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Teaching & Learning

OSCE - Objective Structured Clinical Examination

The OSCE database

Click the “osce database” folder in the Downloads section above for a collection of OSCEs past papers.   Video OSCE database provided below.
OSCEs are a fab educational resource.  Consider using them on your Half-Day Release schemes.

What is an OSCE?

OSCE stands for Objective Structured Clinical Examination – where you are examined in clinical tasks associated with general practice. It is objectively structured which means that there are a strict set of criteria for passing….which in effect removes bias from the examination.

  • It is an interactive learning process using “real life” situations and scenarios.
  • It is a method of teaching or training using scripts and highly skilled people to create and simulate real situations (simulated patients).
  • It is a method where the clients become physically and emotionally involved in the education process.
  • OBJECTIVE – examiners use a standardised checklist (of expected clinical behaviours) for evaluating trainees
  • STRUCTURED – that is, planned, so that every trainee sees the same problem and is asked to perform the same tasks
  • CLINICAL – Each scenario is representative of true clinical situations
  • EXAMINATION –  the test is either formative or summative….decide on which.
      • Formative – used as part of a teaching process to provide feedback to trainees  & can be used to provide teachers with important feedback as to what is still required
      • Summative – used to make formal grading decisions
      • ???? May be a bit of both. Grade it only to determine trainee development

The educational benefits of OSCEs

  • The OSCE is a proven and effective way of learning to deal with difficult situations.
  • The participatory experience gives true practical and emotional knowledge of scenarios being simulated.
  • The trainee experiences the reality of the situation being simulated and is more acutely aware of their own participation and responses to a given situation, without the risk of using real patients
  • Simulated patients allow instructors to carefully control the clinical learning experience. GP Trainees may work with the simulated patients on a one-on-one basis or in groups.
  • The encounter is much less intimidating to the GP Trainee than if he or she was working with an actual patient.
  • Instructors are able to explore the trainee’s thoughts, reasoning process and clinical abilities without worrying about compromising a patient’s well being.
  • GP Trainees can be carefully trained on how to handle many challenging situation (e.g. how to work with difficult patients, deliver bad news, and deal with physical and emotional abuse).

Critiques of health professions training have frequently noted the traditionally heavy reliance on written examinations and the subjective performance ratings that typically led to endorsement of competency in clinical training.  Certification and licensing organisations, faculty, learners, and the public have increasingly expressed dissatisfaction with these evaluative procedures. This dissatisfaction has led to newer evaluative techniques where learners are presented with simulated or real clinical/client scenarios, representative of those faced in professional situations, and are objectively evaluated on their response to the situation.

In this setting, not only is the knowledge base addressed, but competencies falling in the domains of attitude and skills are also addressed: communication skills, problem-solving, or recognition of the moral and ethical dimensions of a problem. These structured experiences are used to provide the learner with immediate formative feedback and the educator with valuable information regarding the learner’s mastery of clinical skills and attitudinal response to various clinical/client dilemmas.

Structured clinical/client scenarios are also used for summative evaluation of learners and provide valuable program evaluation information.  The OSCE promotes proficiency in communication skills, lifelong learning, professionalism, ethics, self-awareness, self-care and self-learning as well as problem-solving, clinical skills and the use of science for diagnostic and therapeutics; this curriculum has made the simple paper and pencil examination outmoded.

OSCEs are labor intensive but are reliable and valid and do provide assessment of the trainee’s competence and the feedback given to trainees immediately after their performance will significantly enhance the experience.

Who are the simulated patients?

  • A simulated patient (SP) is someone who has been carefully trained to portray the emotional, symptomatic and physical characteristics of an actual patient.
  • The SP is able to express the same symptoms and demonstrate the same physical examination findings as the case study and is additionally trained to provide feedback to trainees on their performance during the simulated patient encounter.
  • Because the simulation allows multiple trainees to experience a patient encounter in exactly the same manner, simulated patients are referred to as “standardised patients”. These simulations play an important role in the education of future physicians and health care providers.
  • Simulated patients are usually actors, but they don’t need to be, providing the person acting as the simulated patient has been trained.

Men and women of all ages and types of education are used to represent the various cases and patient problems used for simulations. The “patients” could be almost anyone, from a local coffee proprietor to a bank teller. In other words, acting experience is not necessary nor do they need to have any medical knowledge. These people must spend time with trainers learning the details of specific roles and may play numerous “patients” over the years.

How is it marked?

Everything you do right is ticked off against the criteria sheet, and if you get enough ticks you pass the station. If you pass enough stations you get through this part of the examination.   At the end of each station, you will be given feedback…. You will probably be asked what you thought you did well and bits that you thought you could have done differently.  The actor and the facilitator will each do the same.

What sorts of things might be examined in the OSCE?

You have to be able to take a quick and relevant history, just like you would in real life. Remember to ask ALL the routine questions.    A quick tip : – Listen to the answers that the actors give you ( actors are much more reliable that real patients ) as they will often help in directing your further questions.

In the 10-15 minutes or so that you have for each station, it is unlikely that you will be expected to make a full physical examination of someone but be prepared. You are more likely to be asked to examine a specific are of the body…like the knee joint.

It is quite likely that you will be given a set of data to interpret…..usually blood tests, but it can be something like an ECG or even Spirometry!   Again, this should be second nature to you.  This is not an examination aiming to trick you.  Instead, you are likely to be presented with material which one is ‘expected’ to be able to interpret.

The following is a list of possible data interpretation data types:

  • Respiratory function peak flow , vitalograph and spirometry measurements
  • ECGs
  • Radiological – Simple stuff only
  • Lab tests – Haematology , Coagulation , Thyroid function, Urea and electrolytes, Liver function
  • Communication: It is good to talk, but making it objective is not easy.  There are certain things routing things that you should always do at such stations…such as introducing yourself and responding to verbal and non-verbal cues.  You may be asked to : (i) Counsel someone– eg giving bad news, (ii)  Explaining the diagnosis, Investigations or Treatment  (iii)  Explain a procedure

You need to know about the equipment you use. A common scenario is to be able to demonstrate the use of an ophthalmoscope.  

Some Hot Tips and Tricks

Take your time.  Concentrate on the interview process. The details you obtain are less important than achieving a good flow of information.

  • Welcome and identify the patient, identify yourself, ensure comfort.
  • Obtain the chief complaint(s), set the agenda. Avoid detail here.
  • Encourage the patient to start talking about his or her problems using open-ended questions initially.
  • Establish a personal focus as appropriate. “It must be hard getting up every morning feeling as tired as you do…”
  • Summarise the patient’s problems.
  • Prioritise, focus on the most urgent symptom.
  • Begin with open-ended questions about a specific symptom. “Please tell me more about your leg pain?”
  • Focus with closed-ended questions
  • Location/Radiation
  • Quality/Quantity
  • Timing/Duration/Frequency
  • Aggravating/Relieving Factors
  • Associated Symptoms
  • Pursue other symptoms as time permits.

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Bradford VTS was created by Dr. Ramesh Mehay, a Programme Director for Bradford GP Training Scheme back in 2001. Over the years, it has seen many permutations.  At the time, there were very few resources for GP trainees and their trainers so Bradford decided to create one FOR EVERYONE. 

So, we see Bradford VTS as  the INDEPENDENT vocational training scheme website providing a wealth of free medical resources for GP trainees, their trainers and TPDs everywhere and anywhere.  We also welcome other health professionals – as we know the site is used by both those qualified and in training – such as Associate Physicians, ANPs, Medical & Nursing Students. 

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