OSCE - AMEE

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U P D AT E O N
THE OSCE
Useful resources on MedEdWorld
Dr Catherine Kennedy, AMEE Projects Officer
GLOSSARY
A database of the expanding
vocabulary used in medical education
Objective Structured Clinical Examination (OSCE): Introduced by Harden in 1972, the OSCE provides
a standardised means to assess clinical competencies, including physical examination and history-taking skills,
communication skills with patients and family members, breadth and depth of knowledge, ability to summarise
and document findings, and ability to make a differential diagnosis or plan treatment. The examiners carefully
plan the tested areas and objectives of the test are identified and recorded. The clinical competency to
be tested is broken down into its various components such as taking a history, auscultation of the heart,
interpretation of an ECG, or making a conclusion on a basis of findings. Candidates rotate through a series of
“stations”, usually 10-20, and in a specified time perform a standardised task.
The format of individual OSCE varies significantly. Real patients, clinical mannequins and standardised
patients or simulated patients can be used and large numbers of students can be tested on the same clinical
problem. Direct or indirect observations as well as checklists and rating scales measure the performance
against predetermined standards resulting in a more objective examination than with traditional methods.
This provides a more valid and more reliable examination permitting the move away from testing factual
knowledge to testing a wide range of skills. The variables of the examiner and the patient are, to a large
extent, removed. The OSCE is particularly suited to situations where a pass/fail decision has to be taken and
where a decision has to be made as to whether a student has reached a prescribed standard. It is costeffective when many candidates are examined at once. It requires resources and expertise to administer.
Reference: Adapted from Wojtczak, A. (2003) Glossary of Medical Education Terms. AMEE Occasional Paper No 3. Dundee: AMEE.
The MedEdWorld Glossary can be accessed at www.mededworld.org/Glossary.aspx
WEBINARS
Hour-long interactive presentations
with experts in medical education
Measurement and improvement of the OSCE: Recognition and remediation of
station level problems (part 1)
Date: 2013
Presenters: Richard Fuller and Godfrey Pell
Host Institution: School of Medicine, University of Leeds, UK
www.mededworld.org/Webinars/Webinar-Items/Webinar-70-Fuller-Pell-23-02-13-0900hrs-N.aspx
Part 1 in this Webinar mini-series concentrates on common OSCE standard setting techniques, with special
reference to the borderline methods, and discusses the use and interpretation of a variety of psychometric
indicators using ‘real’ data.
Measurement and improvement of the OSCE: Recognition and remediation of station level problems
(part 2)
Date: 2013
Presenters: Richard Fuller and Godfrey Pell
Host Institution: School of Medicine, University of Leeds, UK
www.mededworld.org/Webinars/Webinar-Items/Webinar-71-Fuller-Pell-05-03-13-0900hrs-N.aspx
Part 2 of the mini-series uses a range of ‘diagnostic’ exercises to assist participants to gain confidence in
interpreting station level metrics and remediation of station level problems.
www.mededworld.org
www.amee.org
TEXTBOOKS
Harden, R.M., Stevenson,M., Downie,W.W. and Wilson, G.M. (1975) Assessment of clinical competence
using objective structured examination. British Medical Journal, 1975:1, pp.447-451.
www.mededworld.org/Publications/Articles/Assessment-of-clinical-competence-using-objective.aspx
Seminal article introducing the OSCE as a method of clinical assessment.
A selection of texts recommended
on MedEdWorld
Akunjee, M., Akunjee, N., Siddiqui, S. and Mallick, A. (2010) The Easy Guide to OSCEs for
Communication Skills. Milton Keynes: Radcliffe Publishing Ltd.
www.mededworld.org/Publications/Textbooks/The-Easy-Guide-to-OSCEs-for-Communication-Skills.aspx
Simplifies and explains key communication theories and concepts, illustrating them through practical role plays.
Homer, M. and Pell, G. (2009) The impact of the inclusion of simulated patient ratings on the reliability
of OSCE assessments under the borderline regression model. Medical Teacher, 31:5, pp. 420-425.
www.mededworld.org/Publications/Articles/The-impact-of-the-inclusion-of-simulated-patient-r.aspx
Analyses whether and how exactly SP data can be best used to enhance the robustness of the formal standard
setting process.
Boursicot, K., Etheridge, L. Setna, Z., Sturrock, A., Ker, J., Smee, S. and Sambandam, E. (2013) “ Clinical
Competence Assessment”, in McGaghie, W.C. (Ed) International Best Practices for Evaluation in the
Health Professions. London: Radcliffe Publishing Ltd.
www.mededworld.org/Publications/Textbooks/International-Best-Practices-for-Evaluation-in-the.aspx
Contains a section discussing the OSCE, including aspects of reliability and validity.
