mbbs, mph, mcps, mrcgp (uk), friph (uk), fhae (uk) osce preparation guidelines ass. prof. dr. abdul...
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MBBS, MPH, MCPS, MRCGP (UK), FRIPH (UK), FHAE (UK)
Osce preparation guidelines
Ass. Prof. Dr. Abdul Sattar KHAN
Family & Community Medicine Department
College of Medicine
King Faisal University
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Think ! Short & Long case Exam
04/18/23 ASK 2
• Equality• Easy & difficult patients• Hawks & Doves examiners • Cost• Getting real patients• Unfair exam: complains
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OSCE is an examination method
OR
Itself a Test?
04/18/23 ASK 3
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Objectives
At the end of the session, participants are expected to:
•Understand the importance of OSCE•Aware about advantages & disadvantages•Know the purpose of OSCE•Understand reliability & validity of OSCE•Learn how to prepare & apply OSCE04/18/23 ASK 4
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OSCE is a method not a test
OSCE (Objective Structural Clinical Examination)1
OSLER (Objective structural Long Examination Record)
OSPE (Objective Structural Practical Examination)
TOSCE (GOSCE)- Team (group) Objective Structural Clinical Examination
OSBE (Objective Structured Biostatistics Examination) Etc………
04/18/23 ASK 5
1 Harden RM, Gleeson FA. Assessment of clinical competence using anobjective structured clinical examination (OSCE). Med Educ. 1979;13(1): 41-54.
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Advantages •
Test a student’s ability to integrate •knowledge, •clinical skills, and •communication with the patient
•An assessment tool that is custom-fit to the goals of a specific education program
• Provide chance for individualized feedback
04/18/23 ASK 6
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Disadvantages
Costly
Time consuming
Case specific evaluation
Quarantining (‘corralling’)
Serious concern (‘yellow card’) reporting systems
04/18/23 ASK 7
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What is the purpose of the OSCE?
Provide feedback on performance
Evaluate basic clinical skill
Measure minimal competency
04/18/23 ASK 8
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Example of some skills•
Communication and professionalism skills (e.g. breaking bad news)
•bad news)
•History taking skills (e.g. taking a history from a patient)
•presenting with acute chest pain)
•Physical examination skills (e.g. performing a respiratory system examination)
•examination)
•Clinical-reasoning skills (e.g. interpreting clinical data
and then prescribing therapy on a drug chart)
04/18/23 ASK 9
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What makes an OSCE a good form of assessment?
Reliability Validity Educational impact Cost efficiency Acceptability
04/18/23 ASK 10
Van der Vleuten CP. The assessment of professional competence:developments, research and practical implications. Adv Health SciEduc. 1996; 1(1): 41-67.
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04/18/23 ASK 11
How to prepare OSCE ?
10 – steps approach
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Step 1: Selection of OSCE committee
Select some peoples to be involved in following responsibilities: 1. determine the content of
the examination2. development and
implementation of OSCE3. to address decisions
related to reliability and validity
04/18/23 ASK 12
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Step 2: Selection of coordinator
A coordinator is the catalyst that facilitates the smooth working of the committee and make liaison with all stakes holders for good arrangement of OSCE.
04/18/23 ASK 13
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Step 3: Lists of what need to be assessed
The examination will measure objectively based on objectives of the course, the competencies in specific areas of; behavior techniques attitudesdecision-making strategies etc.
04/18/23 ASK 14
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A Blueprint
04/18/23 ASK 15
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How to develop case/scenario?
1. The purpose of the station 2. Candidate instructions3. Scoring checklist4. Standardized patient
instructions 5. Instruction for station set-up
04/18/23 ASK 16
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1. The purpose of the stationState the skill and domain to be testedE.g; Skill –Physical examination .Domain –Internal medicine /cardiology .
2. Candidate instructions•Candidate instruction must be clear and concise.
04/18/23 ASK 17
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3. Scoring checklist•The checklist should be complete and include the main components of the skill being assess.
4. Standardized patient instructions•These instruction must be detailed enough to guarantee standardization patient playing the same role.
