BREIFING ON OSCE

BREIFING ON OSCE
Nagy Sayed-Ahmed

The Objectives of the programme
Essential to the practice of medicine –
Knowledge:
Normal and abnormal structure and function
Pathogenesis and epidemiology
Presentation and diagnosis
Prevention and management
Skills:
Clinical method
Basic clinical procedures
Attitudes and Competence needed to practice medicine
as a pre-registration house officer

The Pillars of Education
Knowledge
Biomedical
Contextual
Intellectual
Skills
Communicative
Procedural

Why to Examine?
Assurance of competency
Ranking students for competition
for posts
Educational impacts…..
Others !!!!!!

Lecture
Clinical
Seminars
Knowledge
Understanding
Essays, SEQs,
MCQs, Viva
Skills lab/
Clin Training/
others
Skills
Attitude
Clinical,
OSCE,
OSPE, WPA

Education Process:
What are you assessing?

Clinical Sems – Exams & Marks
Item
Midterm MCQs (2 or 3)
SSC/Presentation & Active
Attendence
Final MCQs/EMQs
Final OSCE
Final Short Essay
Total
Marks
60
70
200
200
120
650

Is it a valid examination?

Is it a reliable examination?

What educational impact will it have?

Is it feasible?

OSCE/OSPE - Format
Observed Structured Clinical Examination / Objective Structured
Practical Examination
Different stations - each testing a specific clinical skill in a set time
One examiner observes and assess each candidate at each station
whilst remaining at the same station for the whole cycle
Circuit- The passage of the candidates through the carousel of the
number of stations
Cycle is the number of times the examination is run on a give diet
Candidates start the examination at a specific station, then progress
through the other stations

WHAT IS AN OSCE?
This is an assessment format in which the candidates
rotate around a circuit of stations, at each of which
specific tasks have to be performed, usually involving
a clinical skill, such as
History taking or
examination of a patient
Communication, Ethics & Attitude
Data interpretation
Preceedure perfection
The marking scheme for each station is structured and
determined in advance.

Advantages & disadvantages

Improving standards – 1
Format
•Structured interaction between examiner and candidate
•Patients participating should have real physical signs
•Patients relate their own history (may have some details
modified to fit the scenario)
•Surrogate or simulated patients - learnt the scenario and
history to be discussed and related to the candidate
•Surrogate patients - have no abnormal physical findings
Format Examiners

Improving standards – 2
Marking
•The marking scheme for each station is
structured
•Weighting
•Global vs. checklist scoring
•Discussion of marking inconsistencies
Examiners
• Examiners must understand the principles of
OSCEs

Practicalities of OSCE
• Suitable venue
• Adjoining rooms
• Big hall with partitions
• Room for students to gather before exam
• Room to brief examiners
• Rest room for patients

Recruitment
• Examiners
• Patients
• Simulated patients
• Administrative support

DESIGNING A CLINICAL EXAMINATION SKILLS
OSCE Station
Consider the curriculum and assessment
objectives
Write instructions for site organisers
Write instructions for examiners
Write instructions for patients or volunteers
Write marking criteria

Matching Curriculum to Assessment:
Blueprinting

On the Day
• Admin to supervise students waiting
• Admin to check examiners all present
• Admin to look after patients/SPs -
?nurse
• Helpers for ‘emergencies’
• Timing system
• Refreshments

Preparation
• Decide running order for stations
• Prepare order for students
• Obtain equipment for each station
• Produce mark sheets

CONSIDER THE CURRICULUM /
ASSESSMENT OBJECTIVES
What are the index clinical situations relevant to
this question?
Which year group is this question designed for?
Year 4
Year 5
Year 6

WRITE INFORMATION FOR SITE
ORGANISERS
What resources are needed?
Real patient or healthy volunteer
If real, full details of condition
m or f or either?
What age range is appropriate?
Any other issues (eg ethnicity)?
Any other resources needed for this station?
Setting up the station
Timing
• 8 minutes
Standard guidance (amend if needed)
The couch should be positioned in such a way to allow the candidate to
examine the ‘patient’ from the patient’s right side
Facilities for handwashing/alcogel will be available

Station
Number
Code
(admin. use
only)
Description
Required logistics
1 MHx History taking (1) Desk, 3 seats
2 MExA Clinical Examination (1) Bed, 2 seats, bed sheet, hand cleaning gel
3 MExB Clinical Examination (2) Bed, 2 seats, bed sheet, hand cleaning gel
4 MD Data interpretation Desk, 2 seats
5 SExA Clinical Examination (3) Bed, 2 seats, bed sheet, hand cleaning gel
6 SPh Photographic material (1)
Desk, 2 seats, PC or laptop (windows operated,
MS office)
7 SExB Clinical Examination (4) Bed, 2 seats, bed sheet, hand cleaning gel
8 UHx History taking (2) Desk, 3 seats
9 UPh Photographic material (2)
Desk, 2 seats, PC or laptop (windows operated,
MS office)
10 UEx Clinical Examination (5) Bed, 2 seats, bed sheet, hand cleaning gel

