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Problems of conventional clinical & practical examination:
The conventional Clincial & Practical examination is beset with the following problems:
1. Lack of objectivity
2. Student skill variability
3. Examiner variability
4. The ability to examine a patient and to come to a conclusion is not observed by the examiner
5. The final evaluation score does not give adequate feedback to the candidate
In order to overcome these shortcomings, Harden introduced Objective structured clinical and practical examination (OSCE) in 1979. Gradually OSCE has become more acceptable examination modality due to its objectivity.
What exactly is OSCE: Objective structured clinical & Practical examination
This system of examination consists of 15 - 20 stations. A student appearing for the exam is expected to spend 4 - 5 minutes inside a station. These stations can be simultaneously run and hence about 15 - 20 students could be examined within 1 hour. The students are expected to complete the task within the station and fill it up in the response sheet provided.
These stations should be carefully planned so that the clinical acumen of the student can be comprehensively tested. All these stations should have observers armed with check lists to assess the student's performance. Some stations are called procedure stations where in the student is expected to perform an examination technique on the patient. These procedure stations should be so designed to test the examination skill of the student.
Testing protocol for procedure stations:
1. Does the student greet the patient on entering the cubicle ?
2. Does the student explain to the patient what he is going to do in simple terms ?
3. Does the student seek permission of the patient before examining him / her ?
4. Does the student provide a screen to maintain privacy of examination ?
Greeting a patient will increase his trust and confidence in you
Advantages of OSCE:
1. The whole examination is objective
2. It ensures integration of teaching and evaluation
3. The sheer variety provided by these tests sustains the interest of the student
4. There is increased examiner / student interaction
5. Patient variablity and examiner idiosyncrasies are avoided
6. A large number of students can be evaluated within a short time
7. It can be adapted according to local needs
Limitations of OSCE:
Any examination method0logy is not foolfroof. Similarly even OSCE also has its own limitations.
1. Observer fatigue (Examiner in this case)
2. It is difficult to evaluate overall competency of a student
3. Considerable care should be taken while setting up the examination cubicles as each of the candidate should spend only 4-5 minutes within a cubicle.
The following points should be borne in mind while setting up these examination cubicles:
1. The questions should be objective in nature
2. The language should be simple and clear
3. There should be standardization i.e. steps to be evaluated, their relative weightage in terms of marks, and time required to answer the questions posed.
4. Assessment of a student's understanding of theoretical concepts, his skill of observation and interpretation of signs should also be tested by designing cubicles which could serve this purpose effectively.
5. Supplemental questions on radiology, graphs, diagrams, specimen should also be given
6. The examniers should be provided with all the material required, questions, key sheet containing answers and mark distribution, and a detailed instruction chart on the steps to be evaluated
7. Students and examiners should be throughly briefed
8. The number of stations should be clearly mentioned at the entrance of the examination hall
9. Time alloted to each station should also be clearly mentioned
10. Bell should chime the start and end of a station
11. Students should proceed in only one direction
12. In general negative marks are not awarded in this examination pattern