OBJECTIVE STRUCTURED CLINICAL EXAMINATION AND

OBJECTIVE STRUCTURED PRACTICAL EXAMINATION (OSCE/OSPE)

INTRODUCTION
An OSCE is a modern type of examination often used in health science (like
medicine, chiro practice, physical therapy, Radiography, nursing, pharmacy and
dentistry) to test clinical skill performance and competence in skill such as
communication, clinical examination, medical procedure/ prescription exercise
prescription,jiont mobilization/manipulation techniques and interpretation of
results.
The term OSCE is an acronym that stands for “Objective structured clinical
examination”
DEFINITIONS
“An exam where by ‘Student demonstrate their competence under a variety of
simulated conditions”.
Watson,2002
Examination in which the student is required to perform specific skills and
behaviors in a simulated clinical or patient care environment”.
PURPOSES
An examination of students’ clinical skills OSCEs:
 Used in both formative and summative assessment in health professional
education.
 Identify objective performance criteria for the skill being examined.
 Structure the performance criteria in a check list to facilitate identification of
desired clinical skills.
 Use asset structure to encourage parity between students.
 Use station designed to asses a specific skill or component of health
professional clinical practice.
 A requirement for accreditation in many health professional programs.
 Encourage collaborative approach between HEIand practice in the creation
of health professionals who are fit for purpose.
 Adoptable across professions and clinical skills in all academic levels.
 Have potential for peer feedback and assessment.
  Have scope for application outside the health arena; Objective structured
professional examination(OSPE)
 Identifying the performance criteria for advanced practice skills or
“expertise can be challenging.
 Experts as examiner must be liberated to asses using global judgment
alongside set performance criteria.
 Knowledge associated with specific advanced practice skills can be assessed
within Aviva subsection of the OSCE checklist.
 Important to differentiate between academic levels in OSCE, not just in the
advanced skills performance required but in the higher challenge for and
expectations of these student.
 “Teachers, examiners and students” feedback on the masters level OSCE is
very positive.
 Conventionally students move between multiple OSCE stations each one
focusing on a different skill, so students demonstrate the breadth of skills
required for clinical practice expected at their stage of learning and
development. During an OSCE, the examiner will assess learners
performance with regard to four distinct elements which includes
“Knowledge and understanding underpinning the skill; motor or technical
aspects

OBJECTIVES
‘O ‘ in the word OSCE stands for “Objectives and Objectivity “ is a defining
feature of this type of assessment
All candidates are assessed using exactly the same station (although if
real patients are used their signs may vary slightly ) with the same marking
scheme. In an OSCE candidates get marks for each step on the mark scheme that
they perform correctly which therefore makes the assessment of clinical skills
more objective rather than subjective. Where one or two examiners decide whether
or not the candidates fails based on their subjective assessment of their skills. By
the nature of their role assessors have the responsibility of marking professional
judgment about the performance of student whom they are assessing.
The assessors is required to make decision based on two key judgment
1. The extent to which a student has met the learning outcomes and standard of
the particulars course or subject that is being examined.
2. whether the student has demonstrated the level of competency that is
expected and consequently whether the students is able to practice safely in
the clinical setting
The OSCE is designed to achieve transparency by minimizing potential
bias
clinical practice and what you have seen while working in the practice
environment, you will recognize that most practitioners have a preferred way
of doing something. For example some nurse might like to set up a sterile
field in preparation for a wound dressing in a particular way , while still
making sure that the key principles of asepsis are maintained .likewise, you
may have seen a colleague make a hospital bed in a slightly different way to
how you or other nurses like to make it. For example: they may like to
position the pillows facing away from the door while another colleague may
be concerned about folding the bedspread in a specific way. regardless of
this it is almost certain that that key principle underlying both techniques
used for bed making are the same.
However if an examiner had a specific way of assessing student
performance in accordance with her/his own particular likes ,dislikes or
habits this could cause difficulties in terms of equity and consistency
especially if there were more than one examiner assessing the same kill.
Problems would arise if student were not assessed objectively on their
competence but instead on how well their performance complied with the
examiner likes or dislike. You can see that if this were to happen the
assessment process would not be fair in fact it could be considered biased
towards the examiner. Therefore it is very important that the clinical exam is
free from any prejudice or bias in other words it need to be objective.
STRUCTURED
The letter ‘s’ stands for structure .to achieve objectivity in the
assessment of competency a clinical skill or procedure is typically broken
down into component parts in a very structured way.
Station in OSCE have a very specific task where simulated patients
are used to detailed scripts are provided to ensure that the information that
they give is the same to all candidates
Another way in which OSCE can be considered to be a structured form of
assessment in the way in which they are organized OSCE consists of
different types of assessment tasks we will consider the most typical OSCE
,which consist of a circuit of short activities, each of must be performed at a
 different station student assessed at each station by the examiner by using
pre determined objective marking sheets
CLINICAL
A clinical examination the OSCE is designed to apply clinical and
theoretical knowledge, where theoretical knowledge is applied
To set the scene at the beginning of each station ,the student will be given a
short scenario to read. This will provide the information necessary to
establish the context in which the specific set of skills is to be performed and
will identify the skills being examined.
EXAMINATION
An examination is the process of testing competence or knowledge. As such,
in an OSCE, clinical competency is assessed by breaking it down in to
various components. In this way students are required to demonstrate not
only what they know but also how to perform a clinical skill.
PREPARATION
Preparing for OSCE is very different from preparing for an examination on
theory. In an OSCE clinical skills are tested rather than pure theoretical
knowledge. It is essential to learn correct methods and then practice
repeatedly until one perfects the method.

