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Objective Structured Clinical Examination (OSCE). Nadine J. Kaslow, PhD, ABPP nkaslow@emory.edu. Context. ACGME Outcome Project – Toolbox of Assessment Methods Royal College of Physicians and Surgeons of Canada – CAN MEDS Assessment Tools Handbook.

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objective structured clinical examination osce

Objective Structured Clinical Examination(OSCE)

Nadine J. Kaslow, PhD, ABPP

nkaslow@emory.edu

context

Context

ACGME Outcome Project – Toolbox of Assessment Methods

Royal College of Physicians and Surgeons of Canada – CAN MEDS Assessment Tools Handbook

slide3
Examples of OSCE Stations1. resuscitation of a child2. consultation skills3. physical examination skills

1

3

2

context1

Context

Competency Assessment Toolkit for Professional Psychology

High fidelity approach for summative assessment of myriad foundational and functional competencies

context2

Context

Competency Assessment Toolkit for Professional Psychology

OSCEs are useful for assessing

Readiness for practicum?

Readiness for internship

Entry level to practice

Advanced credentialing

what is an osce

What is an OSCE?

Objective – all candidates are presented with the same stimuli

what is an osce1

What is an OSCE?

Objective

Structured – Specific foundational and functional competencies are tested at each station and the marking schema for each station is structured

what is an osce2

What is an OSCE?

Objective

Structured

Clinical Examination – Test of performance of clinical competencies, with an emphasis on skills and attitudes

what is an osce3

What is an OSCE?

Evaluation tool that allows people to be observed performing in many different clinical situations

what is an osce4

What is an OSCE?

OSCE combines

Multiple observations

Standardization of content

Range of difficulty

what is an osce5

What is an OSCE?

Effective method to assess foundational competencies

Professionalism (e)

Scientific knowledge & methods (e)

Reflective practice (e)

Individual & cultural diversity (e)

Relationships (o)

Ethical & legal standards & policy (o)

what is an osce6

What is an OSCE?

Effective method to assess functional competencies

Assessment (o)

Intervention (o)

Consultation (e)

Research and evaluation (e)

methodology

Methodology

Standardized patients (SP)

Stations

Marking scheme

standardized patients sp

Standardized Patients (SP)

SPs are lay persons who are trained to portray scripted patient presentations accurately and consistently across many encounters

SP encounters are credible and reliable

standardized patients sp1

Standardized Patients (SP)

SPs are used to teach

Foundational competencies

Interpersonal and communication skills (CIS)

Clinical reasoning

Functional competencies

standardized patients sp2

Standardized Patients (SP)

SP ratings of CIS provide a good proxy for actual patient satisfaction

SP Communication

Increases patient satisfaction

Facilitates doctor-patient relationship

Increases compliance

Decreases malpractice claims

standardized patients sp3

Standardized Patients (SP)

Several encounters are required to obtain a reliable estimate of a person’s competence

SP assessments are frequently organized as a set of cases or stations

This series of encounters is known as OSCE

implementation

Implementation

While there are variants on the original OSCE format, key implementation steps are

Train SPs in the issues of encounter and ensure they don’t provide any information unless the person being assessed requests it

implementation1

Implementation

SP encounters or tasks requiring interpretation of clinical information must be provided at separate stations

These must last 5-10 minutes and be observed by the assessor

Topics – relationship development, risk assessment, diagnosis, therapeutic technique, consultation strategy

implementation2

Implementation

At each station, the person being assessed completes notes about the SP

implementation3

Implementation

The person being assessed moves between stations when an announcer indicates in accord with a specified time sequence

Separate performance scores are generated for the task at each station based on input from the SP, the person being assessed, and the assessor

implementation4

Implementation

The scores from multiple informants across the stations or tasks are combined by the assessors to reach a final outcome determination

role of examiners yes

Role of Examiners - YES

Observe the performance of the trainee at a particular task

Score according to the marking scheme (get practice at marking)

Contribute to the good conduct of the examination

role of examiners no

Role of Examiners - NO

Re-write the station

Interfere with the SP’s role

Design their own marking scheme

Teach

psychometrics

Psychometrics

With appropriate attention to design, OSCEs have acceptable psychometric properties including

Good inter-rater, inter-station, and split-half reliability

Good generalizability

Strong content, construct and concurrent validity

psychometrics1

Psychometrics

OSCE scores correlate moderately with other performance indicators and other forms of evaluations

psychometrics2

Psychometrics

OSCE has increased reliability and content validity with greater number of stations and similarity between tasks at different stations

strengths

Strengths

Provides for a high fidelity assessment

slide29

DOES

Skills & Attitudes

SHOWS HOW

Professional Authenticity

KNOWS HOW

Knowledge

KNOWS

Miller et al., 1990

slide30

DOES

SHOWS HOW

OSCE

KNOWS HOW

KNOWS

Miller et al., 1990

strengths1

Strengths

Measures clinical competence cross-sectionally using standarized means

Focuses on observable behaviors

Enables fairer peer comparison

strengths2

Strengths

Allows for assessing complex competencies without endangering patients’ well-being

Encourages a collaborative assessment approach

Has the potential for peer feedback and assessment

strengths3

Strengths

Has been extensively researched and found to be valuable for summative assessment

Provides valuable information for curriculum review

challenges

Challenges

Is challenging to create and administer

Is labor intensive

Is costly

Only cost-effective when many individuals are examined at one administration

challenges1

Challenges

Requires high demand of other resources

SPs

Assessors

Time commitment

Physical resources

challenges2

Challenges

Doesn’t provide longitudinal assessment

Doesn’t adequately tap complex skills requiring integrated professional judgment

example sp information

Example: SP Information

I am a 25 year old who comes to the Emergency Room for treatment of a 2-3 week old puncture wound that I can see but no one else can

I am having a first episode of psychosis and have numerous alterations in my thinking and function; however it is not immediately obvious that my thoughts are disordered when the student begins taking my history

example sp information1

Example: SP Information

Chief complaint - Stepped on a nail

Opening statement - I stepped on a nail and the wound won’t heal – If pressed to say more… “It’s making me sick and I need help

example sp information2

Example: SP Information

Appearance - alert and oriented, calm, cooperative, poor hygiene (dirty unmatched clothes, hair uncombed, no make up or grooming)

Look like you haven’t showered in days

Have some eye contact but less than normal

Your affect is flat

You talk very little and you have no emotion in your voice when you are talking

example sp information3

Example: SP Information

Thought processes - you are focused on “saving America” and you mostly stay on topic when speaking but sometimes you start talking about one thing and it turns into a related topic but not on point

An example might be “Coke advertisements transmit messages to me. The first coke slogan was ‘Drink Coca-cola’ released in 1886.”

Refer to three Coke slogans during your interview. If possible say these when you can tangentially connect them to something else you are saying.

conclusion

Conclusion

OSCEs are a valuable and well-developed assessment approach in other health professions

It behooves us as psychology to develop and share OSCE scenarios for the essential components of foundational and functional competencies

conclusion1

Conclusion

OSCEs are advantageous to incorporate in our assessment armamentarium for summative evaluations particularly related to key transition phases

Attention needs to be paid to increasing the feasibility of this high fidelity assessment methodology