Objective Structured Clinical Examination (OSCEs Home)

What is Objective Structured Clinical Examination (OSCEs)? 

Objective Structured Clinical Examination (OSCEs) is a form of performance-based testing used to measure candidates’ clinical competence.  During an OSCE, candidates are observed and evaluated as they go through a series of stations in which they interview, examine and treat standardized patients (SP) who present with some type of medical problem.

The hallway of OSCE exam rooms, each occupied by a uniquely challenging patient, is a familiar milieu to the physician or other healthcare professional. When standardized patients (SPs) are utilized in OSCE exams, the linear sequence of the multiple station and skill challenges bears remarkable similarity to that real environment.  

Since the first paper written about the "programmed patient" in the mid-1960's over 1500 papers have been published that deal with teaching or assessment using standardized patients better known now as Objective Structured Clinical Examination (OSCEs).

“The OSCE is an approach to the assessment of clinical competence in which the components of competence are assessed in a planned or structured way with attention being paid to the objectivity of the examination” Harden, 1988 .

OSCE is a form of multi-station examination for clinical subjects first described by Harden et al from Dundee (1975). It was first reported from Dundee and Glasgow (Harden and Gleeson, 1979). It was firstly adopted in North America in a widespread manner. Then widely adopted in the UK in the 90s. The principle method for clinical skills assessment in medical schools and licensure bodies across USA, Canada, UK, Australia, New Zealand and other countries, is now the OSCE.

Objective Structured Clinical Examination (OSCEs) has proved to be so effective that it is now being adopted in disciplines other than medicine, like dentistry, nursing, midwifery, pharmacy and event engineering and law.

“The OSCE examination tests a wide range of skills thus greatly reducing the sampling error. This very significantly improves the reliability of the examination” Harden, 1988.

“The real power of this type of examination lies in the ability of those responsible for teaching and testing to examine their trainees with imagination and forethought, in a reliable way, in areas seldom or never tested before” Hart, 2001.

The curriculum tells the staff what to teach.... 

The OSCEs tells the students what to learn !

Features of the Objective Structured Clinical Examination (OSCEs)

• Stations are short, 

• Stations are numerous 

• Stations are highly focussed , candidates are given very specific instructions

• A pre-set structured mark scheme is used hence…

•  …reduced examiner input and discretion

Emphasis on:  

• What candidates can do rather than what they know

• The application of knowledge rather than the recall of knowledge

Typically…

• 5 minutes most common (3-20 minutes)

• (minimum) 18-20 stations/2 hours for adequate reliability

• Written answer sheets or observer assessed using checklists

• Mix of station types/competences tested

• Examination hall is a hospital ward

• Atmosphere active and busy

Additional options…

• Double or triple length stations

• Linked stations

• Preparatory stations

• “Must pass” stations

• Rest stations

How is the OSCEs done? The exam day

Although OSCEs are performed in  many settings in regard to the exam purpose, the organizing institution, and available facilities, they all share similar procedures. On the examination day, you will go through the following steps in sequence:

   1. Registration: The first step is the registration. You will :

• Show your examination invitation card and an identification.
• Be reminded about the exam rules.
• Be checked for things which are allowed and other not allowed things.
• Receive your exam envelope which contains your ID badge, stickers, a pencil, a notebook o clipboard (both with numbered blank papers),.. etc.

   2. Orientation: The next step is orientation. An orientation video may be shown. Here:

• Exam format, procedures and polices will be reviewed.
• Introduced to your team and team leader.
• Instructed about your starting station and how to proceed.
• Your questions will be answered (and not allowed beyond this step).

   3. Escorting to exam position: Now it is exam time.

You will be escorted to your station. You will stop by the assigned room door until a long bell / buzzer announces the start of the exam.

   4. Station Instruction Time: 

This is one or two minutes to read the instruction about this station situation, patient, and required tasks. Read carefully. At the next bell / buzzer enter the room.

   5. The Encounter: 

Start your encounter with the SP. This is a 5-20 minute encounter. Perform the required tasks. Stop at the next bell / buzzer.

   6. Post Encounter Period: Next is a question period.

There are some differences here. Some OSCEs will have no post encounter periods. Some will have one or two minutes of the encounter period assigned to an oral questions asked by the examiner inside the exam room. No more communication is allowed with the SP. Others have written questions to be answered on paper or computer outside the exam room for 5-10 minutes. At the next long bell / buzzer, the first station ended as well as the next station has started. You have to proceed to the next station quickly as it is the same long bell / buzzer at step 4.

   7. Repeat Steps 4 to 6:

Steps 4 to 6 will be repeated until you have been in all the stations. Some OSCEs will offer one or two short rest periods.   

   8. Exam ended / Escorting to dismissal area: The exam is over.

You will be escorted back to the dismissal area for signing out. You will be asked to handle back all what you had received on signing in, the ID badge, remaining stickers, all the papers, and the pencil. You may also be asked to stay without outside contacts for some time (sometimes hours) for exam security reasons. 

It is a stressful exam, right?!.. But you will make it just fine if you prepare for it and practice, practice, practice..!

Definitely you will be through many OSCEs throughout your medical under and post education. So, you will face all the different OSCE formats. Thus, it is wise to prepare once for all and keep repeating practicing over and over... and your clinical and communication skills will improve more and more... one practice after another... and one OSCE after another!!

For detailed information of your OSCEs, check with its organizers.

For sample OSCEs and how to prepare for it you are in the right site!