From acquiring knowledge to applying knowledge

Clinical performance

Demonstration
Understanding
Knowledge

Miller (1990)recommends that, in order to demonstrate competency ,knows how,

shows how, and does are necessary. This means, in terms of demonstrating clinical
competency, knowledge, competence, demonstration and clinical performance are
all important.
KNOWING, SHOWING, DOING, E.G: PAIN ASSESSMENT
As part of an OSCE, you were required to undertake a pain assessment on a
simulated patient, the examiner would assess you on the following clinical
competencies.
KNOWLEDGE
This is the bottom of triangle, indicating that is the most basic and broadest
component in the framework. It relates to having the appropriate knowledge that
underpins practice. Pain is a very complex Phenomenon. Because of this ,adequate
knowledge and understanding of the potential physiological , psychological and
motional elements of pain is required in order to effectively undertake a pain
assessment knowledge and understanding of the different types of pain and how
these may relate to an individual is also important.
UNDERSTANDING
This is the higher component in the framework because it depends on knowing
how to do something and understanding why it should be done in certain way. In
the given example, this would involve demonstrating knowledge and
understanding of how pain assessment can be effectively undertaken, including the
use of appropriate communication skills. Knowledge of different pain assessment
tools and how to use them is important. Likewise, knowing how to interpret data
obtained from a pain assessment is also essential.
DEMONSTRATION
This is a further step up in the framework because it depends on demonstrating or
showing how to do something. It requires familiarity with the process of pain
assessment and with demonstrating how to perform the assessment in a systematic
and structured way.
Clinical Performance
The performance or the ‘doing’ part is the most important and sometimes, most
challenging part .it requires integrating all three previous points and performing the
skill in a professionally competent way. In this example it includes communicating
with the patient, assessing pain using an appropriate method, documenting it and
interpreting the findings.
 If we consider the key requirements of an OSCE one has to recall that they
need to be objective and structured. To meet these requirement OSCE is conducted
in a simulated environment and all students are assessed in the same way, by
examiners using a structured checklist. It is also important that any actors playing
the role of a patient behave in a consistent manner. This will help to maximize
standardization and consistency of the examination
For example If a patient interview scenario was being used to asses
communication skills it would be important that the patient role player
communicates the same information to each student. Likewise if an actor patient
role player’s pulse was being measured as part of an OSCE station, it is important
that this is stable And free from any significant fluctuations that might compromise
standardization in practice such standardization is not possible as every patient is
different furthermore the environment is which they are cared for are also The
OSCE provides an opportunity for an assessment of competency within a
simulated environment however the doing part requires this competency to be
demonstrated in practice
TYPES OF OSCE
1 .OSCEs comprising a number of short stations within a circuit these are known
as short cases or multi-Station OSCEs used for the students in the beginning of the
program e.g. the OSCE may last an hour during which time students rotate around
six stations demonstrating a simple clinical skill at each station in this case each
station would be 10 minutes duration .
2. in addition to skills some OSCEs may also comprise knowledge stations which
number of skills are assessed referred as long cases or single stations and are most
commonly used for assessing competency in skills for final year students they are
typically used to competency in the integration of skills this type of OSCE may be
one hour long but comprise just one station lasting the whole hour or two stations
each one of 30 minutes duration As part of a long case knowledge may be tested
while a procedure is undertaken or after the skills component has been completed.
Example 1
A nursing student approaching the end of first year an OSCE has to be conducted
to assess clinical skills in the course that are fundamental to nursing practice it is
likely that the OSCE for this student would focus on the assessment of competence
in a range of fundamental skills taught and above all the student would be required
to demonstrate knowledge of key principles such as safety and accuracy in this
type of OSCE the stations would be developed with a focus on discrete skills such
as aseptic technique hand washing technique measurement of vital signs first Aid
etc rather than on the more complex integration skills .
Example 2
For final year students the clinical component of the course requires to demonstrate
competency in skills related to clinical Specialties in that academic year it that
academic year it is likely that the OSCE for this course would focus on assessing
competence in the skills learnt but also be expected to demonstrate the integration
of those skills like the ability to effectively answer any questions in the scenario
may ask. In other words, the OSCE is designed to assess competency in skills that
are fundamental to nursing practice and to so at different levels of complexity,
depending on what stage the student has reached in the program The first OSCE
is to assess how you perform the basic skills required for a range of different tasks
while later OSCEs assess how well you are able to integrate appropriate skills in
specific patient scenarios.
USING PEER ASSESSMENT IN FORMATIVE OSCE
 Peer involvement is beneficial to the students by promoting deeper learning
as they increase their effort knowing peers will be evaluating their work and
by making students rethink their understanding of the skills in order to be
able to provide appropriate feedback. Providing peer feedback prepares
students for professional practice where assessment of peers and students is
expected.
 Peer assessment using formative OSCE provides the student with a clear
understanding of the performance criteria required for clinical practice.
 Peer involvement in teaching and learning helps by improving the success of
student learning and empowering students to progress through feedback.

BOOK REFERENCE

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Delhi. Jaypee Brothers Medical publishers (p) ltd
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JOURNAL REFRENCE:

1. ‘ NURSE EDUCATION TODAY’ volume 28, issue 2, Fibruary 2008,

Page –131-260, ELSEVIER publication.
2. ‘ Nurse Educator ‘ Volume 33, Number 3, sebtember/Oct 2008,
Lipppincott Williams & wilkins
3. ‘Nurse Education in Practice ‘ Volume 13, issue 3,May 2013, Pages 155-
234, ELSEVIER publication

NET SOURCE :-

 www.Wikipedia.org
 www.google.com
 www.medind.com