Objective Structured

Clinical Examination
(OSCE)
Nadine J. Kaslow, PhD, ABPP
nkaslow@emory.edu
 Context
• ACGME Outcome Project – Toolbox
of Assessment Methods
•Royal College of Physicians and
Surgeons of Canada – CAN MEDS
Assessment Tools Handbook
Examples of 1

OSCE Stations
1. resuscitation of a child
2. consultation skills
3. physical examination skills
2 3
 Context
• Competency Assessment Toolkit for
Professional Psychology
•High fidelity approach for summative
assessment of myriad foundational
and functional competencies
 Context
• Competency Assessment Toolkit for
Professional Psychology
•OSCEs are useful for assessing
•Readiness for practicum?
•Readiness for internship
•Entry level to practice
•Advanced credentialing
 What is an OSCE?
• Objective – all candidates are
presented with the same stimuli
 What is an OSCE?
• Objective
•Structured – Specific foundational
and functional competencies are
tested at each station and the
marking schema for each station is
structured
 What is an OSCE?
• Objective
•Structured
•Clinical Examination – Test of
performance of clinical
competencies, with an emphasis on
skills and attitudes
 What is an OSCE?
• Evaluation tool that allows people
to be observed performing in many
different clinical situations
 What is an OSCE?
• OSCE combines
•Multiple observations
•Standardization of content
•Range of difficulty
 What is an OSCE?
• Effective method to assess
foundational competencies
•Professionalism (e)
•Scientific knowledge & methods (e)
•Reflective practice (e)
•Individual & cultural diversity (e)
•Relationships (o)
•Ethical & legal standards & policy (o)
 What is an OSCE?
• Effective method to assess
functional competencies
•Assessment (o)
•Intervention (o)
•Consultation (e)
•Research and evaluation (e)
 Methodology
• Standardized patients (SP)
•Stations
•Marking scheme
Standardized Patients (SP)
• SPs are lay persons who are trained
to portray scripted patient
presentations accurately and
consistently across many encounters
•SP encounters are credible and
reliable
Standardized Patients (SP)
• SPs are used to teach
•Foundational competencies
•Interpersonal and communication skills
(CIS)
•Clinical reasoning
•Functional competencies
Standardized Patients (SP)
• SPratings of CIS provide a good
proxy for actual patient satisfaction
•SP Communication
•Increases patient satisfaction
•Facilitates doctor-patient relationship
•Increases compliance
•Decreases malpractice claims
Standardized Patients (SP)
• Several encounters are required to
obtain a reliable estimate of a
person’s competence
• SP assessments are frequently
organized as a set of cases or stations
•This series of encounters is known as
OSCE
 Implementation
•While there are variants on the
original OSCE format, key
implementation steps are
•Train SPs in the issues of encounter
and ensure they don’t provide any
information unless the person being
assessed requests it
 Implementation
•SP encounters or tasks requiring
interpretation of clinical information
must be provided at separate stations
•These must last 5-10 minutes and be
observed by the assessor
•Topics – relationship development, risk
assessment, diagnosis, therapeutic
technique, consultation strategy
 Implementation
•At each station, the person being
assessed completes notes about the
SP
 Implementation
•The person being assessed moves
between stations when an announcer
indicates in accord with a specified
time sequence
•Separate performance scores are
generated for the task at each station
based on input from the SP, the person
being assessed, and the assessor
 Implementation
•The scores from multiple informants
across the stations or tasks are
combined by the assessors to reach a
final outcome determination
 Role of Examiners - YES
•Observe the performance of the
trainee at a particular task
•Score according to the marking
scheme (get practice at marking)
•Contribute to the good conduct of
the examination
 Role of Examiners - NO
•Re-write the station
•Interfere with the SP’s role
•Design their own marking scheme
•Teach
 Psychometrics
•With appropriate attention to
design, OSCEs have acceptable
psychometric properties including
• Good inter-rater, inter-station, and
split-half reliability
• Good generalizability
•Strong content, construct and
concurrent validity
 Psychometrics
•OSCE scores correlate moderately
with other performance indicators
and other forms of evaluations
 Psychometrics
• OSCE has increased reliability and
content validity with greater number
of stations and similarity between
tasks at different stations
 Strengths
• Provides for a high fidelity
assessment
 DOES
Professional Authenticity

Skills &
Attitudes
SHOWS
HOW

KNOWS HOW
Knowledge

KNOWS

Miller et al., 1990

 DOES

SHOWS OSCE
HOW

KNOWS HOW

KNOWS

Miller et al., 1990

 Strengths
•Measures clinical competence cross-
sectionally using standarized means
•Focuses on observable behaviors
•Enables fairer peer comparison
 Strengths
•Allows for assessing complex
competencies without endangering
patients’ well-being
•Encourages a collaborative
assessment approach
•Has the potential for peer feedback
and assessment
 Strengths
•Has been extensively researched
and found to be valuable for
summative assessment
•Provides valuable information for
curriculum review
 Challenges
• Ischallenging to create and
administer
• Is labor intensive
• Is costly
•Only cost-effective when many
individuals are examined at one
administration
 Challenges
• Requires high demand of other
resources
• SPs
• Assessors
• Time commitment
•Physical resources
 Challenges
•Doesn’t provide longitudinal
assessment
• Doesn’t adequately tap complex
skills requiring integrated
professional judgment
 Example: SP Information
•I am a 25 year old who comes to the
Emergency Room for treatment of a 2-3 week
old puncture wound that I can see but no one
else can
•I am having a first episode of psychosis and
have numerous alterations in my thinking and
function; however it is not immediately
obvious that my thoughts are disordered
when the student begins taking my history
 Example: SP Information
•Chief complaint - Stepped on a nail
•Opening statement - I stepped on a nail and
the wound won’t heal – If pressed to say
more… “It’s making me sick and I need help
 Example: SP Information
•Appearance - alert and oriented, calm,
cooperative, poor hygiene (dirty unmatched
clothes, hair uncombed, no make up or
grooming)
•Look like you haven’t showered in days
•Have some eye contact but less than normal
•Your affect is flat
• You talk very little and you have no emotion
in your voice when you are talking
 Example: SP Information
•Thought processes - you are focused on “saving
America” and you mostly stay on topic when
speaking but sometimes you start talking about one
thing and it turns into a related topic but not on
point
•An example might be “Coke advertisements
transmit messages to me. The first coke slogan was
‘Drink Coca-cola’ released in 1886.”
•Refer to three Coke slogans during your interview.
If possible say these when you can tangentially
connect them to something else you are saying.
Examples
 Conclusion
•OSCEs are a valuable and well-
developed assessment approach in other
health professions
•It behooves us as psychology to develop
and share OSCE scenarios for the
essential components of foundational
and functional competencies
 Conclusion
•OSCEs are advantageous to incorporate
in our assessment armamentarium for
summative evaluations particularly
related to key transition phases
•Attention needs to be paid to increasing
the feasibility of this high fidelity
assessment methodology
Questions