Medical Council of Canada

History of the OSCE

History of the OSCE

Before OSCEs were first developed in 1979, two types of clinical examination formats were used: cases and bell ringers.

In long and short case examinations:
  • The candidate was assigned a patient in a clinical setting that involved varying levels of simulations
  • The candidate was given time to take the patient’s history and do a physical examination
  • A board of examiners interviewed the candidate afterward, asking about the case
  • The candidate was not observed in the patient interaction
  • Each candidate had an entirely unique (inconsistent) examination experience

In bell-ringer examinations,

candidates would rotate from station to station, identifying bones or specimens under a microscope within a set amount of time.

The OSCE concept was originally proposed in 1979 by Professor Ronald Harden of the University of Dundee, Scotland, in a paper entitled: Assessment of Clinical Competence Using an Objective Structured Clinical Examination (OSCE). Medical Education 1979; 13: 41-54.

Fifteen years later in 1995, clinical assessment was clearly moving away from written examination formats. This was documented in an editorial by Dr. Dale Dauphinee, former CEO of the MCC, entitled: Assessing Clinical Performance Where Do We Stand, and What Might We Expect? (JAMA, 1995; 274:741-743). In it, he noted the reasons for this shift:

  • The increasing emphasis on physician accountability was driving examinations to focus on what the candidate “shows” and “does”
  • It had become increasingly possible to administer large-scale, multi-centre performance examinations
  • Improvement in the measurement qualities of performance-based exams

Since then, the OSCE format has become widely used for clinical assessments and is successfully applied from undergraduate to high-level postgraduate education.

Photo: Dr. Dale Dauphinee
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