A checklist of do's and don't for OSCEs - School of Medicine

An OSCE
Guide
For
Simulated
Patients
Byron McGuinness
1

Contents
Page 3: Introduction by Dr Emyr Benbow
Pages 4-5: The OSCE Examination
Pages 6-7: Standardised Patients
Pages 8-11: OSCE Do’s and Don’ts
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Introduction
It is very important that we assess the skills and knowledge of our
medical students during their training, especially before they
become qualified doctors. These assessments have to be fair to the
students, so we mustn’t fail those who deserve to pass. They must
also be fair to the patients as these students will soon be young
doctors, so we mustn’t pass those who deserve to fail, or require
additional training.
Our simulated patients have a very important role to play in these
assessments, and Manchester Medical School is justifiably proud of
their contribution.
We were pioneers in the use of simulated patients many years ago
and we continue to expand and develop the role. We have also used
OSCEs for many years. External examiners, who are senior
examiners from other universities, consistently praise the high
standard of our simulated patients in OSCEs. We want to maintain
and improve our excellent reputation. To help us do this, Byron has
produced this guide. I think it is very helpful and recommend you to
read it carefully.
We always welcome suggestions for improvement, so if you think
there is any aspect of our OSCEs which needs to change, please
speak to Byron.
I look forward to seeing you at our OSCEs.
Dr Emyr Benbow
Academic Lead for Assessment
Manchester Medical School
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The OSCE Examination
What is an OSCE?
OSCE stands for:
Objective
Structured
Clinical
Examination
The OSCE examination was first devised in the mid 1970’s by Dr R
Harden (now Professor), and his colleagues at Dundee University
Medical School. OSCEs take place in many medical schools in over 50
countries across the world including the UK, USA, Canada and
Australia.
The OSCE
The structure of the OSCE involves a range of skills being assessed at
what are called ‘stations’. These range from clinical skills such as
interpreting an x-ray, taking someone’s blood pressure to prescribing
medication and examining various body systems. There are also
communication stations at which students are assessed in terms of
their ability to interact and communicate with a ‘simulated’patient.
Testing each student across a range of skills makes it is possible to
build up a detailed picture of their overall strengths and weaknesses
How does it work?
Each student visits the same series of stations during an OSCE, with
each station lasting 8 minutes. There is a gap of just one minute
between each student. The examiner will grade the student during that
gap.
Why is it Objective?
It is because each student is assessed using standardised marking
principles and a specific mark scheme that can be applied by an
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examiner, irrespective of where the examination takes place. For
example, the OSCEs taken by our students in years 3-5 occur on four
different sites: Preston Royal Infirmary, Manchester Royal Infirmary,
Salford Royal Hospital and Wythenshawe Hospital. The OSCEs taken by
our first and second years involve examiners assessing the same
scenario at the same time in different rooms at the Stopford Building.
One of the strengths of the OSCEs is that they assess, in an objective
way, what it is that a medical student can do rather than just what
they know.
How are communication skills assessed?
Communication skills are assessed using ‘standardised’ patients who
are interviewed by a medical student for a defined period of time. The
interviews are observed by examiners who use a common marking
guide.
There are basically two types of communication stations.
History stations
The student is required to take a medical history from a Standardised
Patient (SP), who will have been trained and provided with a scenario
and character profile prior to the day
Explanation and planning stations
Here, the student is asked to explain a procedure or perhaps seek
consent for a procedure that the standardised patient’s character may
need. The student may also be required to share information with the
patient as part of the explanation. Another typical task is to explain a
diagnosis and potential treatment.
As well as being examined for medical accuracy, each student is
assessed on their ability to communicate effectively with a ‘simulated’
patient. So such qualities as empathy and ‘patient-centeredness’ are
key aspects in the assessment of each student’s performance. Other
key skills that are assessed include opening and closing an interview,
different questioning styles, and the ability to summarise and to
structure a consultation in a logical way.
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Standardised Patients
What is a standardised patient?
Standardised Patients are members of the public who are asked to role
play a character who may have medical issues and concerns. Each
standardised patient is provided with a scenario/script that will outline
the medical history of the character as well as important biographical
details, aspects of the character’s social history and their underlying
concerns.
Confidentiality
The scripts that you receive for an OSCE are part of the examination
and should be kept completely confidential. Also, it is really important
