The Objective Structured Clinical Examination (OSCE)

 

Background

    It is a modern type of examination often used in medicine to test skills such as communication, clinical examination, medical procedures, surgical techniques and interpretation of results.
     It has also been used to assess clinical skills performance in surgical residents as well as nursing.
    It normally consists of several short (5-10 minute) stations and each is examined on a one-to-one basis with either real or simulated patients or models. It is considered to be an improvement over traditional examination methods because the stations can be standardized enabling fairer peer comparison and complex procedures can be assessed without endangering patient’s health.
    One of the ways OSCE's are made objective is to have a detailed mark scheme and standard set of questions. For example a station concerning the resident’s needle handling technique would mark specific points of the process such as needle loading in the needle holder, creating an entrance, exit bite.
    There is however criticisms that the OSCE stations can never be truly standardized and objective in the same way a written MCQ can. It has been known for different examiners to afford more assistance and for different marking criteria to be applied - especially where different Training Laboratories are involved.
    Finally - it is not uncommon at certain institutions for members of teaching staff known to students and vice versa to assess students. This need not affect the integrity of the examination process although there is a deviation from anonymous marking.

Preparation

    Preparing for OSCEs is very different to preparing for a theory examination. What are being tested are skills rather than pure theoretical knowledge. The computer simulation is one way of accomplishing this, other one is to create a life like modeling situations that closely duplicates the procedure, using exact clinical equipment and instrumentation.
    Before the exam, it is essential to learn correct clinical methods and then practice repeatedly until one perfects the methods. Although the laboratory practice time is limited but it is adequate for a measurable progress in case of a motivated resident.
    Marks are awarded for each step in the method hence it is essential to dissect the method into its individual steps, learn the steps and then learn to perform the steps in a sequence, such as a correct square or surgeons knot tying.

 

 

Zoltan Szabo, Ph.D.,F.I.C.S.
MOET Institute, San Francisco