Division of medical and dental education -update on OSCEs Rhoda MacKenzie

Why am I telling you this?

Because we need you!

Division of Medical and Dental Education MBCHB years 1-5 BDS year 2-4 PA programmes years 1-2 All have summative OSCEs Every student must encounter every assessment method as a formative exam first Over 1000 students

OSCE Objective Structured Clinical Examination – Miller’s pyramid of clinical competence

Stations Range from 3 to 16 stations per exam over one or 2 days exam 5, 8, 10 or 11 minute stations Increasingly huge drain on resources: Time, space, administrators, technicians Site coordinators, patients, actors, makeup, props, standbys Examiners!! Can be 100+ in one day

Sites and runs students per years of the MBCHB course – all to sit the exam in one day Simultaneous stations run over 3-10 sites in the Suttie Centre 4-6 runs per day

Stations types Information gathering - history Information giving –BBN, consent Practical procedures Physical examination CPR/critical care Prescribing Patient safety Procedures and examinations on patients – Real, volunteer, simulated, actors, manikins

What has changed over the last 5 years?

Ability of students and the passmark All students now taught as part of new curriculum Aiming to pass the just competent student Need to pass 2/3 stations AND achieve passmark Use borderline regression using the global score Global score is assigned by the examiner – A more subjective score based on the student’s overall performance

Borderline regression

Descriptors for year 1-3 Excellent (5) Excellent demonstration of a cohesive and logical approach. Demonstrated excellent medical knowledge and clinical skills. Uses insightful and adaptive approach to patient with excellent interaction with the patient. Demonstrates accomplished level of professionalism. Highly satisfactory (4) Demonstrated cohesive and logical approach. Demonstrated thorough medical knowledge and clinical skills. Appropriate and adaptive approach to patient with good interaction with the patient. Demonstrates professionalism. Satisfactory (3) Overall reasonably cohesive and logical approach. Demonstrated adequate medical knowledge and clinical skills. Evidence of attempts to adapt approach to patient with reasonable interaction with the patient. Attempted to demonstrate professionalism. Borderline (2) Lacks cohesive or logical approach. Demonstrated basic understanding (with some inaccuracies) of required medical knowledge and clinical skills. Limited attempts to adapt to situation and very poor interaction with the patient. Demonstrated little evidence of professionalism. Unsatisfactory (1) Disorganised approach with several significant omissions. Very limited understanding of required medical knowledge and/or clinical skills. Fails to demonstrate logical approach with little flexibility and poor interaction with the patient. Fails to demonstrate professionalism.

Descriptors for year 4&5 Excellent (5) Very organised, efficient & faultless performance. Demonstrated superior medical knowledge and clinical skills beyond that expected for their academic year. Flexible adaptive approach with excellent interaction with the patient. Demonstrated an outstanding level of professionalism and clinical reasoning skills. Highly satisfactory (4) Good level of organisation with only a few minor faults. Demonstrated very good medical knowledge and clinical skills for their academic year. Clear evidence of flexibility of approach with very good interaction with the patient. Demonstrated a high level of professionalism and clinical reasoning skills. Satisfactory (3) Organised approach with only minor faults. Demonstrated adequate medical knowledge and clinical skills for their academic year. Some evidence of flexibility of approach with acceptable interaction with the patient. Demonstrated good level of professionalism and some clinical reasoning skills. Borderline (2) Had difficulty organising approach to station with some important omissions. Demonstrated only basic medical knowledge and clinical skills for their academic year. Formulaic approach with little flexibility and poor interaction with the patient. Demonstrated little professionalism or clinical reasoning skills. Unsatisfactory (1) Disorganised approach with several significant omissions. Clearly lack required medical knowledge and/or clinical skills for their academic year. Unable to adapt to situation and very poor interaction with the patient. Poor level of professionalism and clinical reasoning skills.

Patient global scores Patients used to award up to 2 marks – but it was added to the station score Now, up to 4 marks – not part of the station score, but summed to give a percent score with 70% as the cut off for acceptable behaviour towards patients (not validated) NOT based on students’ medical knowledge Useful, but not yet used summatively

Simulated and volunteer patient programme Now moving towards a united programme, across all programmes in the division Patient partners Increasing public engagement to increase patient pool Any interesting chronic conditions/signs or indeed bored patients, please send them along! Can participate as much or little as they wish

iPad marking Roll out almost complete Most examiners manage! Saves time, paper, staff Less errors – missing marks Initially expensive – but saves on Speedwell paper

Students with disabilities/extra time Dylexia – Purely written stations almost gone now Speech impediments Injuries Glove issues OSCE/performance phobias Chronic illness

Examiner feedback From you to exam coordinator and vice versa

Question bank Useless Qs stripped out Out of date Qs saved if possible New Qs required! (Please)

Online training Password protected Calibration videos Dilemmas and errors videos with explanations Certification How to write a new Q and submit it