1. OSCE

2. Background about OSCE Background about OSCE Definition of OSCE Definition of OSCE Harden ’ s12 tips for organizing OSCE Harden ’ s12 tips for organizing OSCE Advantages Advantages Disadvantages Disadvantages Examples of OSCE Examples of OSCE Station profile Station profile Reflections Reflections Summary Summary

3. Abbasid era in Baghdad in 931 AD Caliph Al-Muqtadir, ordered his chief physician to examine all healers Licensing Boards The chief physician License for practicing

4. Miller ’ s Pyramid of Clinical Competence

5. What is OSCE? The candidates rotate through a series of stations at which they are asked to carry out a (usually clinical) task

6. Background about OSCE Started in 1972 Dundee, Scotland by R. Harden and F.Glesson First literature about OSCE 1975, BMJ Used in undergraduate as well as postgraduate Formative & summative Used in many disciplines

7. MODIFICATION OF OSCE OSLER:objective structured long examination record OSPE: objective structured practical examination OSVE: objective structured video examination OSTE: objective structured teaching evaluation OSPRE: objective structured performance- related examination OSSE: objective structured selection exam.

8. Characteristics of the OSCE It is an assessment approach primarily used to measure clinical competence Should be planned or structured (predetermined clinical competences) Examination format or framework Different types of test method can be incorporated into it

9. Characteristics of the OSCE (Cont.) In most stations students are observed (by one or more examiners) Scored as they carry out the task or interpret clinical materials (e.g.laboratory data, X-rays), write notes or answer question

10. Harden ’ s 12 Tips for Organizing an OSCE What is to be assessed? Duration of station Number of stations Use of examiners Range of approaches New stations

11. Harden ’ s 12 Tips for Organizing an OSCE (Cont.) Organization of the examination Assigning priority Resource requirements Plan of the examination Change signal Records

12. Exam Venue

13. Changing Stations

14. Advantages of the OSCE Valid examination The examiners can control the complexities of the examination Used as summative as well formative Can be used with larger number of students Reproducible

15. Advantages of the OSCE (cont) The variable of the examiner and the patient are to a large extent removed Fun activity within the department or college, which promotes team work

16. Disadvantages of the OSCE Knowledge and skills are tested in compartments The OSCE may be demanding for both examiners and patients More time in setting it up More time in setting it up Shortage of examiners Shortage of examiners Might be quite distressing to the student Might be quite distressing to the student

17. A student from Newcastle, UK New meanings for OSCE: Obligatory sweepingly crushing experience Obnoxiously stupefying celebration of the evil A collection of “ overwhelmingly significant clinical errors ”

18. Station description Equipments Simulated patient/Std History from a patient with schizophrenia NoneYes History from a patient with affective disorder NoneYes Video of patients with EPS signs Video player and television No History from an alcoholic patient NoneYes Checking for symptoms of anticholinergic s.e. from a patient, who is on Amitryptilline NoneYes OSCE stations-Dec 2002

19. Simulated Patient (Hx taking)

20. Simulated Patient(examination)

21. Video station

22. Task Content area Type Cognitive Psychomotor Attitude Abdominal examination GI SP + +++ ++ Discharge summary General Essay +++ SuturingGeneral Practical +++ Interview relative General SP ++ +++ Scientific appraisal Research Essay +++ Post graduate surgical OSCE

23. OSCE in Peadiatrics

24. OSPE in Pharmacology (Nepal) (I): Spotter section: A student identifies a drug among the choices displayed for a particular condition and then answers one or two questions related to the drug. (II): communication skills: A student communicates with and prescribes a drug for a simulated patient.

25. Station Profile A) Instruction to students:. Mr.Mohammed is a 22-year-old working in Thumrith base, presented to our clinic with headaches, generalized loss of interest in life, poor social performance, chest discomfort..

26. Station Profile (cont) A) Instruction to students:(cont) You have 8 minutes to assess the affective state of this patient, by taking the proper and relevant history You have 8 minutes to assess the affective state of this patient, by taking the proper and relevant history An observer, using a checklist, will assess your performance while you interact with the patient An observer, using a checklist, will assess your performance while you interact with the patient

27. Station Profile (cont) B) Briefing to the Observer: The student is required to assess the affective state of Mr. Salim, by taking the proper and relevant history. The student is required to assess the affective state of Mr. Salim, by taking the proper and relevant history. Observe your students using the following checklist, without any probing or interference from you. Observe your students using the following checklist, without any probing or interference from you.

28. Station Profile (cont) C) Briefing to the patient: Don not give more information than asked for. Don not give more information than asked for. Try to answer the questions as clearly as possible. Try to answer the questions as clearly as possible. Try to be consistent with all the students as the interview you. Try to be consistent with all the students as the interview you.

29. Checklist Student greeted the patient Student greeted the patient Introduced her/himself Introduced her/himself Asked the patient ’ s name Asked the patient ’ s name Mood state Mood state Duration of mood disturbance Duration of mood disturbance Interest & enjoyment of life Interest & enjoyment of life Diurnal swings of mood Diurnal swings of mood Recent change in sleep pattern Recent change in sleep pattern Change in appetite Change in appetite Suicidal thoughts/& or attempts Suicidal thoughts/& or attempts

30. Anecdotes Using the whistle Tuning the video! Shortage of patients Staff as SP ’ s Preparing the equipment Choosing the number of stations

31. Key Points Staff development Dynamic process StimulationBank Videos & simulators EnjoyableFeedback

32. Feedback from Students (positive) To assess our performance in action To assess our performance in action To detect our weaknesses To detect our weaknesses To assess our abilities in solving clinical problems To assess our abilities in solving clinical problems To assess our clinical skills, skills in communication and approaching patients To assess our clinical skills, skills in communication and approaching patients

33. Feedback from Students (positive) The student is made to organize his/her thoughts The student is made to organize his/her thoughts Increases self confidence Increases self confidence Fair to all students Fair to all students Clinically oriented Clinically oriented To train the students because OSCE is an international examination To train the students because OSCE is an international examination

34. Feedback from Students (negative) Might be exhausting for the real patient Might be exhausting for the real patient It ’ s humiliating to patients It ’ s humiliating to patients Needs extra preparation time Needs extra preparation time burden on the student burden on the student Only 10 stations!!! Only 10 stations!!! No need for the presence of an observer No need for the presence of an observer Some stations require more time than the others Some stations require more time than the others

35. Examiners after the OSCE

36. When used correctly, the OSCE can be highly successful as an instrument to assess competence in medicine Ronald Harden

37. THANK YOU