OSCE

1. OSCE O : OBJECTIVE S: STRUCTURED C : CLINICAL E: EXAMINATION

2. DEFINITION: An OSCE is a modern type of examination often used in the health sciences (e.g. medicine, nursing, pharmacy, dentistry) to test clinical skill performance and competence in skills such as communication, clinical examination, medical procedures, prescription-writing, manipulation techniques, and interpretation of results.

3. An OSCE comprises a series of short, timed stations or visual cues. Candidates respond objectively. All candidates take the same exam. This is an improvement over traditional exams because stations are standardized enabling fairer comparison. Complex procedures, techniques, etc. can be assessed without endangering patients (if applicable) or requiring the use of multiple cues.

4. What is an OSCE? • A multi-station, multi-task assessment process . . . . . • There can be clinical or practical tasks

5. What is OSCE? The candidates rotate through a series of stations at which they are asked to carry out a (usually clinical) task

6. اطاق قرنطینه ایستگاه1 B ایستگاه 1A SP condidate / observers ایستگاه2 B ایستگاه 2 A ایستگاه3 A ایستگاه3 B ایستگاه3 B ایستگاه4 A ایستگاه4 B ایستگاه5 A ایستگاه5 B خروج

7. Simulated Patient (Hx taking)

8. Simulated Patient(examination)

9. Video station

12. Why OSCE?

15. ؟ طب سنتی؟

16. ؟ طب سنتی؟

20. There is difference between knowing how to do something and actually being able to do it. OSCE with existing long case examination can fulfil the goal.

21. Professional authenticity Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7. Simple model of competence Does Shows how Knows how Knows

22. Does Knows how Knows Shows how Testing formats Professional practice Behaviour~ attitude/skills OSCEs EMQs, SEQs Cognition~ knowledge MCQs

24. Background about OSCE • Started in 1972 Dundee, Scotland by R. Harden and F.Glesson • First literature about OSCE 1975, BMJ • Used in undergraduate as well as postgraduate • Used in many disciplines

25. MODIFICATION OF OSCE OSLER:objective structured long examination record OSPE: objective structured practical examination OSVE: objective structured video examination OSTE: objective structured teaching evaluation OSPRE: objective structured performance-related examination OSSE: objective structured selection exam.

26. Characteristics of the OSCE • It is an assessment approach primarily used to measure clinical competence • Should be planned or structured (predetermined clinical competences) • Examination format or framework • Different types of test method can be incorporated into it

27. Characteristics of the OSCE (Cont.) • In most stations students are observed (by one or more examiners) • Scored as they carry out the task or interpret clinical materials (e.g.laboratory data, X-rays), write notes or answer question

28. Candidates are assessed using exactly the same stations or cues with the same marking scheme. Candidates get marks/points for each step that they perform/answer correctly. This makes the assessment of clinical skills more objective rather than subjective.

29. OSCE-Objective • All the candidates are presented with the same test • Specific skill modalities are tested at each station • History taking • Explanation • Clinical examination • Procedures

30. Objective • ارزیابیاستاندارد بر اساس رفتارهای بالینی معین

31. subjective objective Getting the balance right?

32. STRUCTURED • آزمون از پیش برنامه ریزی شده به گونه ای که هر یک از داوطلبان باسوالات و وظایف مشابهی روبرو هستند

33. OSCE - Structured • Structured interaction between examiner and student

34. Stations/cues have specific tasks. Where simulated patients are used, detailed scripts are provided to all candidates, including emotional data. Instructions are carefully written/spoken to ensure that candidates are given specific tasks to complete or questions to answer. The OSCE is carefully designed to include all elements of the curriculum.

35. Clinical Examination • هر یک از سناریو ها معرف یک وضعیت بالینی حقیقی است

36. OSCE – Clinical Examination • Test of performance of clinical skills • candidates have to demonstrate their skills, not just describe the theory

37. An OSCE is designed to apply clinical and theoretical knowledge. Where theoretical knowledge is required, questions are standardized.

38. Advantages of the OSCE • Valid examination • The examiners can control the complexities of the examination • Can be used with larger number of students • Reproducible

39. Advantages of the OSCE (cont) • The variable of the examiner and the patient are to a large extent removed • Fun activity within the department or college, which promotes team work

40. Disadvantages of the OSCE • Might be quite distressing to the student

41. Disadvantages of OSCEs • Costly • Time consuming to construct & administer • Needs space • Training needed to achieve reliability • Experience to administer • If students not familiar with OSCEs, must be oriented to this assessment format

42. OSCE is suggested the first best method for evaluation of: • Interviewing • Counseling & educating pt’s & families • Performing procedures • Physical examination • Preventive health services • Creation of therapeutic relationship with patients • Listening skills • Respectful & altruistic behaviors • Sensitive to cultural, age, gender & disability issues

43. Validity Measurement properties Validity is the hallmark of OSCE (Stillman, et al, Newbel, et al). Van der Vleuten, C. The assessment of professional competence: developments,research and practical implications Advances in Health Science Education 1996, Vol 1: 41-67

44. Validity Validity: does the test measure what it is supposed to? Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Upper Saddle River, NJ: Prentice-Hall; 2000:86-89.

45. Validity of an Assessment • Validity of a test / measureContent is deemed appropriate by relevant experts • Test measures the characteristic (e.g. knowledge, skills) that it is intended to measure • Performance of a particular task predicts future performance

46. راهنمائي جهت بالا بردن روائيOSCE 1- مشكلات ارائه شده توسط بيمار يا بيمار نما مهم و مرتبط با برنامه آموزشي باشد. 2- ايستگاه هاي مورد ارزيابي قبلا آموزش داده شده باشند. 3- بررسي و مرور ايستگاه ها توسط متخصصين 4- تعداد مناسب ايستگاه ها (كمتر از 10 ايستگاه نباشد)

47. Reliability Validity Measurement properties Van der Vleuten, C. The assessment of professional competence: developments,research and practical implications Advances in Health Science Education 1996, Vol 1: 41-67

48. Reliability • پایایی:  میزان همخوانی یک ابزاری است که متغیری را می سنجد

49. Reliability Reliability:does the test measure consistently between people and over time? Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Upper Saddle River, NJ: Prentice-Hall; 2000:86-89.

50. Test characteristics • Reliability of a test / measure • reproducibility of scores across raters, questions, cases, occasions • capability to differentiate consistently between good & poor students