OSCE

Introduction to OSCE

OSCEs have been around for many years, but have become very widely adopted
during the past few years and, although originally developed for use in medical
exams, they are now used by a number of different professions. They were first used
in dentistry in the mid-1990s at The Royal London.

OSCEs can test a wide range of clinical skills under controlled conditions, so the
content can be highly valid (ie it tests appropriate things in appropriate ways) and the
results can be very reliable.

Typically, students find OSCEs fairly demanding but they
judge them to be a fair and comprehensive way of enabling them to demonstrate
their clinical skills under exam conditions.

An OSCE must contain all 4 elements that the name implies – it is an examination of
clinical skills and competencies that must be objective and structured.

In the past, it was often felt necessary to have ‘killer’ stations which, if a candidate
failed, meant that they failed the whole exam irrespective of their performance on
other stations. This is now considered to be bad practice (for one thing, it can be
unfair). Instead, marks are weighted so that essential or time-consuming components
of the task are weighted more than less important or shorter elements.

What is an OSCE?

An OSCE is a multi-station examination in which candidates spend a fixed period of
time at each station before moving on to the next. It is essentially a rotation, although
stations may be set up in several different rooms. The stations may require the
candidates to undertake a task, such as mixing impression material, setting out an
instrument tray, or giving advice or an explanation to a real or simulated patient.
Each station has its own special assessment sheet, designed specifically for the skill
being assessed. Each station might be marked out of a different total, but they will be
converted to the same scale (usually a percentage) to ensure that each contributes
equally to the final score.

It has been researched, that to achieve adequate reliability, an OSCE circuit needs at
least 15 well-performing stations if each has around 5 minutes of testing time, so a
major OSCE will contain between 15 and 25 stations and candidates will usually
spend about 5 to 8 minutes at each. Every so often is a rest station with a chair and
refreshments. At these stations, candidates can take a short break or sometimes
read the notes or short scenario they will need in preparation for the next station.

OSCE stations with real or simulated patients will also have an examiner present
(although it is increasingly common for the patient to also be the examiner – or
contribute a supplementary marking sheet). At some other stations there might be no 

examiner – students complete their question form and post it into a sealed
‘letterbox’. However, stations of this type are normally kept to a minimum because the
most valid OSCE stations have patients and/or examiners present