Patrício, M.F., Julião, M., Fareleira, F. and Vaz Carneiro, A. (2013) Is the OSCE a feasible tool to assess
competencies in undergraduate medical education? Medical Teacher, 35:6, 503-514.
www.mededworld.org/Publications/Articles/Is-the-OSCE-a-feasible-tool-to-assess-competencies.aspx
This article reviews the evidence on the technical and economic feasibility of the OSCE in undergraduate
medical studies.
Burton, N. (2011) Clinical Skills for OSCEs. Oxfordshire: Scion Publishing Ltd
www.mededworld.org/Publications/Textbooks/Clinical-Skills-for-OSCEs.aspx
A concise and comprehensive guide of clinical skills for OSCE stations.
Pell, G., Fuller, R., Homer, M. and Roberts, T. (2012) Is short-term remediation after OSCE failure
sustained? A retrospective analysis of the longitudinal attainment of underperforming students in
OSCE assessments. Medical Teacher, 34:2, pp. 146-150.
www.mededworld.org/Publications/Articles/Is-short-term-remediation-after-OSCE-failure-susta.aspx
Investigates the longitudinal performance of the UK undergraduate medical degree students, with a particular
focus on comparing the poorly performing with the main cohort of students.
Etheridge, L. and Boursicot (2013) “Performance and workplace assessment” in Dent, J.A. and Harden,
R.M.(Eds.), A Practical Guide for Medical Teachers (4th Ed.) London: Churchill Livingstone Elsevier.
www.mededworld.org/Publications/Textbooks/A-Practical-Guide-for-Medical-Teachers-%284th-Ed-%29.aspx
Chapter includes discussion of the OSCE and other assessments of clinical competence.
Pell, G., Fuller, R., Homer, M. and Roberts, T. (2010) How to measure the quality of the OSCE: A review of
metrics - AMEE Guide No.49. Medical Teacher, 32:10, pp.802-811.
www.mededworld.org/Publications/Articles/How-to-measure-the-quality-of-the-OSCE-A-review-of.aspx
The authors review the metrics available for measuring quality and indicate how a rounded picture of
OSCE assessment quality may be constructed by using a variety of such measures, and consider which
characteristics of the OSCE are appropriately judged by which measure(s).
Dornan, T. and O’Neill, P. (2006) Core Clinical Skills for OSCEs in Medicine. Philadelphia: Churchill
Livingstone Elserveir.
www.mededworld.org/Publications/Textbooks/Core-Clinical-Skills-for-OSCE-in-Medicine.aspx
An invaluable aid for everyone preparing for clinical practice and the associated OSCE examinations.
Harden, R.M. and Laidlaw, J.M. (2012) Essential Skills For A Medical Teacher. Edinburgh: Churchill
Livingstone Elsevier.
www.mededworld.org/Publications/Textbooks/Essential-Skills-for-a-Medical-Teacher-An-Introduc.aspx
Chapter 30 provides an overview of the OSCE and other approaches to clinical assessment.
Preusche, I., Schmidts, M. and Wagner-Menghin, M. (2012) Twelve tips for designing and implementing
a structured rater training in OSCEs. Medical Teacher, 34:5, pp.368-372.
www.mededworld.org/Publications/Articles/Twelve-tips-for-designing-and-implementing-a-struc.aspx
These 12 tips were developed as a result of a tailored rater training programme.
Hodges, B. (2009) The Objective Structured Clinical Examination: A Socio-History. Saarbrücken:
Lambert Academic Publishing.
www.mededworld.org/Publications/Textbooks/The-Objective-Structured-Clinical-Examination-A-So.aspx
This Foucauldian socio-history explores how discourses of performance, psychometrics and production have
legitimised the widespread adoption of OSCEs.
Trowbridge, R.L., Snydman, L.K., Skolfield, J., Hafler, J. and Bing-You, R.G. (2011) A systematic review of the
use and effectiveness of the Objective Structured Teaching Encounter. Medical Teacher, 33:11, pp. 893-903.
www.mededworld.org/Publications/Articles/A-systematic-review-of-the-use-and-effectiveness-o.aspx
The Objective Structured Teaching Encounter (OSTE) has been proposed as a means of promoting and
assessing the teaching skills of medical faculty. This paper describes the uses of the OSTE and the evidence
supporting its effectiveness.
Hurley, K.F. (2011) OSCE and Clinical Skills Handbook (2nd Ed.). Toronto: Elservier Saunders.
www.mededworld.org/Publications/Textbooks/OSCE-and-Clinical-Skills-Handbook-%281%29.aspx
Summarises important history and physical examination skills, presenting the information in a Q & A format.
