What is the OSCE Examiners' Checklist?

The Objective Structured Clinical Exams (OSCEs) cases cover common and important situations that a physician is likely to encounter in common medical practice in clinics, doctors’ offices, emergency departments, and hospital settings in real practice. Thus you are evaluated as if it is a real life practice. 

OSCE exams use standardized patients (SP), i.e., people trained to portray real patients. These SPs follow a certain script to play with you during the encounter. These scripts are written in details including patient general look, cloths, gestures, emotions, and all negative and positive answer. It also include any unexpected behaviors such as the SP turns agitated, upset, violent, restless, impolite, or leaves the room during the encounter.

As SPs follow strictly these scripts, OSCEs examiners also have a standard printed checklist or blueprint for each station that they have to fill out while observing you. These checklists are standardized to reduce examiners' bias. On these checklists, there are station specific points and a general performance points to be assessed. There are up to 40 points to be checked in each station. Some OSCEs may also include a checklist to be filled out by the standardized patient.

SPs will reveal information when specific related questions are asked. They wont voluntarily give you information as some times happens in real life patient encounters. For example, if you don't ask about all their medication now and in the past, they wont show you a printed list of their medication.

In some OSCEs, SPs are instructed to follow different paths or ask specific questions according to your performance. For example, turning uncooperative if you are not responding to their concerns or gestures.

What is the OSCE Examiners' Checklist?

Checklists are organized to assess the followings:

• Medical knowledge specific to this station, such us, symptoms, signs, associated factors, risk factors, prevalence, complications, prognosis, management plans, .. etc.

• Data gathering skills: Your way of patient information collection by history taking and physical examination.

• Documentation – completion of a patient note summarizing the findings of the patient encounter, diagnostic impression, and initial patient work-up.

 

• Communication and Interpersonal Skills: 

• Initiative of interview: acknowledgement of patient, introduces self, at ease, attentive to patient.
• Questioning skills: e.g., use of open-ended questions, transitional statements, confident and skilful questioning, appropriate language, use of different types questions, or awkward, exclusive use of closed ended or leading questions, jargon, interrupts patient inappropriately. 
• Information-sharing skills e.g., None given, avoidance of jargon, responsiveness to patient questions or concerns, provision of counseling when appropriate, confident and skilful at giving information, attentive to patient understanding; truthful.
• Professional manner and rapport e.g., Condescending, offensive, aggressive, judgmental, negative attitude to patient, or polite and interested, warm, polite, empathic, concern for patient's comfort and modesty, examinee's attention to personal hygiene, expression of interest in the impact of the illness.  
• Listening skills: Interrupts patient inappropriately, impatient, attentive to patient’s answers and concerns.
• Organization of interview: Scattered, shot-gun approach, logical flow, purposeful, integrated handling of encounter
• Closing: Abrupt, or acknowledges end of interview, or attempts closure, or clear closure, or organized, thoughtful closure.
• Ethical conduct: Markedly inappropriate or awkward handling of ethical issues, or considers and responds to ethical issues with care and effectiveness.
• Compliance optimization: Did the candidate do everything possible to optimize the patient’s compliance?

 

• Physical examination: no consent, awkward, uses jargon, no interaction or acknowledgment of patient, or clear, concise instructions, elicits consent to physical examination, at ease with patient.

• Attention given to patient's physical comfort: Inattentive to patient's comfort or dignity; e.g., no draping and/or causes pain unnecessarily, or consistently attentive to patient’s comfort and dignity.
• Organization of physical examination: Scattered, patient moved unnecessarily, logical flow,  purposeful, integrated handling of examination.

 

• Spoken English Proficiency: Clarity of spoken English communication within the context of the doctor-patient encounter (e.g., pronunciation, word choice, and minimizing the need to repeat questions or statements).

Are all of the above skills weighed equally in all stations?

Although you will be evaluated for all the above listed skills in each OSCE station, they are weighed differently from station to station. For example, an emergency station management of a comatose patient scenario will weigh medical knowledge and examination skills more than communication skills (up to 90%). While a long suffering depressed patient in a psychiatric scenario station will weigh communication skills up to 60-70% of the station mark.

You are expected to show all the above skills in 5 to 20 minutes!!

You need to be alert throughout the encounter to all of the above listed points and, yes, this is not easy but not impossible. You have to develop a a way to perform these OSCEs so that all the above points have been taken care of automatically and practice it so that it will be an eternal part of your future practice. Is that possible?... Yes it is!.. 

When you arrive home after a long day at your medical school or hospital (or in the future, at your practice), how many times did you wondered which way did you take driving back home?!! You didn't figure it out although you were sure it was the right safe way home and you did follow traffic laws and road ethics!!.

You don't need to look for what is the OSCE examiner checklist for each and every illness or symptom commonly seen in OSCE exams! 

Check the A Step By Step Guide To Mastering The OSCE to transform yourself into an autopilot efficient physician.

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