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Ospe (objective structured practical examination)





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  1. 1. Objective Structured Clinical Examination (OSCE) / Objective Structured Practical Examination (OSPE) Dr. Dinesh T, Asst Prof. Physiology, Member- MEU, DSMCH, Perambalur. 1
  2. 2. Objectives  Define objective structured clinical/ practical examination  Identify the ways in which OSCE/ OSPE differs from conventional practical examination  Realize the circumstances that necessitated introduction of OSCE/ OSPE  Identify the Advantages and Disadvantages of OSCE/OSPE  Plan and organize the conduction of an OSCE/ OSPE 2
  3. 3. What is an OSCE?  Objective: Examiners use a checklist for evaluating the trainees  Structured: Trainee sees the same problem and perform the same tasks in the same time frame  Clinical: The task are representative of those faced in real clinical situation 3
  4. 4. Definition- OSCE A multidimensional practical examination of clinical skills, as a tool for assessing clinical competence 4
  5. 5. Objective structured practical examination (OSPE)  A method of practical examination, assessment tool  Subjects and materials are used instead of patients 5
  6. 6. Purpose of OSCE Problems in routine clinical examination  Variability  Global assessment  Marks awarded by overall impression  Many abilities are ignored  Difficulty in terms of time, money and number of patients and examiners required  “Tests the product not the process”  OSCE is designed to overcome these deficiencies 6
  7. 7. History of OSCE  OSCE was developed in University of Dundee (Dundee, Scotland) in the early 1975 by Dr. Harden and his colleagues  After some modification it was described in detail on 1979.  This method was the subject of an international conference in Ottawa in 1985 and experience were exchanged about OSCE & OSPE  More than 50 countries accepted it  Globally used now 7
  8. 8. What is assessed by OSCE?  Various clinical skills – history taking , physical examination, technical procedure, communication, interpersonal skills  Knowledge and understanding  Data interpretation  Problem solving  Attitudes 8
  9. 9. Miller’s Pyramid 9
  10. 10. How to prepare OSCE ? 10
  11. 11. The steps in designing and implementing an OSCE/OSPE Have Set of CLEAR OBJECTIVES Identify the PRACTICAL aspects Select the TASK Break into SUB- TASKS Assign SCORES (WEIGHTS) for each sub task Set up STATIONS CONDUCT after orienting students and examiners Make NOTES of the process and review ANALYZE the results and use the same for student assessment 11
  12. 12. The key to a successful OSCE/ OSPE is Careful Planning 12
  13. 13. How to develop case/scenario?  Define the purpose of the station  Candidate’s instructions  Scoring checklist  Standardized patient instructions  Instruction for stations set-up 13
  14. 14. Define the purpose of the station  The examination will measure objectively the competencies based on the objectives of the course or the requirement of the licensing body  State the skill and domain to be tested  Skill – Ex. Elicit signs of Anaemia  Domain – Knowledge, Psychomotor 14
  15. 15. Candidate instructions  Candidate instruction must be clear and concise  Before examination a briefing about whole system is very much effective for a successful OSCE 15
  16. 16. Scoring checklist  The checklist should be complete and include the main components  Any unnecessary or exaggerated term must be avoided 16
  17. 17. Instructions for station set-up  List the equipments required for the station  Instructions or questions to be performed by the candidate, for example “Record the ankle jerk response for this patient”  Materials -Table/chair/couch and other materials as required for the task e.g. Knee Hammer  Patient or subject (OSPE)  An assessor or examiner  Time frame and changing signal 17
  18. 18. The Examinees The examinee is the student, resident or fellow in training or at the end of training of a prescribed course 18
  19. 19. The Examiners The examiner is needed in where clinical skills (history-taking, physical examination, interviewing and communication) are assessed 19
  20. 20. Examinations Station  A “station” is the site at which the student is assessed on a particular ability  The total number of stations will vary based the number of skills, behaviors and attitudinal items to be tested  For most clerkships or courses, the total will vary from 10-25 (Usually 20) 20
  21. 21. Set up “Stations” Stations are of different types  History Taking stations: e.g. “This patient complains of abdominal pain. Take a history pertaining to abdominal pain”  Examination stations: Student’s ability to perform a clinical examination is assessed, e.g. “Record ankle jerk response”  Skill stations: Student’s are tested on their ability to perform a skill eg. Provide CPR, Start IV line 21
  22. 22. Set up “Stations”...  Communication stations: Communication ability of a student is assessed e.g. “Advise the mother of a three year old child with diarrhea regarding use of ORT for her child”  Response stations: Interpretative ability of a student is assessed e.g.“ Interpret this Chest X ray of a 40 year old patient with acute dyspnea and state 3 reasons for your answer”  Rest stations: To give students a chance to organize their thoughts 22
  23. 23. Couplet & Double Station  Some competencies may best be assessed by coupled or linked stations  The use of linked stations extends the time available to complete a task  Double stations- for providing adequate time Examination Of a patient with Anemia Findings Interpretation Plan of management 23
  24. 24. Duration of station  Duration of stations has been fixed  Make sure that the task expected of the student can be accomplished within the time  Time ranging from 4 to 15 minutes. 5 minute station probably most frequently chosen  The time depends on the competencies to be assessed in the examination 24
  25. 25. Movement in the Stations 25 1 2 34 5
  26. 26. Observer Assessment Method  Checklist or Key  Rating scale 26
