Objective structured clinical examination

An objective structured clinical examination (OSCE) is a modern type of examination often used in health sciences (e.g. midwifery, occupational therapy, orthoptics, optometry, medicine, physician assistants/associates, physical therapy, radiography, rehabilitation medicine, nursing, pharmacy, dentistry, chiropractic, paramedicine, podiatry, veterinary medicine, athletic training). It is designed to test clinical skill performance and competence in skills such as communication, clinical examination, medical procedures / prescription, exercise prescription, joint mobilisation / manipulation techniques, radiographic positioning, radiographic image evaluation and interpretation of results. It is a hands-on, real-world approach to learning that keeps examinees engaged, allows them to understand the key factors that drive the medical decision-making process, and challenges the professional to be innovative and reveals their errors in case-handling and provides an open space for improved decision-making, based on evidence-based practice for real-world responsibilities.

An OSCE usually comprises a circuit of short (the usual is 5–10 minutes although some use up to 15 minute) stations, in which each candidate is examined on a one-to-one basis with one or two impartial examiner(s) and either real or simulated (actors or electronic patient simulators) patients. Each station has a different examiner, as opposed to the traditional method of clinical examinations where a candidate would be assigned to an examiner for the entire examination. Candidates rotate through the stations, completing all the stations on their circuit. In this way, all candidates take the same stations. It is considered to be an improvement over traditional examination methods because the stations can be standardised enabling fairer peer comparison and complex procedures can be assessed without endangering patients health.

As the name suggests, an OSCE is designed to be objective – all candidates are assessed using exactly the same stations (although if real patients are used, their signs may vary slightly) with the same marking scheme. In an OSCE, candidates get marks for each step on the mark scheme that they perform correctly, which therefore makes the assessment of clinical skills more objective, rather than subjective, structured – stations in OSCEs have a very specific task. Where simulated patients are used, detailed scripts are provided to ensure that the information that they give is the same to all candidates, including the emotions that the patient should use during the consultation. Instructions are carefully written to ensure that the candidate is given a very specific task to complete. The OSCE is carefully structured to include parts from all elements of the curriculum as well as a wide range of skills. A clinical examination - the OSCE is designed to apply clinical and theoretical knowledge. Where theoretical knowledge is required, for example, answering questions from the examiner at the end of the station, then the questions are standardized and the candidate is only asked questions that are on the mark sheet and if the candidate is asked any others then there will be no marks for them.

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