Objective Structured Clinical Examination


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.......... www.surgicaleducation.com association for surgical education
The Objective Structured Clinical Examination
..........
2nd Edition
PREPARED BY THE COMMITTEE ON TESTING AND EVALUATION ASSOCIATION FOR SURGICAL EDUCATION Copyright 2001 - Association for Surgical Education

EDITORS

James A. McCoy, M.D. Hollis W. Merrick, M.D.

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Table of Contents

EDITORS................................................................................................................................................2

FOREWARD TO THE FIRST EDITION ....................................................................................................7

FOREWARD TO THE SECOND EDITION................................................................................................8

THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION:

PRESENT AND FUTURE ..............9

THE COMPONENTS OF THE OSCE .....................................................................................................11

REFERENCES .....................................................................................................................................17

THE ROLE OF THE OSCE IN THE ASSESSMENT OF STUDENT PERFORMANCE ..............................18

What is the role of the OSCE? ..............................................................................................................18 Why administer OSCEs in the 3rd year clerkship? .................................................................................20

Disadvantages of administering OSCEs in the junior clerkships ............................................................23

How we do it.........................................................................................................................................24

Conclusions..........................................................................................................................................25

REFERENCES .....................................................................................................................................26

IMPLEMENTATION OF THE OSCE.......................................................................................................28

Introduction ..........................................................................................................................................28

Developing the OSCE...........................................................................................................................28

Coordinating Committee .......................................................................................................................28

Other Personnel ...................................................................................................................................29

Authoring Team....................................................................................................................................29

Content ................................................................................................................................................29

Station components..............................................................................................................................30

Instructions to the examinee .................................................................................................................30

Skill assessment checklist ....................................................................................................................30

Items for post encounter testing............................................................................................................30

Instructions for the standardized patient................................................................................................31

Artifacts and equipment ........................................................................................................................31

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Patient recruitment and training ............................................................................................................31 Costs/Budgeting ...................................................................................................................................32 Administering the OSCE.......................................................................................................................32 Location ...............................................................................................................................................32 Personnel .............................................................................................................................................33 Setting up the OSCE ............................................................................................................................33 Examination Day ..................................................................................................................................33 References...........................................................................................................................................35 IMPLEMENTATION AND USES OF OBJECTIVE STRUCTURED CLINICAL EXAMINATIONS (OSCE).................................................................................................................................................36 Organization of an OSCE .....................................................................................................................36 Conducting an OSCE ...........................................................................................................................39 OSCE Results ......................................................................................................................................39 Disadvantages/Limitations of OSCE .....................................................................................................40 Applications of OSCE ...........................................................................................................................41 References...........................................................................................................................................42 HOW TO PREPARE AND IMPLEMENT AN OBJECTIVE STRUCTURED CLINICAL EXAMINATION .....................................................................................................................................43 Introduction ..........................................................................................................................................43 An Example: The 1987 CSAU-OSCE....................................................................................................44 How to Develop an OSCE ....................................................................................................................45 The Coordinating Committee ................................................................................................................45 The First Meeting..................................................................................................................................45 The Authoring Team.............................................................................................................................46 Guide for Creating a Station..................................................................................................................47 The Instructions to the Candidate .........................................................................................................47 The History/Physical Examination Checklist (The First Five Minutes) ..................................................47 The Problem-Solving Questions ( The Second Five Minutes)...............................................................48 Instruction for the Standardized Patient.................................................................................................48 Equipment Listing for Stations ..............................................................................................................49
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Patients for the OSCE: Real or Simulated.............................................................................................49 Follow-up Meeting ................................................................................................................................49 The Training of the Examiners ..............................................................................................................49 Choosing a Site for the OSCE ..............................................................................................................50 Running the OSCE ...............................................................................................................................50 Setting up the OSCE ............................................................................................................................51 REFERENCES .....................................................................................................................................53 Table 1.................................................................................................................................................54 ADDITIONAL USES FOR OSCES .........................................................................................................80 References: ..........................................................................................................................................85 EARLY FEEDBACK FOR AN OSCE .....................................................................................................90 MEASUREMENT CONSIDERATIONS IN PLANNING AND EVALUATING AN OSCE............................95 REFERENCES ...................................................................................................................................104
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. . . . ......
Acknowledgements
We thank the Association for Surgical
. . . . . . . . . . Education and its founders for making this work possible. We thank the authors and member institutions for their expertise in the preparation of this manual. Our special thanks to the coordinators and administrative support staff who have processed, edited and reprocessed this manuscript. Lastly, we are grateful to the many patients who entrust us with their lives daily in practice, teaching and research. May we always strive to serve you with our very best skill, dedication, integrity and compassion.

