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OSCE. Dr Omar Al- Hussaini , MBChB,CNN,DipMedEd , CBS. Background about OSCE Definition of OSCE Harden ’ s12 tips for organizing OSCE Advantages. Disadvantages Examples of OSCE Station profile Reflections Summary . Abbasid era in Baghdad in 931 AD

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OSCE

Dr Omar Al-Hussaini,

MBChB,CNN,DipMedEd, CBS


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Background about OSCE

Definition of OSCE

Harden’s12 tips for organizing OSCE

Advantages

Disadvantages

Examples of OSCE

Station profile

Reflections

Summary


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  • Abbasid era in Baghdad in 931 AD

  • Caliph Al-Muqtadir, ordered his chief physicianto examine all healers

  • Licensing Boards

  • The chief physician

  • License for practicing


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Miller’s Pyramid of Clinical Competence


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What is OSCE?

The candidates rotate through a series of stations at which they are asked to carry out a (usually clinical) task


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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


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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.


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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


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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


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What is to be assessed?

Duration of station

Number of stations

Use of examiners

Range of approaches

New stations

Harden’s 12 Tips for Organizing an OSCE


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Harden’s 12 Tips for Organizing an OSCE (Cont.)

  • Organization of the examination

  • Assigning priority

  • Resource requirements

  • Plan of the examination

  • Change signal

  • Records


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Exam Venue


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Changing Stations


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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


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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


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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

  • Shortage of examiners

  • Might be quite distressing to the student


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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”


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OSCE stations-Dec 2002


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Simulated Patient (Hx taking)


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Simulated Patient(examination)


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Video station


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Post graduate surgical OSCE


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OSCE in Peadiatrics


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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.


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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. .


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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

  • An observer, using a checklist, will assess your performance while you interact with the patient


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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.

  • Observe your students using the following checklist, without any probing or interference from you.


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Station Profile (cont)

C) Briefing to the patient:

  • Don not give more information than asked for.

  • Try to answer the questions as clearly as possible.

  • Try to be consistent with all the students as the interview you.


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Student greeted the patient

Introduced her/himself

Asked the patient’s name

Mood state

Duration of mood disturbance

Interest & enjoyment of life

Diurnal swings of mood

Recent change in sleep pattern

Change in appetite

Suicidal thoughts/& or attempts

Checklist


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Anecdotes

•Using the whistle

•Tuning the video!

•Shortage of patients

•Staff as SP’s

•Preparing the equipment

•Choosing the number of stations


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Key Points

Staff development

Dynamic process

Stimulation

Bank

Videos & simulators

Enjoyable

Feedback


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Feedback from Students (positive)

  • To assess our performance in action

  • To detect our weaknesses

  • To assess our abilities in solving clinical problems

  • To assess our clinical skills, skills in communication and approaching patients


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Feedback from Students (positive)

  • The student is made to organize his/her thoughts

  • Increases self confidence

  • Fair to all students

  • Clinically oriented

  • To train the students because OSCE is an international examination


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Feedback from Students (negative)

  • Might be exhausting for the real patient

  • It’s humiliating to patients

  • Needs extra preparation time

  • burden on the student

  • Only 10 stations!!!

  • No need for the presence of an observer

  • Some stations require more time than the others


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Examiners after the OSCE


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

Ronald Harden


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THANK YOU


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