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About OSCEs

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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.

A= Excellent

B= Good

C= Average (pass)

D= Fail

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, 272, 1321-1328. 

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.




Miller's triangle