WRITE INSTRUCTIONS FOR STUDENT
This is a 5 / 10 minute station, set in the
[Specialty: ] outpatient department / ward
/A&E / general practice.
This is [insert name of ‘patient’
Describe scenario if appropriate and task for
student

WRITE INSTRUCTIONS FOR PATIENT OR
ROLE PLAYER
Are there any instructions you need to
give to the patient?
eg what clothes to wear (and what
needs to be removed), how to
behave etc

Role play – Training & Briefing

DESIGN THE MARKING CRITERIA

Calibration
Examiners must review and discuss the patients prior to the examination.
This process, known as calibration, is essentially a standard setting
process, and is critical to the fair and consistent conduct of the
assessment.
Examiners should ensure that the problem described in each of the
scenarios is correct
•Examiners should rehearse the history and check the physical signs
•Examiners should agree which parts of the physical examination they
feel the candidate should undertake
•They should ensure that the patient or surrogate understands their role
•The requirements to pass each of the skills should be agreed by the
examiners.
•If the station’s scenario is felt to be unworkable a the reserve scenario
should be used.

What can go wrong?
• Examiners late or absent
• Patients ill or absent
• Too hot room
• Too much noise
• Candidate getting distressed

Examiner Briefing for OSCEs

Thank you!
• We appreciate your commitment
in time and effort
• Even if you have examined
many times before, we would
appreciate your attention for the
next few minutes

The objectives of the OSCE – 1
The main objective of most of the OSCE stations is
to evaluate the students skills.
Evaluate the students’ attitude, conduct, and
behaviour
Evaluate communication skills
Evaluate performance skills in history taking and
clinical examination
Proper data extraction and interpretation

The objectives of the OSCE – 2
Style of examination and/or ability to describe
clinical findings or appreciated normality
Ability of student to interpret and complement
findings to reach proper diagnosis and/or
management
Manual skills in diagnostic and therapeutic
maneuvers
Evaluation of the depth of knowledge and
information may be a 2ry but not a 1ry target

Check your station
• If your station contains patients or
simulated patients, check their story or
signs with them before the students arrive
• Do not alter the details of the simulated
patient’s story or the marking scheme as
this will impair standardisation across sites
• If your station needs equipment, check it
is all present and correct

How the station works
• Students read the instructions outside the
station
• They have 60 seconds to read them
• When they come in:
– Confirm their identity
– Let them start immediately
– Do not delay them by reading the instructions
again
• Let them leave as soon as the bell goes

The mark sheet
• These are comprehensively
prepared
• Fill in students’ names /numbers
• Fill in your own name and examiner
PIN number before the exam starts

The mark sheet
There are 3 parts:
• The ‘different sections’
• The overall global mark
• Written feedback
All sections are equally important

Marking the different sections
Based on your observation, decide how
completely the student has performed each
section
Do not adjust for difficulty of station or the
relative importance of each section; you are
recording what you observe
This information will be fed back to the
students, so it is vital each row is completed
Please use the full range of the marking
scheme

Written feedback
• There is a box at the bottom of the sheet
for written comments (please be legible!)
• This must be completed if you award a
mark of

Marking fairly
• The student should be unknown to you
• If you do know them for any reason,
please
judge them on how they perform today
• Do not be influenced by your previous
knowledge of their skills (good or bad)

Marking fairly
• Do not compare students with each
other
• Judge the student against the marking
scheme
• You are judging whether each student
is competent
• All could pass, all could fail at your
station

Judge carefully
• As a medical school, we are accountable
for our assessments
• By allowing a student to pass our
examinations, we are confirming that he/she
is competent to progress to the next stage of
medical training
• If you have doubts about a student’s
competence, please help us and them by
marking them as borderline or lower

You are not the final decision!
• No student will fail because they have
failed one station
• It is their overall performance across
the exam which counts
• However, if you observe worrying
behaviour, please make notes in the
feedback box and speak to the Site
Exam Lead after the exam

What we expect of you
Do
• Treat candidates
politely and
pleasantly
• Treat candidates
fairly and without
any discrimination
• Let them start and
finish on time
Don’t
• Turn it into a
teaching session
• Give candidates
verbal feedback as
to how they are
doing (good/bad)
• Let them see your
marks

Thank you!
We welcome suggestions for
improving the OSCEs further

5
4
3
2
1
start
10
9
8
7
6
END

10
9
8
7
6
5
4
3
2
1

1
2 3
4
5
Circuit
Manager
1
0
9
8
7
Resting
Station
6

And more importantly