objective structured clinical examination (osce) based learning/objective structured... · history...
TRANSCRIPT
Objective Structured Clinical
Examination (OSCE)
History of OSCE
• First described by Harden & Gleeson (1975)
• Using OSCE for the Canada Medical Licensing
Examination (1990)
• Using OSCE by the Education Commission for
foreign Medical Graduate (ECFMG) in USA (1994)
• Medical students have to pass OSCE before entering
clinical practice in Japan (2003)
• United State Medical Licensing Examination
(USMLE) step 2 clinical skill examination (2004)
Taiwan?
• Medical Licensing Examination step 2 clinical skill
examination in 2010
• Nursing licensing examination from 2016?
Objective
• All the candidates are presented with the
same test.
• Clear goals
• Specific criteria for evaluation
Structured
• The marking scheme for each station is structured.
• Specific skill modalities are tested at each station
- History taking
- Explanation
- Clinical examination
- Procedures
Clinical
•Use case scenarios
•Test of performance of clinical skills
•Not a test of knowledge
•The candidates have to demonstrate their skills
Examination
•Direct observation by raters
–Formative examination
–Summative examination
–High stake examination
Learning Assessment
• Pre-assessment
• Formative assessment
• Summative assessment Pre-
assessment
Formative
assessment
Summative
assessment
High Stake Testing
• When the outcome of a standardized test is used as
the sole determining factor for making a major
decision.
OSCE-3
• Usually used to assess performance
• Mostly using standardized patients
– “Standardized” refers to the fact that the person is
specifically trained to model the “real” patient’s
condition, including symptoms and emotional
states, and to do so consistently over time.
Model of Competence
Knowledge
performance
Competence
actions
Harden, R., Stevenson, M.,
Wilson Downie, W., Wilson, G.
(1975). Assessment of clinical
competence using objective
structured examination. British
Medical Journal, 22, 447–451.
Harden et al.
(1975)
Harden et al.
(1975)
Harden et al.
(1975)
Approaches to nursing OSCE/
simulated examination
• Multi station OSCE
• Scenario based OSCE (sometimes called objective
structured clinical assessment (OSCA))
• ‘Top to Toe’ assessment
• OSCE/simulated assessment with random allocation
– Not all students assessed on same scenarios/
systems
Rushforth, H. E. (2006). Objective structured clinical examination (OSCE): Review of
literature and implications for nursing education. Nurse Education Today, 27, 481–490.
Example 1
• 5 min for each
station
• Stations one and
two on
psychomotor and
communication
skills.
• Station three on
knowledge
Brosnan et al. (2006). Implementing objective structured clinical skills evaluation (OSCE)
in nurse registration programmes in a centre in Ireland: A utilisation focused evaluation.
Nurse Education Today, 26, 115–122
Example 2
Alinier, G. (2003).
Nursing students’ and
lecturers’ perspectives of
objective structured
clinical examination
incorporating simulation.
Nurse Education Today,
23, 419–426.
Benefits of OSCE-1
• Greater objectivity than in most assessment of
practice.
• Wide range of different examiners, hence reduced
risk of examiner bias.
• Reduced risk of different students being assessed by
different assessors.
• Positively viewed by students and lecturers.
Rushforth, H. E. (2006).
Benefits of OSCE-2
• Broader range of skills tested.
• Reduced ‘luck of the draw’/increased consistency of
experience between students.
• Motivation for learning.
• High level of reliability and validity.
• Flexibility is one of the OSCE’s major advantages
and a reason for adoption.
Rushforth, H. E. (2006).
Patri´cio, M. F., Julia˜o, M., Fareleira, F., & Carneiro,
A. V. (2013). Is the OSCE a feasible tool to assess
competencies in undergraduate medical
education? Medical Teacher, 35, 503–514.
Disadvantages of OSCE
• Organizational training
• The idealized ‘textbook’ scenarios may not mimic
real life situations
• Expensive
Zayyan, M. (2011). Objective structured clinical examination: The assessment of
choice. Oman Medical Journal, 26(4), 219-222.
Issues Regarding OSCE Testing
• Reliability
• Validity
• Scoring
• Practical Issues and Feasibility
Turner, J. L. & Dankoski, M. E. (1975). Objective structured clinical exams: A critical
review. Family Medicine, 40(8), 574-8.
The basic steps in modelling an OSCE
• Determination of the OSCE team.
• Skills to be assessed (OSCE Stations).
• Objective marking schemes
• Recruitment and training of the standardized patients.
• Logistics of the examination process.
Zayyan, M. (2011). Objective structured clinical examination: The assessment of
choice. Oman Medical Journal, 26(4), 219-222.
Standardized Patient Training
• Recruiting, auditioning, hiring, training, mentoring
SP actors for simulation programs
• Character and scenario development
• Realistic enactments
• Actor contributions to debriefing
• Actor retention, compensation, and development
Pascucci, R. C., Weinstock, P. H., O’Connor, B. E., Fancy, K. M., & Meyer, E. C. (2014).
Integrating actors into a simulation program. Simulation in Healthcare, 9(2), 120-126.
SP Patient
• SP candidates must be intelligent, flexible, quick
thinking, and reliable.
• SP’s understanding of the concept of the OSCE and
the role given to them is critical to the overall process.
Zayyan, M. (2011). Objective structured clinical examination: The assessment of
choice. Oman Medical Journal, 26(4), 219-222.
Writing for Scenarios and Associated
Materials
• Design scenario and evaluation form
• Guide to students
• SP instruction/training guide
• Rater checklist
• SP checklist
• Errors of OSCE
Write a scenario
with a script for
SP training
Station: B
Subject: CV system
Situation: Sudden onset of chest pain
Instructor: Hsing-Mei Chen
B
SP Training • Date and Time for the training
• Date and Time for the exam
• Location
• Stations A-F
• Musculoskeletal system
• Cardiovascular system
• Neurological system
• Female reproductive system
• Abdominal system
• Newborn assessment
• List the requirement for SP and
their names
Informed consent
for SP
SP instruction/training guide-1
Background information and
history
SP instruction/training guide-2
Script for training SP
to answer students’
questions
Student Guideline
Location: OPD ER Ward other____
Scenario:
Your task is to
History taking
PE
Communication to the patient
Time: 17 minutes for skills,
3 minutes for feedback
During the OSCE
Checklist History
taking
Physical
examination
Feedback
SP Evaluation by Rater
Student Satisfaction Evaluation
Open questions
Report the Outcome
Mid-term score
90 and above 13
80-89 12
70-79 4
60-69 0
50-59 0
Total 29