OSCE is an acronym for Objective Structured Clinical Examination. Simulated or standardised patients have been used for over 30 years. First known effective use of simulated patients was by Barrows & Abrahamson (1964), who used them in
neurology examination. OSCE was first described by Harden & Gleeson as, ‘a timed examination in which medical students
interact with a series of simulated stations that may involve history taking, physical examination, counselling or patient
management’ (Harden & Gleeson 1979)1.
The traditional oral examination has poor reliability and validity
(Hodges at el 1997)2. Data gathered by the National Board of Medical
Examination is the USA between 1960-1963, involving over 10,000 medical students showed that the correlation of independent
evaluations by two examiners was less than 0.25 (Hubbard et al 1963)3.
The original part I involved examining a patient following by interrogation
by an examiner. There is variation in complexity of cases and degree of co-operation
from the patient. It was shown that it was necessary for each candidate to interview
at least 10 patients to achieve the reliability required (Watson et al 2001)4.
Miller’s triangle of clinical competence (Miller GE 1990)5
(Link at the bottom of the page)
OSCE stations are designed around focussed task within common clinical
work in which candidate is expected to demonstrate a basic competency within the allotted time after a year of SHO training
(Mortimer et al 2004)6. Skills tested include history taking, mental
state examination, physical examination, practical skills like ECG, interpreting blood results, emergency management of DT,
NMS, SS etc and communication skills.
The marking is not binary. The
schedule is a 5-point scale as used in other college examinations. OSCEs are
objectively marked. Weighting of particular objectives within each OSCE station
is determined before the examination and the examiner’s task is to award marks for each objective as listed on the mark
sheet. Whether the candidate passes or not is determined by performance on these
objectives (F. Oyebode 2002)7.
Grades range between A and E.
C= Average (pass)
E= Severe fail
Grade E is given if the candidate fails to attempt the task set out
in the instructions.
1.Harden & Gleeson 1979. Assessment of clinical competence using
an objective structured clinical examination format: reliability and generalizability. Medical Education, 30, 38-43.
2.Hodges at el 1997. An
objective structured examination for examining clinical clerks. Academic Medicine, 73, 910-912.
3.Hubbard et al 1963. An
objective evaluation of clinical competence. New England Journal of Medicine,
4.Watson et al 2001. Standardized
or real patients to test clinical competence, Medical Education, 35, 321-325.
5.Miller’s GE. The
assessment of clinical skills/competence/performance. Academic Medicine 1990. 65, 563-567.
6.Mortimer et al. Psychiatric
Bulletin 2004. 28: 458.
7.F. Oyebode (2002) Advances in Psychiatric Treatment, 8: 348-350.