ASE: THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION

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FOREWARD TO THE FIRST EDITION
This Manual is designed to describe some of the basic principles and concepts of the Objective Structured Clinical Examination (OSCE). We hope that it will be useful not only to the Departments of Surgery of our member institutions, but to other clinical disciplines as well.
Hollis W. Merrick, M.D. Editor

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FOREWARD TO THE SECOND EDITION When the first edition of this Manual was published in 1989, the
Objective Structured Clinical Examination (OSCE) was a relatively new tool in the effort to obtain an accurate measurement of medical student knowledge and the effectiveness of the surgical clerkship curriculum. Eleven years later, as more and more institutions have accepted its validity and have initiated their own OSCE programs, the need remains for a basic guidebook on the principles and concepts of the OSCE. It is our combined hope that this Manual will prove helpful to all users, novice and experienced alike.
James A. McCoy, M.D. Hollis W. Merrick, M.D. Editors
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ASE: THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION

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THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION: PRESENT AND FUTURE
Hollis W. Merrick, M.D. James A. McCoy, M.D.

The advent of the Objective Structured Clinical Examination (OSCE) has offered a strikingly new and exciting way of making valid assessments of the clinical performance of medical students, residents, and fellows. Since its introduction by Dr. Harden and colleagues in 1975, the technique has gained steady and widespread acceptance around the world. Reports in the literature concerning its use come from England, Scotland, Australia, South Africa, Nigeria, the Netherlands, Canada and the United States.
The advantages of the examination are greatly apparent when one reviews the wide spectrum of clinical tests that can be incorporated into the OSCE. Such tests include multiple choice written questions, reviews of radiographs, use of models, and examination of simulated or real patients. The breadth of data that can be encompassed in this type of examination is limited only by the imagination of the examiners.
Nevertheless, there are drawbacks to the OSCE. It is cumbersome and expensive to set up, and it requires a great deal of personnel for its implementation. The expense involved in obtaining the examination site, the use of models or simulated patients, and the time of the examiners, can often be intimidating factors for those considering using an OSCE format for evaluating students, residents, and fellows.
The Objective Structured Clinical Examination (OSCE) has in some institutions become a finely tuned instrument used to evaluate clinical skills, attitudes and behaviors that are considered standards used by practitioners in the care of their patients. It is hoped that the competencies demonstrated by students, residents and fellows in the OSCE will be manifested daily in the lives of their patients as the medical profession struggles to maintain skillful, high quality, competent health care in the United States as managed care continues to erode the doctor-patient relationship.

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This 2nd edition will offer different perspectives and implementation protocols from different institutions. Whereas the core components are the same, the philosophy and implementation by different institutions with varying resources are different. An innovative addition, the Early Feedback OSCE, is presented by the Medical College of Ohio. Merrick, et al. used the computer to compute the student and the residents assessments throughout the examination. Thus shortly following completion of the examination, the examinees receive their objective computer generated assessment.
The objective of this Manual is to summarize the state of the art as it exists in the United States and Canada at this point, and to make this information available to our member institutions. Many of the authors in the Manual have had extensive experience with the OSCE.
The NBME/USMLE continues on a path to introduce the OSCE as a part of the USMLE sometime in the future. This represents a massive undertaking. Even though the Royal College of Physicians and Surgeons of Canada uses the OSCE as standard to evaluate its foreign medical graduates, the number of examinees is small in comparison to the 15,000 plus American Medical Graduates. The ASE should, perhaps, help medical schools establish OSCE standards that could be approved by the NBME/USMLE and implemented by local or regional medical schools.
The OSCE does allow examiners to document competencies in clinical skills, behaviors and attitudes in an examination setting. There is no question that these objective measures should be made. What impact has this had on improving care of our patients? How do we measure commitment integrity and dedication?
Who will take the time to obtain the history, do the physical exam, generate and execute the appropriate diagnostic and treatment plans that are evidenced-based? How do we measure commitment, integrity, and dedication?
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