Webb, E.A., Davis, L., Muir, G., Lissauer, T., Nanduri, V. and Newell, S.J. (2012) Improving postgraduate
clinical assessment tools: The introduction of video recordings to assess decision making. Medical
Teacher, 34:5, pp.404-410.
www.mededworld.org/Publications/Articles/Improving-postgraduate-clinical-assessment-tools-T.aspx
Explores competency in the management of acutely unwell patients using an objective structured clinical
examination (OSCE).
Zabar, S., Kachur, E., Kalet, A. and Hanley, K. (2012) Objective Structured Clinical Examinations: 10 Steps
to Planning and Implementing OSCEs and Other Standardized Patient Exercises. New York:Springer.
www.mededworld.org/Publications/Textbooks/Objective-Structured-Clinical-Examinations-10-Step.aspx
This book serves as a comprehensive how-to manual for planning and implementing OSCEs and addresses
the need for best practice guidelines.
JOURNAL ARTICLES
RESOURCES
A selection of key articles recommended
by the MedEdWorld Community
Resources contains over 300 images, video clips, websites and conference presentations that
may be incorporated into lectures, including:
Burgess, A., Clark, T., Chapman, R. and Mellis, C.(2013) Senior medical students as peer examiners
in an OSCE. Medical Teacher, 35:1, pp. 58-62.
www.mededworld.org/Publications/Articles/Senior-medical-students-as-peer-examiners-in-an-OS.aspx
Reports on the use of peer assessment using a practice OSCE at Sydney Medical School.
The OSCE Examiner: Training and Development
www.mededworld.org/Resources/Resources-Items/OSCE-Training-website.aspx
A valuable web tool for OSCE examiners from Queens University, Belfast, The OSCE Examiner
features a Global Scoring Exercise, as well as a Dilemma Sorter as resources for examiners.
Gormley, G.J., Johnston, J., Thomson, C. and McGlade, K. (2012) Awarding global grades in OSCEs:
Evaluation of a novel eLearning resource for OSCE examiners. Medical Teacher, 34:7, pp. 587-589.
www.mededworld.org/Publications/Articles/Awarding-global-grades-in-OSCEs-Evaluation-of-a-no.aspx
Reports on a novel online resource developed to aid OSCE examiner training, involving a series of videos of
OSCE performances that allow inter-examiner comparison of global grade decisions.
www.mededworld.org
Including reports, websites, video clips,
images and diagrams.
www.amee.org
www.mededworld.org
www.amee.org
LEARNING TECHNOLOGY
Recommended to support teaching,
learning and assessment
CliniQuest OSCE Software
www.mededworld.org/Learning-Technology/Equipment-Items/CliniQuest-OSCE-Software.aspx
CliniQuest can be used to create individual station or assessment sheets, with candidate response
interpreted by Speedwell’s OSCE software CliniQuest and Optical Mark Reading (OMR) technology.
eOSCE : A three component digital OSCE process
www.mededworld.org/Learning-Technology/Equipment-Items/eOSCE-A-three-component-digital-OSCEprocess.aspx
The Electronic Registration of Objective Structured Clinical Examination (eOSCE) aims to create a more
efficient and entirely digital preparation, execution and analysis process of OSCEs which is less erroneous
and quicker to evaluate.
moscee
www.mededworld.org/Learning-Technology/Equipment-Items/Moscee-For-OSCE-examiners.aspx
moscee is an application designed to run on mobile devices such as the Apple iPhone™.It can be used to
set up an OSCE exam, mark and collate the results.
OSCEonline
www.mededworld.org/Learning-Technology/Equipment-Items/OSCE-Online-Free-iPad-demo-app-for-OSCE.aspx
A free iPad demo app for conducting online paperless Objective Structured Clinical Examinations (OSCE).
Qpercom: OSCE Solution
www.mededworld.org/Learning-Technology/Equipment-Items/Qpercom-OSCE-Solution.aspx
An OSCE Management Information System (OMIS) which allows universities to create forms, administer
OSCEs and analyse results.
FORUMS
A space for debating a wide range of topics of
current interest to the health professions.
eLearning for OSCE
www.mededworld.org/Forums/f129/t2579/e-learning-for-OSCE.aspx
Post you queries, ideas and suggestions about eLearning for OSCE here for
discussion with colleagues.
You can also add your recommendations on topics to a forum for upload into the
MedEdWorld site.
POLL
Our survey said…
Which do you use in an OSCE: Real patients or standardised/ simulated patients?
www.mededworld.org/News/News-Articles/Poll-Results-Which-do-you-use-in-anOSCE.aspx
The results of our June survey revealed that 55% of respondents reported that they
used both real patients and standardised/ simulated patients for the OSCE, whilst 45%
use standardised/ simulated patients only. None of the respondents used only real patients.
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