that you refrain from discussing the scenario on the day with other
people, for example, students who may be acting as volunteers for the
OSCE.
Training
It is important that the portrayal of a patient and the information that
is given in response to the students’ questions is standardised by
everyone who plays the same character on an OSCE day. To facilitate
this, you will be asked to attend a training session at the Medical
School. The purpose of the training session is to discuss the scenario
and deal with any issues that may not be clear in the script. At the
training session you will also have the opportunity to role play the
scenario with the other people who will be doing the same scenario(s)
as you at one of the other hospital sites.
Will I be marking the students?
For the majority of the examinations you won’t be marking. However,
you will be asked to mark in the first and second year exams, as well
as the examination the third year students do in January.
What else do I need to know?
In general terms, you will be asked for your availability to work
approximately 6 weeks before the OSCE takes place.
How long does an OSCE last?
An OSCE exam can be run over several days depending on the number
of stations needed to examine all of the skills relevant to that year
group.
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How long is an OSCE day?
The OSCE day varies in length. It is possible that you may have to
work until about 5pm. It is likely that you will be asked to arrive at the
hospital where you are going to work at approximately 8.30am.
How do I get paid?
You will be asked to sign an attendance sheet at the hospital where
you are working. Your fee will be paid into your bank account within
two weeks of doing the work.
Where do I go on the day?
In the pack that you receive for each OSCE there will be a sheet giving
you information about where within the hospital you should go. You
will also be provided with information about the length of the day and
an emergency contact telephone number to use if you are delayed on
the day or have any other problems with arriving on time.
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OSCE Dos and Don’ts
All the following points came from the SPs who attended the OSCE
training session for the Year 3 exams in February 2009. Thank you to
all who contributed.
Prior to the day
Do
-learn the role thoroughly in order that you can be a credible character
for the students
-keep the scenario confidential
Don’t
-add details that will change the emphasis of the script
-discuss the role with others or let others see the details of the
scenario
On the day
Do
-arrive on time
-confer with other SPs playing the same role and with your examiner in
order to ensure standardisation
-be suitably dressed for the character/situation
-switch off your mobile telephone
Don’t
-leave your scenario lying around for others, such as students, to pick
up and read.
You and the Examiner
Do
-talk to the examiner prior to the exam about what is required
-check with the examiner to ensure you are being consistent
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Don’t
-let the examiner change the script
-let the examiner’s mark influence your mark. They may well be
looking for different things to you
You and the candidate(s)
Do
-remember that the students will be nervous
-come fresh to each candidate
-challenge jargon
-give each student the opportunity to succeed
Don’t
-react subjectively to the candidate
-make personal remarks about the candidates or talk about the
students after they leave the OSCE station. You may be overheard
The Exam
Do
-be consistent/standardised
-stick to the script/ follow instructions on the script
-be aware of time constraints
-stay in character/role
-listen for cues and prompts
-give appropriate cues
-remain professional and discrete at all times, especially at the end of
an interview as the student is leaving
Playing the role
Do
-use appropriate body language
-be clear in what you say or do
Don’t
-get too emotionally involved in the role at the expense of the
interview
-over act
-talk too much or take over the conversation
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-use misleading body language
-allow personal likes or dislikes to interfere with your portrayal
Responding to questions from the student
Do
-give correct information when asked
-get to the point quickly
-answer all questions
-respond appropriately
-respond with yes/no or minimum amount of information if asked a
closed question
-ensure that symptoms are given if requested by a student
-reward open questions
-keep to known facts. If it isn’t in the script the answer to a question
should be ‘No’ or ‘I don’t know’
-listen to the student to ensure that you answer the correct question
-answer the question that is asked and no more
Don’t
-linger on irrelevant questions
-give too much information too soon
-go off at a tangent
-give too much information all at once
-feel it is your responsibility to assist a student if they miss something
in their questioning
-be inconsistent
Marking (If required)
Do
-be objective in your marking
-treat each candidate as an individual when marking
-remember to be objective
Don’t
-base your mark on a small part of the interview. Think of the entire
consultation
-base your mark on how a student looks or dresses. If you think the
student’s dress was inappropriate, indicate your view to the examiner,
discretely, after the student has left the station.
Byron McGuinness
10

October 2010
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