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The Objective Structured Clinical Examination

The Objective Structured Clinical Examination. To become familiar with OSCE format and scoring To explore standard setting techniques To provide an overview of quality assurance methods To identify strengths and weaknesses of the OSCE To facilitate good design of OSCE stations. Objectives.

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The Objective Structured Clinical Examination

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  1. The Objective Structured Clinical Examination

  2. To become familiar with OSCE format and scoring To explore standard setting techniques To provide an overview of quality assurance methods To identify strengths and weaknesses of the OSCE To facilitate good design of OSCE stations Objectives

  3. Number of stations through which students rotate Demonstration of a clinical skill or respond on paper to a series of related questions Wide variety of skills tested: History, physical examination, interpretation of tests, communication and interpersonal skills What is an OSCE?

  4. Advantages • Standardization • Can test a range of skills • Can pre set standards • Flexible • Does not rely on real patients

  5. Disadvantages • Can seem artificial • Takes a lot of planning • Expensive • Needs well trained patients…and examiners!

  6. How to run an OSCE • Decide what you want to assess • Identify the Team • Decide the content • Planning the site • Patients • Examiners • Candidates • Support staff • The day before • The day • The day after • Final follow up

  7. Is it formative or summative?

  8. Decide what you want to assess • Communication skills • History taking • Examination technique • Ethical issues • Patient education • Emergencies • Technical skills

  9. Identify the team • Discussion

  10. Decide station content • Sort or long stations • Mixture of the two • Post encounter tasks eg read an x ray, interpret data • Rest stations may be added

  11. Consists of patient encounters and post encounter probe Provides opportunity to test data interpretation in context Allows for an increase in test capacity without additional costs Couplet Stations

  12. You need to know the age and sex of available patients in order to plan the station content Define a time line for recruitment, training and testing roles You MUST talk to the standardised patient coordinator early

  13. Test the station • You MUST test the station to see if it works…try to get someone else to play the role of the student

  14. For each station you will need • Clear instructions to the candidate • A very detailed patient role • Prompts for the patient • A scoring checklist • A list of equipment needed in the room

  15. Instructions to the candidate • Who are they? • Where are they? • Eg You are a medical student working in the emergency room • What are they to do? • Do you want to give them any other information eg “The patient has diabetes”

  16. How to run an OSCE • Decide what you want to assess • Identify the Team • Decide the content • Planning the site • Patients • Examiners • Candidates • Support staff • The day before • The day • The day after • Final follow up

  17. Planning the site • How many students? • How many stations? • How many tracks can you run? • How long is each encounter? • This will depend on your local site

  18. You need • An area for registration and administration • Orientation of students, patients, examiners • Refreshment area • Area to keep students after their examination • Book the space early, a few months before!

  19. Draw a map of the site • Assign stations, considering the flow of students

  20. Equipment lists • Blood pressure cuff • Reflex hammer etc • Pencil for examiner • Check list • Water etc • Clearly define who is responsible for these…or they WILL be forgotten!!

  21. How to run an OSCE • Decide what you want to assess • Identify the Team • Decide the content • Planning the site • Patients • Examiners • Candidates • Support staff • The day before • The day • The day after • Final follow up

  22. Examiners • Find your examiners early • Faculty • Nurses? • Any other options? • At least one per station and a small number of spares • Send a letter explaining when they should arrive etc • Record their answers and send reminders • You may not have time to offer much training.

  23. Instructions to examiners • They should meet together, and with the patient, and run through the checklist • Is it all clear to them? • Rules for interacting with the student • Rules for completing the list • What to do with completed checklists

  24. Candidates • Need to know day of OSCE and time of arrival • What can they bring? Eg stethoscope • What can they NOT bring? Eg Phone • Where do they register?

  25. Orientation • What signal will they hear? • To enter station • To leave station • What is the time interval between stations • Will there be an additional question whilst in the station?

  26. Identification • Best to give the a large sticker with their name or number on it • Examiner MUST check it corresponds to the scoresheet they have in front of them

  27. How to run an OSCE • Decide what you want to assess • Identify the Team • Decide the content • Planning the site • Patients • Examiners • Candidates • Support staff • The day before • The day • The day after • Final follow up

  28. Support staff • Registration • Time keeper • Escorts (standing in corridor etc) • Clerical staff….responsible for signs, catering etc

  29. The time keeper

  30. The Day before • Post signs…outside each room and also inside by the door • Check signal system. • Find a spare whistle!! • Make sure all the standardized patients have remembered to come, especially teenagers

  31. On the Day • Have a clear schedule for when everyone arrives and where they go • Where will orientation take place and who will do it? • Where will the dry runs take place? • When does the OSCE start?

  32. Remember breaks for examiners with small bladders • When you make the master schedule you must build in breaks…. A bigger break allows you to catch up if things are running over

  33. Things that go wrong • Patients fail to turn up – rare • Examiners fail to turn up – common • Scoresheets turn out to be ambiguous or confusing – common • Food does not arrive • Bell cannot be heard onside rooms - common

  34. How to run an OSCE • Decide what you want to assess • Identify the Team • Decide the content • Planning the site • Patients • Examiners • Candidates • Support staff • The day before • The day • The day after • Final follow up

  35. The day after • Evaluations from examiners and participants are useful • Payments to patients etc • Send thank you letters

  36. There is a difference between the examiners scoring of the OSCE and the final interpretation of the score afterwards. Scoring

  37. Checklist for important items - Done or Not done • Global rating section • Section to identify borderline candidates • Comments box – eg hurt patient, incorrect technique

  38. Will you have “red flag” items? • How much will the global section be worth eg 25% • How do you define a pass mark? • How many stations can be failed?

  39. We will design an OSCE We need to run through everything so far discussed Then we will create some roles and checklists Group work

  40. In groups • Decide content for an 8 station OSCE • We will split up and develop roles and stations

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