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
 1. K.P.Neeraja.(2003), “Text book of Nursing Education”. I edition, New Delhi. Jaypee
Brothers Medical publishers (p) ltd
2. B. Sankaranarayan.(2009), “Learning and teaching Nursing”. III edition, calicut.
Brainfill publications,
3. B.T. Basavanthappa. 2003, “Text book of Nursing Education. First Edition, New Delhi.
Jaypee brothers Medical publishers (p) ltd
4. K.L.Kumar. (2008), “Educational technology” II edition. New Delhi. New age
international (p) ltd publishers.
5. I.clement. (2008), “text book on communication and educational technology, I edition,
Bangalore Emmess Medical Publishers, .
6. Loretta and Hedjerkhans. (1999), “Teaching and learning in schools of nursing, 7th
edition, Delhi, Konark publications
7. Lynne Eyoung and Barbara. (2007), “Teaching Nursing” 9th edition, philedelphia,
Lippincott Willam & Wilkins publication,

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