  27. 27. Procedural station Check list  Mr. X. Presents with a swollen ankle for 6 weeks DoDon’t 1-Introduces self to patient 2-Explain to the patient what will be do 3-Demonstrate concern for not excessive rough 4-Inspecting for swelling , erythema and deformity if any 5-Inspection: Standing From anterior Posterior 6- Gait examination 7- palpation 27
  28. 28. Communication skills checklist (Rating Scale) Excellence 5 V Good 4 Good 3 Fair 2 Poor 1 1- Interpersonal skill: Listen carefully 2-Interviwing skill: Uses words to patient as understandable 28
  29. 29. Standardized Patients (SP) • A standardized patient is an individual who is trained to portray scripted patient • These instruction must be detailed as standardized patient playing the same role • Standardized patients may be volunteers or paid employee • Clinically stable patient can also be used as standardized patient • Ideally a physician will observe the standardized patients before the examination 29
  30. 30. Simulated patients  Persons playing the role of patients (i.e."simulated" patients) can be used instead of actual patients  But to make it more reliable use as many actual patients as possible 30
  31. 31. Advantages of OSCE  More objective  Test not only skills and knowledge but attitudes also  Test the student’s ability to integrate knowledge, clinical skills and communication with the patient 31
  32. 32. Advantages..  Can be used with large number of students  Reproducible  Provides unique programmatic evaluation  Less complexity  Valid examination  Summative and well formative 32
  33. 33. Disadvantages  Development and administration are time consuming and costly  OSCE involves lots of planning  The assessment of skills tends to get compartmentalized in an OSCE, “on the whole” is not assessed  Inadequate for Postgraduate examinations 33
  34. 34. Disadvantages ...  The reliability of OSCEs has been found to be low if there are a small number of stations, noisy environments, untrained patients and lack of structured checklists  Need for standardization of simulated patients and examiners  Repetitive and boring  Requires time, effort on the part of the examiners, during the examination 34
  35. 35. Watched Structured Clinical Examination (WSCE)  Alnasir (2004) created this method  WSCE found to be more useful than OSCE  Less time-consuming, more cost-effective, requires less supervising staff to conduct the examination and less stressful to the students 35
  36. 36. The Objective Structured Long Examination Record (OSLER)  OSLER was introduced by Gleeson in 1992  An attempt to remodel and improve the long case examination  He suggested modifications to improve the long case examination 36
  37. 37. OSLER..  The long case is divided into 10 items on which each candidate is assessed  The 10 items cover all aspects of working up a long case  The process of history taking, examination and management of the patients is observed  In addition to observation during history taking, communication skills are also evaluated 37
  38. 38. 10 items in OSLER  History taking 1. Pace and clarity of presentation 2. Communication process 3. Systematic approach 4. Establishment of case facts  Physical examination 1. Systematic approach 2. Examination technique 3. Establishment of correct findings  Management 1. Appropriate investigations in logical sequence 2. Appropriate management plan 3. Clinical acumen 38
  39. 39. OSLER All candidates will be assessed on same 10 items by the examiners in the same frame Grades:  P+ (very good/ excellent)  P (pass)  P- (below pass)  Examiners and co –examiners analyze and give overall grade 39
  40. 40. Conclusion  In conventional examination marks awarded is on candidates global performances not for individual competencies  The OSCE is a highly reliable and valid clinical examination that provides unique information about the performance of residents  OSCE overcome most of those obstacles  Combining OSCE with long cases can assess the competency effectively 40
  41. 41. Exercise 1: Procedure station  Instruction to the candidate Check the Blood pressure of the given patient accurately  Materials required Bed or couch, stool for candidate, BP apparatus, stethoscope, patient, examiner, instructions to candidate and checklist for the examiner  Marks allotment: 0.5+1+1+1+1+0.5 = 5 marks  Time allotment: 5 minutes 41
  42. 42. Specific sub tasks Marks allotted Marks obtained 1. Greet the patient and supply proper instructions 0.5 2. Position patient sitting with arm exposed •Arm at heart level •Apparatus at level of observer’s eyes (0.25 each) 0.5 3. Check BP by palpatory method – Palpates over the Radial artery 1 4. Check BP by auscultatory method – •Positions stethoscope over Brachial artery in cubital fossa •Deflates by 2 mmHg every second •Records Systolic BP •Records Diastolic BP (0.25 each) 1 5.Records SBP/DBP accurately within 5 mmHg of patients known BP (0.5 each) 1 6.Deflates, removes cuff & replaces equipment carefully. Thanks patient (0.25 each) 1 42
  43. 43. EXERCISE 43
  44. 44. “If you can’t make a mistake, you can’t learn anything” - M Collins Thank you all.... 44
  45. 45. References  Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J 1975; 1:447-51.  Sethuraman KR. Objective Structured Clinical Examination. New Delhi: Jaypee Brothers, 1993.  Ananthakrishnan, N. Objective structured clinical/practical examination (OSCE/OSPE). Journal of Postgraduate Medicine 1993; 39:82-84.  David A. Sloan, M.D., Michael B. Donnelly, Ph.D., Richard W. Schwartz, M.D.and William E. Strodel, M.D. The Objective Structured Clinical Examination.The New Gold Standard for Evaluating Postgraduate Clinical Performance. Annals of surgery 1995. 222 (6), 735-742. 45
  46. 46. References...  Samira Alsenany, Amer Al Saif. Developing skills in managing Objective Structured Clinical Examinations (OSCE), Life Science Journal 2012;9(3); 600-602.  Alnasir, F.A. The Watched Structured Clinical Examination (WSCE) as a tool of assessment. Saudi Medical Journal 2004; 25(1):71-47.  Barman A. Critiques on the Objective Structured Clinical Examination. Ann Acad Med Singapore 2005;34 478-82.  Patil JJ. Objective Structured Clinical Examinations; CMAJ 1993;149; 1376-78. 46
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