those of an upper motor neuron lesion Total

25 Read the given ECG (Time : 5 Minutes) Station: Roll No: PROCEDURE STATION: ECG EXAMINATION

26 Answer the following questions about ECG you have just examined (Write Y for Yes, N for No in response box) Station: Roll No: QUESTION STATION: AFTER ECG EXAMINATION No.QuestionResponse Marks a The axis of the ECG is -45 b The patient has the heart rate of 110/min. c ECG shows atrial fibrilation d R-R interval is constant e Atrial rate is 450/min. f The patient has anterior myocardial infarction

27 No.QuestionCorrect Response Marks aThe axis of the ECG is -45 Y1 bThe patient has the heart rate of 110/min. N1 cECG shows atrial fibrilation Y1 dR-R interval is constant Y1 eAtrial rate is 450/min. Y1 fThe patient has anterior myocardial infarction Y1 Total 6 KEY FOR QUESTION STATION NO:

28 Answer the following questions about the instrument (Time : 5 Minutes) (Write Y for Yes, N for No in response box) Station: Roll No: QUESTION STATION: INSTRUMENT No.QuestionResponse Marks aThe tube is used for the endotracheal suction bThis tube can be localized on X-ray cThe mark corresponding to 40 cm indicates the tube is approximately in the pylorus dThe mark corresponding to 65 cm indicates the tube is in the duodenum. eThe tube is not useful in Upper GI bleeding. Total marks

29 No.QuestionCorrect Response Marks aThe tube is used for the endotracheal suction N bThis tube can be localized on X-ray Y cThe mark corresponding to 40 cm indicates the tube is approximately in the pylorus N dThe mark corresponding to 65 cm indicates the tube is in the duodenum. Y eThe tube is not useful in Upper GI bleeding. Y Total KEY FOR QUESTION STATION NO: (Ryles tube)

a.Calculate the bleeding time(BT) in this case b.Give normal range of BT c.Mention ONE condition where BT is increased d.Name the method used to detect bleeding time in our laboratory 2

a. Name the clinical feature seen in this picture. Which is the hormone responsible for it ? b. Give physiological basis for the above feature. c. Name two other possible clinical features in this patient. 3

11 a. Identify this device. b. Explain the mechanism of action of this device. c. Name the permanent contraceptive method adopted in males and females

a.Identify the focused WBC b.Mention its normal count c.Mention one function of it d.Name one clinical condition where it’s count increases 13

Figure shows the recording of basal body temperature (BBT) in a woman during a menstrual cycle: a.Has the woman ovulated? Give reason. b.What is the cause for elevated BBT in the latter half of the cycle? c.Name the important physiological event that occurs at the time of ovulation. d.Name the ovarian hormone which peaks at the time of ovulation. 15

35 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.Instruments 4.Specimens 5.Fundus examination -

36 EXAMINE ABDOMEN ANS.-Q. ON ST.7 QUE.ON ECG ANS.-Q ON CT CT SCAN QUE.ON ST. 1 HISTORY QUE. ON ST. 5 HISTORY ANS.-Q ON ST.3 EXAMINE CHEST SPECIMEN & QUE. INSTRU. & QUE. QUE.ON ST.17 NEURO EXAM. QUE.ON ST.15 CVS EXAM. LAB DATA INSTRU. & QUE EXAMPLE OF OSCE Rest

EXAM VENUE

SIMULATED PATIENT(EXAMINATION)

ADVANTAGES OF THE OSCE  All components of clinical Exams are assesed So More Valid examination  Can be used with larger number of students  Reproducible  Components of clinical Skills & standards of competencies are predetermined So Objectivity & Reliability is higher  The variable of the examiner and the patient are to a large extent removed

DISADVANTAGES OF THE OSCE  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

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42 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

43 You are provided with an oxygen-filled spirometer. Determine your vital capacity. (Time: 5 Minutes) OSPE : PROCEDURE STATION Station: Roll No:

44 You are provided with an oxygen-filled spirometer. Determine your vital capacity. OSPE : PROCEDURE STATION Station: EXAMINER’S CHECKLIST Roll No: NoExaminationYesNo 1 Does he check the spirometer for leakage ? 10 2 Mouth piece inserted properly 10 3 Nose clipped properly 10 4 Does he take a few normal breaths before 10 5 Determining vital capacity ? 10 6 Takes a deep inspiration 10 7 Exhales maximally 10 8 Takes the highest reading as the vital capacity 10 9 Determines two-stage vital capacity 10 Total 10

45 OSPE : QUESTION STATION

46 DEMO. MOVEMENTS X RAY LAB DATA Q.ANS ON10 URINE PROTEIN NEUB. CHAMBER QUE.ON ST. 7 NEURO EXAM. QUE. ON ST. 5 VITAL CAPACITY IDENTIFY PART Q.ANS ON 2 PRESCRI- PTION FDC- EVALUATE. DOSAGE FORM WITHDRAW FROM VIAL. QUE.ON ST.15 GROSS SPECIMEN. LAB DATA SLIDE (SPOT EXAMPLE OF OSPE

47  Determining vital capacity  Charging the Neubauer chamber for doing the RBC count  Recording blood pressure by auscultatory method  Preparing the blood smear from given sample  Identification of structures in the specimen (e.g. horizontal section of brain) or a dissected part or x ray  Interpretation of histological specimen  Examination and interpretation of gross specimen

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49  Advance Planning  Organization The Day Before Examination  The Day Of Examination

(A) Advance Planning : 1) Examiners decide - What is to be examined. - Weightage to different components - Minimum standard to pass. 2) Briefing the examiners and concerned staff 3) Preparing the ward (venue) and ward staff 4) Selection and briefing Patients 5) Preparation of documentation including checklist, instructions for examiners and questions. 50

51 B) The Day Before The Examination: 1)Final check for preparations & arrangement in ward 2)Final documentation to be given to each examiner

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 52

Each participant to prepare 1 station with check list & material required Group 1: Procedure station-OSCE Group 2: Question station- OSCE Group 3: Procedure station- OSPE Group 4: Question station- OSPE -To be presented in the plenary session Time- 15 minutes 53

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