The Objective Structured Clinical Examination Kazakhstan Health Technology Transfer and Institutional Reform Project
Objectives • To become familiar with OSCE format and scoring • To explore standard setting techniques • To provide an overview of quality assurance methods • To identify strengths and weaknesses of the OSCE • To facilitate good design of OSCE stations Kazakhstan Health Technology Transfer and Institutional Reform Project
What is an OSCE? • Number of stations through which students rotate • Demonstration of a clinical skill or respond on paper to a series of related questions • Wide variety of skills tested: History, physical examination, interpretation of tests, communication and interpersonal skills Kazakhstan Health Technology Transfer and Institutional Reform Project
Advantages • • Standardization Can test a range of skills Can pre set standards Flexible • Does not rely on real patients Kazakhstan Health Technology Transfer and Institutional Reform Project
Disadvantages • Can seem artificial • Takes a lot of planning • Expensive • Needs well trained patients…and examiners! Kazakhstan Health Technology Transfer and Institutional Reform Project
How to run an OSCE • • • Decide what you want to assess Identify the Team Decide the content Planning the site Patients Examiners Candidates Support staff The day before The day after Final follow up Kazakhstan Health Technology Transfer and Institutional Reform Project
Is it formative or summative? Kazakhstan Health Technology Transfer and Institutional Reform Project
Decide what you want to assess • • Communication skills History taking Examination technique Ethical issues Patient education Emergencies Technical skills Kazakhstan Health Technology Transfer and Institutional Reform Project
Identify the team • Discussion Kazakhstan Health Technology Transfer and Institutional Reform Project
Decide station content • Sort or long stations • Mixture of the two • Post encounter tasks eg read an x ray, interpret data • Rest stations may be added Kazakhstan Health Technology Transfer and Institutional Reform Project
Couplet Stations • Consists of patient encounters and post encounter probe • Provides opportunity to test data interpretation in context • Allows for an increase in test capacity without additional costs Kazakhstan Health Technology Transfer and Institutional Reform Project
You MUST talk to the standardised patient coordinator early • You need to know the age and sex of available patients in order to plan the station content • Define a time line for recruitment, training and testing roles Kazakhstan Health Technology Transfer and Institutional Reform Project
Test the station • You MUST test the station to see if it works…try to get someone else to play the role of the student Kazakhstan Health Technology Transfer and Institutional Reform Project
For each station you will need • Clear instructions to the candidate • A very detailed patient role • Prompts for the patient • A scoring checklist • A list of equipment needed in the room Kazakhstan Health Technology Transfer and Institutional Reform Project
Instructions to the candidate • Who are they? • Where are they? • Eg You are a medical student working in the emergency room • What are they to do? • Do you want to give them any other information eg “The patient has diabetes” Kazakhstan Health Technology Transfer and Institutional Reform Project
How to run an OSCE • • • Decide what you want to assess Identify the Team Decide the content Planning the site Patients Examiners Candidates Support staff The day before The day after Final follow up Kazakhstan Health Technology Transfer and Institutional Reform Project
Planning the site • • How many students? How many stations? How many tracks can you run? How long is each encounter? • This will depend on your local site Kazakhstan Health Technology Transfer and Institutional Reform Project
You need – An area for registration and administration – Orientation of students, patients, examiners – Refreshment area – Area to keep students after their examination – Book the space early, a few months before! Kazakhstan Health Technology Transfer and Institutional Reform Project
Draw a map of the site • Assign stations, considering the flow of students Kazakhstan Health Technology Transfer and Institutional Reform Project
Equipment lists • Blood pressure cuff • Reflex hammer etc • Pencil for examiner • Check list • Water etc • Clearly define who is responsible for these…or they WILL be forgotten!! Kazakhstan Health Technology Transfer and Institutional Reform Project
How to run an OSCE • • • Decide what you want to assess Identify the Team Decide the content Planning the site Patients Examiners Candidates Support staff The day before The day after Final follow up Kazakhstan Health Technology Transfer and Institutional Reform Project
