OSCE: definition, purpose and format
The definition of an OSCE
An OSCE is a type of examination often used in health sciences. It is designed to test clinical skill performance and competence in a range of skills. It is a hands-on, real-world approach to learning and assessment.
The OSCE content and scoring procedures are standardized. Each examination station is designed to focus on an area of clinical competence. A standardized scoring tool is used to record what you do or do not do well.
Every OSCE candidate experiences the same problem, and is asked to perform the same task, within the same timeframe. You will be exposed to the same level of difficulty, no matter where the examination is taken, and is marked using the same marking scheme.
The tasks in each OSCE station represent real-life clinical situations. These assess your ability to apply clinical knowledge and skills when, for example, meeting with a patient, writing an admission or discharge order, conferring with a colleague, etc.
An OSCE enables a reliable assessment of a candidate’s competence. OSCEs are suitable for use in high-stakes assessments, such as the National Assessment Collaboration (NAC) Examination and the Medical Council of Canada Qualifying Examination (MCCQE) Part II. OSCEs are now used widely in undergraduate, postgraduate and licensing assessments.
The following are typical of the OSCE format:
- You will rotate through a series of timed stations
- Each station presents a specific clinical scenario
- Each station assesses one or more areas of clinical competence (for example, history taking, communication, physical examination skills, etc.)
- All candidates are exposed to the same clinical problems
- The assessment applies a standardized approach, which includes standardized patients (SPs), standardized scoring tools, and standardized exam-day logistics
The daily work of physicians includes some essential skills that cannot be evaluated by traditional written examinations of knowledge. OSCEs were developed to fill that gap.
Multiple-choice and other written exams are very good at assessing biomedical knowledge, but they do not directly observe the candidate in practice. A different approach is needed to assess:
- Communication skills
- Physical examination techniques
- Attitudes for effectively interacting with patients and health-care workers
These skills are best assessed during actual performance. Examinations that assess skills during actual performance are known as competency-based or performance-based assessments. Among the various types of competency based tests, OSCEs are most widely used because they are valid, reliable, and fair.
The major attraction of the OSCE format is realism. OSCEs use standardized clinical scenarios that can be repeated. This means every candidate can receive an equal and fair evaluation.
At the Medical Council of Canada (MCC), OSCEs are rigorously developed and managed in these ways:
- They are administered in highly controlled settings
- OSCE stations are carefully written based on specific criteria for each exam
- Simulated Patients, or SPs, are rigorously trained to portray a specific clinical situation within a given amount of time
- Examiners are rigorously trained to use the scoring tools
- Administrative staff ensure that everyone and everything functions on exam day so that each candidate experiences the same examination
In the MCCQE Part II and the NAC Examination, the interaction between the candidate and SP is directly observed by a physician examiner. Examiners are trained to use a scoring checklist and rating scales. This includes:
- A content component, which assesses, for example, if the candidate obtained adequate quantity and quality of information from the patient
- Global ratings of the clinical process, such as a candidate’s organization, communication skills and professional behaviours
Although OSCEs are complex to administer, many studies have shown that these examinations result in fair and reproducible scores at various levels of clinical training.