Structured Clinical Examination
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
better known now as Objective Structured Clinical Examination
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
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
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
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.
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”
The curriculum tells
the staff what to teach....
OSCEs tells the
students what to learn !
Features of the Objective Structured
Clinical Examination (OSCEs)
Stations are short,
Stations are numerous
Stations are highly focused
, candidates are given very
A pre-set structured mark scheme is used hence…
…reduced examiner input and discretion
5 minutes most common (3-20 minutes)
(minimum) 18-20 stations/2 hours for adequate reliability
Written answer sheets or observer assessed
Mix of station types/competences tested
Examination hall is a hospital ward
Atmosphere active and busy
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
- 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
- Introduced to your team and team leader.
- Instructed about your starting station and how
- 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
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
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!