1. Objective Structured Clinical examination (OSCE) Presented by Prof. Namir G. Al-Tawil M.B.Ch.B., F.I.B.M.S./C.M. namiraltawil@yahoo.com

2. Objectives At the end of this lecture, the audience must know: At the end of this lecture, the audience must know: –Definition of OSCE –Advantages and disadvantages of OSCE –Components of OSCE

3. The essential components of communication skills are linked to: Knowledge. Knowledge. Skills. Skills. Attitudes. Attitudes. OSCE is the “ best ” test that can really and effectively assess communication skills (CS) performance. OSCE is the “ best ” test that can really and effectively assess communication skills (CS) performance.

4. History OSCE was developed in Dundee, Scotland in the early 1970 ’ s. OSCE was developed in Dundee, Scotland in the early 1970 ’ s. Introduced by Dr. Harden and colleagues in 1975. Introduced by Dr. Harden and colleagues in 1975. Reports in the literature concerning its use come from England, Scotland, Australia, South Africa, Nigeria, the Netherlands, Canada, and the US. Reports in the literature concerning its use come from England, Scotland, Australia, South Africa, Nigeria, the Netherlands, Canada, and the US.

5. Definition of OSCE: “ O ” stands for Objective. “ O ” stands for Objective. Every student gets the same patient (same chance). Every student gets the same patient (same chance). “ S ” stands for Structured. “ S ” stands for Structured. Several skills are tested at one time. Several skills are tested at one time. Each skill is tested in a separate station. Each skill is tested in a separate station. The examiner have a checklist for doing the marking. The examiner have a checklist for doing the marking. marking. marking.

6. Definition, cont. “ C ” stands for clinical. “ C ” stands for clinical. Testing the skills of students: Testing the skills of students: - Manual skills, like examining the anterior chamber of the eye. - Manual skills, like examining the anterior chamber of the eye. - Communication skills like taking - Communication skills like taking patient ’ s history. patient ’ s history. “ E ” stands for Examination. “ E ” stands for Examination.

7. Highlights OSCE is designed to assess clinical competence and communication skills. OSCE is designed to assess clinical competence and communication skills. No. of stations: 12-18 (5 min. each) No. of stations: 12-18 (5 min. each) Three areas have to be tested: Three areas have to be tested: - Communication skills. - Communication skills. - Physical examination. - Physical examination. - Short answer stations. - Short answer stations.

8. Example The student may be asked to take a history of a young man patient (real or standardized patient) presenting with a loin pain. The student may be asked to take a history of a young man patient (real or standardized patient) presenting with a loin pain. The student would be assessed according to the checklist. The student would be assessed according to the checklist. A list of questions to be asked in the next station (as MCQs or short assay questions). A list of questions to be asked in the next station (as MCQs or short assay questions).

9. Advantages of an OSCE: Tests the student ’ s ability to integrate knowledge, clinical skills, and communication with the patient. Tests the student ’ s ability to integrate knowledge, clinical skills, and communication with the patient. Provides the faculty with an assessment tool that is custom-fit to the goals of a specific education program. Provides the faculty with an assessment tool that is custom-fit to the goals of a specific education program. Provides unique programmatic evaluation. Provides unique programmatic evaluation.

10. Advantages of an OSCE, cont. Objectivity and validity are highly ensured in OSCE. Objectivity and validity are highly ensured in OSCE. Tests in condition akin to professional practice. Tests in condition akin to professional practice. A wide range and variety of facts can be tested at a time. A wide range and variety of facts can be tested at a time. Contains detailed feedback for students and teachers. Contains detailed feedback for students and teachers.

11. Disadvantages of an OSCE: Expensive. Expensive. Takes long time to construct a case and a scoring checklist. Takes long time to construct a case and a scoring checklist. Technical limitations. Technical limitations.

12. Components of an OSCE

13. 1.The examination coordinating committee Composed from qualified members (appointed or volunteers) who are devoted to the evaluative and educational process. Composed from qualified members (appointed or volunteers) who are devoted to the evaluative and educational process. Its responsibility is to determine the content of the examination, development, and implementation. Its responsibility is to determine the content of the examination, development, and implementation.

14. 2. The examination coordinator Facilitates the smooth working of the committee in developing, implementing, and assessing the performance of the OSCE. Facilitates the smooth working of the committee in developing, implementing, and assessing the performance of the OSCE. Local site coordinator is needed if the examination is carried out in different sites. Local site coordinator is needed if the examination is carried out in different sites.

15. 3. List of skills, behaviors, attitudes to be assessed The OSCE should be able to reliably assess clinical competence, in history taking, physical examination, laboratory, radiographic, and other data interpretation, technical and procedural skills, as well as, counseling and attitudinal behavior. The OSCE should be able to reliably assess clinical competence, in history taking, physical examination, laboratory, radiographic, and other data interpretation, technical and procedural skills, as well as, counseling and attitudinal behavior.

16. 4. Criteria for scoring the assessment (Marking scheme of checklist) Checklist should be concise, unambiguous, and written to contribute for the reliability of the station. Checklist should be concise, unambiguous, and written to contribute for the reliability of the station. The more focused the checklist, the greater the power of the station to differentiate effectively among the abilities of the students. The more focused the checklist, the greater the power of the station to differentiate effectively among the abilities of the students.

