OSCE and OSPE
PREPARED AND PRESENTED BY SUMAIRA AYAZ ALI
MSC NURSING 1 S T YEAR
Content
Introduction
Definition
What to assess?
Methodology of OSCE/OSPE
Procedure of OSCE/OSPE
Examples of OSCE & OSPE
Differences between OSCE/OSPE
Advantages
Disadvantages
Conclusions
Bibliography
Introduction
The conventional clinical and practical examination is beset with several problems. Although marking should depend only
on student variability, patient (or in the case of practical - experiment) variability and examiner variability significantly
affect scoring. In fact, the subjectivity involved may reduce the correlation coefficient between marks awarded by different
examiners for the same candidates performance to as low as 0.25. The marks awarded also reflect only the global
performance of the candidate and are not based on demonstration of individual competencies. Problems in communication
significantly affect the outcome. Attitudes are usually not tested at all by the conventional examination. Even in clinical
skills, often the student is questioned only regarding his final conclusion. The ability to examine a patient and arriving at
that conclusion is not observed by the examiners. The final score indicating his overall performance gives no significant
feedback to the candidate.
These defects of clinical and practical examinations have been realized for long and have given rise to attempts at improving the current
scenario. All these attempts are relatively new and are still in the process of being tried out.
Definition
OSCE is an assessment tool in which the components of clinical
competence such as history taking, physical examination, simple
procedures, interpretation of lab results, patient management
problems, communication, attitude etc. are tested using agreed check
lists and rotating the student round a number of stations some which
have observers with cheek lists.
What is assessed by OSCE?
Various clinical skills:
History taking
Physical examination
Technical procedure
Knowledge and understanding
Data interpretation
Problem solving
Attitude
Methodology of OSCE/OSPE
The OSCE examination consists of about 15-20 stations each of which requires about 4-5 minutes of time.
All stations should be capable of being completed in the same time. The students are rotated through all
stations and have to move to the next station at the signal. Since the stations are generally independent
students can start at any of the procedure stations and complete the cycle. Thus, using 15 stations of 4
minutes each, 15 students can complete the examination within 1 hour.
Each station is designed to test a component of clinical competence. At some stations called the procedure
stations students are given tasks to perform on patients. At all such stations there are observers with agreed
check lists to score the student's performance. At other stations called "response stations", students respond to
questions of the objective type or interpret data or record their findings of the previous procedure station.
Designing and implementing an
OSCE/OSPE (Procedure)
OSCE: (example image)
Example of OSCE:
Task - Examine the scrotal swelling in this patient.
Points in the check list:
1. Does he explain to the patient what he is going to do?
2. Does he take permission?
3. Does he provide a screen?
4. Does he ask the patient to expose the whole abdomen and genitalia?
5. Does he examine both sides of the scrotum?
Cont.…
6. Does he take care not to cause discomfort?
7. Does he palpate the spermatic cord?
8. Does he palpate the abdomen (for lymphnodes in case it is a patient with a testicular tumour)
9. Does he palpate the supraclavicular nodes?
10. Does he thank the patient?
Weightage for each item in the check list can be decided by the examiners depending on their importance. Points 1, 3, 6, 10
test the affective domain which is not usually tested by the clinical examination.
Example of OSPE
Task - Examine the specimen of urine provided for proteins.
Check list
1. Does he take a urine sample to 2/3 level in the test tube?
2. Does he boil upper 1/3 of the column?
3. Does he add 2% acetic acid drop by drop?
4. Does he compare change in the top layer with the bottom layer of urine?
Similarly, OSCEs and OSPEs can be made for any subject. At the end of the examination, the scores obtained in the procedure stations
are totaled to give the candidate score. Scores at individual stations can also be released to give the candidate a meaningful feedback.
Difference between OSCE/OSPE
Features OSPE OSCE
Domain Higher level of knowledge Psychomotor
Testability Identifies structures on images, Apply structure knowledge to
spicemens, radio, graphs and perform examination and
relate it with clinical scenario procedure
Time 2 to 4 minutes More than 4 min
Space One big hall (LAB) Isolated small class rooms close
to each other
Examiner Non specific 2-3 persons per hall Expert examiner for each station
Checklist Not required Required
Standardized patients Not required Required
Advantages
•OSCE ensures integration of teaching and evaluation. Variety maintains student's
interest.
•Less bias as checklist is used for evaluation
•It can assess both clinical and experimental skills
•There is increased faculty-student interaction. OSCE is adaptable to local needs.
•A large number of students can be tested within a relatively short time.
Disadvantages
•There is risk of observer fatigue if the observer has to record the
performance of several candidates on lengthy check lists.
•All stations must invariably demand only equal time. Ensuring this,
therefore, requires careful organization.
•Time consuming process
Conclusions
In conclusion, OSCE/OSPE has several distinct advantages. However, in
the current situation it may not be realistic to expect its inclusion in the
formal summative evaluation schedule of universities. However, it is
feasible in view of the tremendous advantages that it offers, to include the
formative (day to day) assessment of students to improve their clinical
competence and to derive an objective score for internal assessment.
Bibliography
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[Link] RM, Gleeson FA. Assessment of clinical competencies using an objective structured clinical examination
(OSCE) In: ASME Medical Education Booklet No. 8. Dundee: ASME; 1979. Back to cited text no. 4
[Link] RM, Stevenson M, Wilson DW, Wilson GM. Assessment of clinical competencies using objective
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[Link] IR, Honden RM, Walton HJ. Newer developments in assessing clinical competence. In: Hart IR, Honden RM,
Walton HJ, editors. International Conference Proceedings. Ottawa: Congress Centre; 1985. Back to cited text no. 6