5. Instruction for station set-up•List of all equipment required for the station
04/18/23 ASK 18
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Step 4: The examinees / students
The examinee is the student, resident, or fellow in training or at the end of training of a prescribed course ORDuring course for practice – formative assessment
04/18/23 ASK 19
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Step 5 : The Examiners
• Physicians/Surgeons etc.
• Simulated Patients
• Real patients
• Video recording only
• Self-assessor (Student as examiner)
04/18/23 ASK 20
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Step 6: The Examination Site
•
Special rooms •
Big room with partition
• Outpatient facility
04/18/23 ASK 21
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Step 7: Examinations Station
•The total number of stations vary based on a function of the number of skills and time managment, ranging from 10-25.
E.g., MRCGP exam has 14 stations
04/18/23 ASK 22
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Duration of station•T
imes ranging from 4 to 15 minutes have been reported in different examinations (MRCGP – 10 minutes & USMLE – 15 minutes) and a five minute station probably most frequently chosen.
•This times depend to some extent on the competencies to be assessed in the examination.
04/18/23 ASK 23
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Couplet/Linked Station
Some competencies may best be assessed by coupled or linked stations.
Finding Interpretation
Finding Interpretation
Treatment or ManagementTreatment or Management
04/18/23 ASK 24
Station No. 10
Station No. 11
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Couplet/Linked Station
May measure competencies at different levels
Basic Level Intermediate Advance level
04/18/23 ASK 25
Station No. 10
Station No. 11
Station No. 12
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Step 8: Observer Assessment Method
•Checklist
•Rating scale
04/18/23 ASK 26
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04/18/23 ASK 27
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The borderline regression (BLR) method
04/18/23 ASK 28
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Step 9: Selection of Standard patient
•A standardized patient is an individual with a health problem that is in a chronic but stable condition;
•Standardized or simulated patient usually used when properly trained for history &physical assessment .
04/18/23 ASK 29
http://apt.rcpsych.org/content/8/5/342.full#ref-16
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Step 10: Ensure Reliability & Validity
•The patient problem relevant and important to the curriculum
•The station assess skill that have been taught
•Content experts reviewed the station
04/18/23 ASK 30
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Factor leading to lower reliability
•Too few station or too little testing time
•Checklists or items that don’t discriminate (too easy OR too hard)
•Unreliable patient or inconsistent portraits by standard patient
•Examiners who score idiosyncratically
•Administrative problem (disorganized staff OR noisy room)
04/18/23 ASK 31
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Ready to run the show !
Before the exam:1.Standard setting2.Instructions to supervisors3.Draw a map
04/18/23 ASK 32
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Station 1
Station 2
Station 3
Station 4
Station 5
Station 6
Station 7
Station 8
Station 9
Station 10
Station 11
Station 12
Example of 10 station OSCE accommodating 12 studentsExample of 10 station OSCE accommodating 12 students04/18/23 ASK 33
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Enter in to station
2 – minute: Ending of station (A buzzer warning sound)
After 10 minutes: Exit station (A buzzer sound)
Enter new station
8 min
1 – minute: Standing outside of station
04/18/23 ASK 34
1 – minute: Standing outside of station
An algorithm for time management during movement in examination day
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On the day of the exam:1.Arrive early2.Check completeness3.Note attendance4.Brief candidates
04/18/23 ASK 35
Ready to run the show !
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Ready to run the show !
After the exam:1.Store resources2.Re-arrange venues3.Feedback4.Present results to board/committee5.Amend / bank stations6.Analyze the result
04/18/23 ASK 36
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Some final tips !
Spare standardized patients and examiners
Back-up equipment
Staff available during the examination to maintain exam security
The bells or buzzers can be heard from all location with closed door
Prepare an extra station
04/18/23 ASK 37
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Take Home Message
Attaining clinical competence is not a one-off event but a career long learning
routine
04/18/23 ASK 38
Epstein RM. Assessment in medical education. N Engl J Med. 2007;356(4): 387-96