Objective structured clinical examination

Objective Structured Clinical Examination (OSCE) is a modern type of examination often used in health sciences (e.g., medicine, nursing, pharmacy, physical therapy) to test clinical skill performance and competence in skills such as communication, clinical examination, medical procedures/prescription, exercise prescription, and interpretation of results. The OSCE format is a way to assess healthcare professionals in a clinical setting, using standardized patients (SPs) who are actors trained to consistently simulate particular clinical scenarios.

History

The OSCE was introduced in the 1970s by Harden and Gleeson as a response to the need for more objective methods of assessing clinical competencies in the medical education field. Before the introduction of OSCEs, clinical examinations were largely unstructured and subjective, relying heavily on oral examinations and observations of students in clinical settings.

Format

An OSCE typically consists of a circuit of short stations, in which each student is examined on a one-to-one basis with one or more examiners. Each station has a different scenario and a different set of tasks that may include history-taking, physical examination, interpretation of laboratory results, and patient education. The student is expected to perform these tasks within a specific time frame, usually 5 to 15 minutes per station.

Scoring

Scoring in an OSCE is done using checklists that examiners use to mark students' performance in each station. These checklists can include both global ratings and task-specific checklists. Global ratings assess overall performance, communication skills, and professionalism, while task-specific checklists focus on the steps required to complete a specific task correctly. Some stations may also include patient or examiner feedback as part of the score.

Advantages

The OSCE is considered to be a more objective method of assessment than traditional clinical examinations because it standardizes the way in which clinical skills are assessed. This means that all students are tested under the same conditions and are assessed using the same criteria. Additionally, the OSCE can cover a wide range of skills and knowledge, making it a comprehensive assessment tool.

Challenges

Despite its advantages, the OSCE has some limitations. Organizing an OSCE is resource-intensive, requiring a significant amount of planning, trained personnel, standardized patients, and equipment. Furthermore, the artificial nature of the examination setting may not accurately reflect real-life clinical situations. There is also the potential for subjectivity in scoring, particularly with global rating scales.

Future Directions

With advancements in technology, there is a growing interest in integrating virtual reality (VR) and augmented reality (AR) into OSCEs to enhance the realism of clinical scenarios and to overcome some of the logistical challenges associated with traditional OSCEs. Additionally, efforts are being made to improve the objectivity of the scoring system and to develop more efficient ways of training standardized patients.