Examiners • Find your examiners early – Faculty – Nurses? – Any other options? • At least one per station and a small number of spares • Send a letter explaining when they should arrive etc • Record their answers and send reminders • You may not have time to offer much training. Kazakhstan Health Technology Transfer and Institutional Reform Project
Instructions to examiners • They should meet together, and with the patient, and run through the checklist • Is it all clear to them? • Rules for interacting with the student • Rules for completing the list • What to do with completed checklists Kazakhstan Health Technology Transfer and Institutional Reform Project
Candidates • Need to know day of OSCE and time of arrival • What can they bring? Eg stethoscope • What can they NOT bring? Eg Phone • Where do they register? Kazakhstan Health Technology Transfer and Institutional Reform Project
Orientation • What signal will they hear? – To enter station – To leave station • What is the time interval between stations • Will there be an additional question whilst in the station? Kazakhstan Health Technology Transfer and Institutional Reform Project
Identification • Best to give the a large sticker with their name or number on it • Examiner MUST check it corresponds to the scoresheet they have in front of them Kazakhstan Health Technology Transfer and Institutional Reform Project
How to run an OSCE • • • Decide what you want to assess Identify the Team Decide the content Planning the site Patients Examiners Candidates Support staff The day before The day after Final follow up Kazakhstan Health Technology Transfer and Institutional Reform Project
Support staff • Registration • Time keeper • Escorts (standing in corridor etc) • Clerical staff…. responsible for signs, catering etc Kazakhstan Health Technology Transfer and Institutional Reform Project
The time keeper Kazakhstan Health Technology Transfer and Institutional Reform Project
The Day before • Post signs…outside each room and also inside by the door • Check signal system. • Find a spare whistle!! • Make sure all the standardized patients have remembered to come, especially teenagers Kazakhstan Health Technology Transfer and Institutional Reform Project
On the Day • Have a clear schedule for when everyone arrives and where they go • Where will orientation take place and who will do it? • Where will the dry runs take place? • When does the OSCE start? Kazakhstan Health Technology Transfer and Institutional Reform Project
Remember breaks for examiners with small bladders • When you make the master schedule you must build in breaks…. A bigger break allows you to catch up if things are running over Kazakhstan Health Technology Transfer and Institutional Reform Project
Things that go wrong • Patients fail to turn up – rare • Examiners fail to turn up – common • Scoresheets turn out to be ambiguous or confusing – common • Food does not arrive • Bell cannot be heard onside rooms - common Kazakhstan Health Technology Transfer and Institutional Reform Project
How to run an OSCE • • • Decide what you want to assess Identify the Team Decide the content Planning the site Patients Examiners Candidates Support staff The day before The day after Final follow up Kazakhstan Health Technology Transfer and Institutional Reform Project
The day after • Evaluations from examiners and participants are useful • Payments to patients etc • Send thank you letters Kazakhstan Health Technology Transfer and Institutional Reform Project
Scoring • There is a difference between the examiners scoring of the OSCE and the final interpretation of the score afterwards. Kazakhstan Health Technology Transfer and Institutional Reform Project
1. Checklist for important items - Done or Not done 2. Global rating section 3. Section to identify borderline candidates 4. Comments box – eg hurt patient, incorrect technique Kazakhstan Health Technology Transfer and Institutional Reform Project
• Will you have “red flag” items? • How much will the global section be worth eg 25% • How do you define a pass mark? • How many stations can be failed? Kazakhstan Health Technology Transfer and Institutional Reform Project
Group work • We will design an OSCE • We need to run through everything so far discussed • Then we will create some roles and checklists Kazakhstan Health Technology Transfer and Institutional Reform Project
In groups • Decide content for an 8 station OSCE • We will split up and develop roles and stations Kazakhstan Health Technology Transfer and Institutional Reform Project
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