2. Present scenario: Clinical/Practical assessment A student may get:  Practical of B.P. examination  Hemoglobin estimation by Sahli’s method  Determination of vital capacity spirometery.  Perimetry of right temporal vision  Clinical examination of facial nerve  Gangrene  Hydrocele Different students gets Different exercise of Different contents.

3. Intra Examiner variability: Student is assign task of taking BP of Hypertensive Patient (170/95) Student follows most of the standard steps of BP measurement & reports BP as 160/80 Examiner 1 5/10 marks Examiner 2 0/10 marks

4. What is solution ? Task of BP measurement may be brocken down into various component & procedure is observed. NoExaminationYesNo 1Explained procedure to the patient10 2Checks the BP instrument for leakage10 3Applied BP cuff properly10 4 Allow the Pt to rest before measurement10 5Checked the systolic BP by palpatory method 10 6Measured the BP by Auscultatory method20 7Matching of the result30 Total10

5. This is OSCE/OSPE

6. Dr. G. U. Kavathia Asso. Professor in Microbiology P. D. U. Govt. Medical college, Rajkot.

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

8. 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. Each task is broken down in to its various components. Each components are examined using check lists prepared in advance

9. 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

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

11.  Started in 1972 Dundee, Scotland by R. Harden and F. Glesson  Began with OSCE  OSPE  Now used in over 50 countries  Used in many disciplines, UG as well as PG evaluation.  It may be requirement of MCI in near future.

12.  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

13. Knows Shows how Knows how Does Knows Knows howShows how Performance assessment in vitro: OSCEs OSPE Does Miller’s Pyramid

14. Important terminologies: Station: each task assigned to the student is termed as a station Procedure Station Question stations Rest Station Linked Station

15. Formulating OSPE Supplementation of station with  Graph  Diagram  Chart  Table  Specimen  Animal  Normal subject/Patient/Simulated Pt.  Mannequin

16. Formulating OSPE Instruction to examinee Checklist is the most important component of OSCE/OSPE

17. Skill to be tested is given in form of a specific question Each question is a station For each station a check list is prepared in advance Check list prepared by breaking the skill to be tested into its vital components.

18.  Student rotates round a number of stations – about 20  Spends specified time on each station (5-10 minutes)  On a signal (e.g. bell) moves to the next.

19. 19 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 Que. 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. 1 14 15 16 17 18 19 20 9 8 7 6 5 4 3 2 1010 11 12 13 EXAMPLE OF OSCE Rest

20. 20 PROCEDURE STATION e.g. Taking history of a patient Examine eye of a patient QUESTION STATION Questions related to finding Interpretation of lab report etc.

21. 21 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.

22. 22 OSCE Competencies tested  Clinical competencies  Procedural skills  Communication skills including attitude  Psychomotor skill  Observation  Interpretation

23. This patient complains of ‘Stomach Pain”. Obtain a detailed & relevant history from him (Time : 10 Minutes) PROCEDURE STATION: HISTORY TAKING Station No:

24. Key points in History MarksKey points in History Marks OccupationNausea, Vomiting Pain typeMalena SiteFamily history Radiation of painDrug history Relieving factorSmoking Aggravating factor Weight loss AppetiteAlcohol TOTAL This patient complains of ‘Stomach Pain”. Obtain a history from him (0.5 Marks for each key point in history) PROCEDURE STATION: HISTORY TAKING Station No:Roll No:Examiners check list

25. 25 Carry out the abdominal examination of patient (Time: 10 Minute) PROCEDURE STATION: ABDOMINAL EXAMINATION Station No:

26. 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 ( 0.5 marks for each point of examination) PROCEDURE STATION: ABDOMINAL EXAMINATION Station No:Roll No:Examiners check list

27. 27 Answer the following questions regarding the abdominal examination you have just performed. (Time 10 Minutes) (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 kidney 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

28. 28 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 kidney 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:

