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  1. O S C E Objective Structured Clinical Examination

  2. Objective Structured Clinical Examination

  3. What is OSCE ? • series of stations with tasks • planned • marking form • examiner • patient : SP • organization > examination

  4. Why OSCE ? • before OSCE (1975) • viva (oral), long case, short case • valid ? • know how NOT show how • reliable ? • different patients • different examiners

  5. Why OSCE ? • more valid • show how • more reliable • same task | patient • same examiner or • same structured marking sheet

  6. 1 2 3 4 8 7 6 5 Basic Structure

  7. 1 1 2 2 3 5 4 6 4 8 7 3 6 8 7 5 Basic Structure

  8. 1 2 3 4 A B 8 7 6 5 C D Basic Structure : Parallel

  9. 2 1 3 7 6 5 4 Basic Structure : Double 2

  10. How to start ? • blueprint of the whole OSCE • design the station • design the mark sheet

  11. Blueprint • reversed table of classification

  12. Station & Marking • learning by doing • 8 groups : name list • 8 stations • 2(p) - 4(x) - 4(d) • signal • materials & ID • task (flexible) • lunch : 3rd floor

  13. Station Design • station time 4-15 min. • total time < 2 hrs • focus task • examiner used : Y | N, who? • pilot

  14. Type of Stations • static | written • practical : technique • clinical

  15. Marking Sheet Design • checklist • rating scale • score

  16. Checklist • dichotomous : Yes | No • Pros • high objectivity • high reliability • easy to feedback • Cons • only quantity check

  17. Checklist • How to improve? • stem • clear • observable • not too long • overall • not too long

  18. Rating Scale • rating • quality concern • lower objectivity • lower reliability

  19. Rating Scale • How to improve? • 3-7 scale • more clarification of each scale • more raters • rater training • common errors of rating scale

  20. Rating Scale • common errors • leniency error • central tendency error • halo effect • logical error • proximity error • contrast error

  21. Examiner • station developer • non station developer • teacher • not teacher • other staff • SP • participation => reliability

  22. Observation • direct • indirect • one-way mirror • monitor • video

  23. Getting Feedback: How? • verbal • marked checklist & be the subject • marked checklist & watch video • printed answer • relevant papers

  24. Getting Feedback : When? • during the exam • intra-station • in another station • stress? • NB: too much information! • after the exam • end of all stations

  25. Setting an OSCE • learning by doing | 8 groups • structured task | medical student V • time • 7 min. test (without feedback) • 5 min. test + 2 min. with feedback • available tools : pls ask • draft of test and marking sheet : ~ 4 p.m. • preparation 8 - 9 a.m.

  26. Minimal Passing Score • criterion-referenced (อิงเกณฑ์) • holistic • modified Angoff • norm-referenced (อิงกลุ่ม) • borderline method • relative method

  27. Holistic Method • medical school’s faculty-wide pass mark • e.g. 60%

  28. Modified Angoff Method • group of experts • get the OSCE • “Think of a group of borderline candidates” • decide the passing score • expert discussion is acceptable in original Angoff

  29. Minimal Passing Score • criterion-referenced (อิงเกณฑ์) • holistic • Modified Angoff • norm-referenced (อิงกลุ่ม) • borderline method • relative method

  30. Borderline Method • marking form : checklist + global rating • all categorized ‘borderline’ students • mean scores of ‘borderline’ group

  31. Borderline Method Mean borderline score = (72+70+80) / 3 = 74

  32. Relative Method • 1st method : Wijnen Mothod • Passing mark = mean -1.96SE • 2nd method • 60% of the 95th percentile rank score

  33. Minimal Passing Stations • criterion-referenced

  34. Staff & OSCE : Like • emotional comfort • validly assess • consistent

  35. Staff & OSCE : Dislike • too compartmentalized • no opportunity to observe the complete patient evaluation of the student • repetitive nature => boring

  36. Students & OSCE • fairer than other methods • less stressful • unsure whether the important aspects tested

  37. Limitations of OSCE • lengthy preparation • need more observational skill of the staff • costly • low inter-station correlation • test security?

  38. What’s next? • evaluation => learning • summative => formative

  39. Innovation • senior student as SP and examiner in OSCE • study sheet listing Dx that might appear on the OSCEs • add structured oral exam into OSCE • GOSCE

  40. GOSCE : Group OSCE • Pros • economy • mutual teaching • mutual support • opportunity to examine social skill • Cons • lack of individual assessment • different participants do different tasks

  41. Potential Use of GOSCE • formative assessment • end-of-course assessment • exploring interpersonal relationship • teaching method for short course

  42. Re-using OSCE stations • across rotation in the same academic year • statistically OK • from year to year • statistically not OK

  43. Conclusion : OSCE • What ? • stations + tasks + checklist • Why ? • more valid, more reliable • How ? • How to organize? • How to analyze?