17. 5. The examinees Could be: student, resident, or fellow in training or at the end of training of a prescribed course. Could be: student, resident, or fellow in training or at the end of training of a prescribed course. Could be: undergraduate, graduate, or enrolled in continuing medical education program. Could be: undergraduate, graduate, or enrolled in continuing medical education program.

18. 6. The examiners Most stations require an examiner. Most stations require an examiner. The examiner at a station where clinical skills (history taking, physical examination, interviewing, and communication) are assessed, may be either a physician or standardized patient. The examiner at a station where clinical skills (history taking, physical examination, interviewing, and communication) are assessed, may be either a physician or standardized patient.

19. 7. Examination site: Could be special part of the teaching institution. Could be special part of the teaching institution. The examination could be conducted in an out-patient clinic where offices are available in close proximity to each other. The examination could be conducted in an out-patient clinic where offices are available in close proximity to each other.

20. 8. Examination stations: Generally, fewer than 10 stations is inadequate number, and more than 25 is not practical or feasible. Generally, fewer than 10 stations is inadequate number, and more than 25 is not practical or feasible. The time per station should be uniform as possible. It ranges from 5-20 minutes. The time per station should be uniform as possible. It ranges from 5-20 minutes. The skill, behavior or attitude to be tested in a station determines whether the station requires a real patient, simulated patient, lab. data, X ray film, or patient ’ s record. The skill, behavior or attitude to be tested in a station determines whether the station requires a real patient, simulated patient, lab. data, X ray film, or patient ’ s record.

21. 8. Examination stations, cont. Specially constructed plastic models or simulations may be used, e.g. rectal or breast models. Specially constructed plastic models or simulations may be used, e.g. rectal or breast models. Couplet station for e.g. may consist of history-physical examination combined with problem solving station. Couplet station for e.g. may consist of history-physical examination combined with problem solving station. Environment of the station, should be quiet, good lighting … Environment of the station, should be quiet, good lighting … Clearly marked directions leading from one station to the next should be displayed. Clearly marked directions leading from one station to the next should be displayed.

22. 9. Patients standardized or simulated. A standardized patient is an individual with a health problem that is in a chronic but stable condition. A standardized patient is an individual with a health problem that is in a chronic but stable condition. Simulated patients may be volunteers. Simulated patients may be volunteers. Both must be trained, and more training is required for patients used in history taking than for patients used for physical examination. Both must be trained, and more training is required for patients used in history taking than for patients used for physical examination.

23. 10. Timekeeper, Time clock, and Time signal A well-functioning time clock, and a clearly audible time signal are required. A well-functioning time clock, and a clearly audible time signal are required.

24. 11. Contingency plans It includes reserve-standardized patients who are trained to assume a number of roles, and a patient trainer who circulates to deal with any patient problems that arise. It includes reserve-standardized patients who are trained to assume a number of roles, and a patient trainer who circulates to deal with any patient problems that arise.

25. 12. Assessment of the performance of the OSCE It is the responsibility of the examination coordinating committee. It is the responsibility of the examination coordinating committee. The following points should be considered: The following points should be considered: a) The OSCE should be tested for appropriate measurement characteristics such as: validity, reliability, feasibility, and credibility. a) The OSCE should be tested for appropriate measurement characteristics such as: validity, reliability, feasibility, and credibility. b) Types of validity includes: predictive, b) Types of validity includes: predictive, concurrent, and content validity. concurrent, and content validity.

26. Points to be considered, cont. c) A valid OSCE station measures what it was designed to measure. A reliable station measures its consistency. d) Item analysis should be completed for an OSCE to provide indications concerning the difficulty of each station in relation to the overall exam. e) Grading can be based on a criterion- referenced system, norm-referenced system, or a combination of both.

27. Examples: General communication skills (time: 5 minutes) Choose the most appropriate answer Where do you prefer to examine a patient with abdominal pain lying in general surgical ward? Where do you prefer to examine a patient with abdominal pain lying in general surgical ward? a) In the same place in front of his relatives. b) In the same place but not in front of his relatives. c) In a single room, opened-door. d) In a single room, closed-door.

28. General communication skills How do you call an old man, his name is Ali, and his son is called Hasan? How do you call an old man, his name is Ali, and his son is called Hasan? أهلا عمي أبو حسن. أهلا عمي أبو حسن. أهلا عمي علي. أهلا عمي علي. أهلا عمي. أهلا عمي. أهلا. أهلا.

29. General communication skills How do you prefer to let the patient to sit in the clinical examination room? How do you prefer to let the patient to sit in the clinical examination room? a) In front of you, a table between him and you. b) Beside you about half meter distance. c) Beside you, about 2 meters distance. d) Two meters in front of you.

30. General communication skills Keeping an eye contact with your patient while he is talking about his complaint is: Keeping an eye contact with your patient while he is talking about his complaint is: a) Very bad habit may embarrass the patient. b) Very important to encourage the patient. c) Not useful. d) Only useful in psychological disease.

31. Information giving skills: This patient in front of you is a 22 year old, has been newly diagnosed yesterday as a case of diabetes mellitus, his FBS was 300 mg/dl. His urinalysis was (+++) positive for glucose. He is irritable. Give him valuable health education about the nature of his disease, treatment, self- care, and complications. This patient in front of you is a 22 year old, has been newly diagnosed yesterday as a case of diabetes mellitus, his FBS was 300 mg/dl. His urinalysis was (+++) positive for glucose. He is irritable. Give him valuable health education about the nature of his disease, treatment, self- care, and complications.

32. Thanks for listening