29. Carry out a neurological examination of lower limbs excluding sensation & coordination (Time: 10 Minutes) PROCEDURE STATION: PHYSICAL EXAMINATION Station No:

30. 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

31. 31 Answer the following questions about the patient you have just examined. (Time: 10 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

32. 32 KEY FOR QUESTION STATION NO: No.QuestionResponse Marks aInspection reveals muscle wasting in left leg. N0.5 bThe tone in the left leg is decreased. N0.5 cFlexion power at left knee is decreased N0.5 dMuscle power at the left ankle is decreased N0.5 eThe knee jerk on left side is increased Y0.5 fThe ankle jerk on left side is increased Y0.5 gClonuses is present at the left ankle. Y0.5 hThe left plantar reflex is flexor Y0.5 iThe signs in the left leg are those of an upper motor neuron lesion Y0.5 Total4.5

33. 33 Read the given ECG & write your observation (Time : 10 Minutes) PROCEDURE STATION: ECG EXAMINATION Station No:

34. 34 Answer the following questions about ECG you have just examined (Time 10 Minutes) QUESTION STATION: AFTER ECG EXAMINATION 1.What is the diagnosis of ECG on previous station 2.What are the four likely immediate complications of this 3.What are the two late complications 4.What are the four most relevant risk factors for this Station No:Roll No:

35. 35 No. Question Marks 1Acute anterior wall MI 5 2Sudden death, Acute LVF, Cardiogenic shock, Arrythmias 2 3Cardiac failure, Post MI angina 1 4Age, heredity, obesity, smoking 2 Total 10 CHECK LIST FOR QUESTION STATION NO:

36. 36 1.Interpretation of Patient’s charts / Lab. Investigations : Record of temperature B.P. Chart Chest X-Ray. Biochemical / Hematological report Respiratory function report 3.Instruments 4.Specimens 5.Fundus examination -

37. 37 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 Que. 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. 1 14 15 16 17 18 19 20 9 8 7 6 5 4 3 2 1010 11 12 13 EXAMPLE OF OSCE Rest

38. EXAM VENUE

39. SIMULATED PATIENT(EXAMINATION)

40. 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

41. 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

42. 42

43. 43 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

44. 44 You are provided a spirometer. Determine your vital capacity. (Time: 10 Minutes) OSPE : PROCEDURE STATION Station No:

45. 45 You are provided spirometer. Determine your vital capacity. OSPE : PROCEDURE STATION 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 Station No: Roll No: Examiners check list

46. 46 OSPE : QUESTION STATION

47. 47 Identify parasite specimen & Answer the following questions. (Time 10 Min.) QUESTION STATION: No.Question Marks aIdentify specimen: bWrite mode of transmission in human. cWrite type of anaemias produce by it. dWrite infectious form of this parasite: Station No: Roll No:

48. 48 KEY FOR QUESTION STATION: No.Question Marks AIdentify specimen: Adult form of Ankylostoma duodenale2 BWrite mode of transmission in human. By penetration of skin1 CWrite type of anaemias produce by it. Microcytic Hypochromic1 DWrite infectious form of this parasite: Filariform larva1 Total 5

49. 49 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 1 14 15 16 17 18 19 20 9 8 7 6 5 4 3 2 1010 11 12 13 EXAMPLE OF OSPE

50. 50  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

51. 51

52. 52  Advance Planning  Organization The Day Before Examination  The Day Of Examination

53. (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. 53

54. 54 B) The Day Before The Examination: 1)Final check for preparations & arrangement in ward 2)Final documentation to be given to each examiner

55. 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 55

56. Each participant will prepare 1 station with following information 1. Station 2. Checklist 3. Discipline 4. Domain 5. Time 6. Marks 7. Object (material) & Subject required Group 1: Procedure station-OSCE Group 2: Question station- OSCE Group 3: Procedure station- OSPE Group 4: Question station- OSPE Only One from Each group will present in the plenary session. 56

57. THANK YOU