OBJECTIVE STRUCTURED PRACTICAL/ CLINICAL

EXAMINATION
Introduction

Assessment of clinical competence is an essential requirement of health professional

education. For some particular assessment situation, observation is most appropriate
approach. It is used as a method of assessment when actions speak louder than voice. In
observation assessment, teachers gather data not by asking information but by watching
closely. Student performs some actions and her behavior is observed and recorded.

In nursing traditional system of practical examination consists of either assigning a procedure

to a student or a patient for identifying the needs and problems. This depends upon student’s
ability and availability of the patient for a particular procedure. Some time it is challenging
to assess of clinical practice skills in health profession’s education in term of its objectivity.
Realizing the problems related to the conventional practical exams, the department of
Physiology (Nayaretal 1986) at All India Institute of Medical Sciences, introduce a new
pattern of practical examination called OSPE, which has greater objectivity, reliability and
validity.

OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE)

Meaning of OSCE
Objective: because examiners use a checklist for evaluating candidate.
Structured: making scheme for each station is structured. A clinical skills or procedure is
typically broken down into component parts in a very structured way. Stations are short,
numerous, highly focused.
Clinical: the task are representative of thoses faced in real clinical situations.
Examination: because the skills are assessed in the form of examination.
Definition

An approach to assessment of clinical competence in which the components of competence

are assessed in a well planned or structured way with attention being paid to objectivity of the
examination. –Harden 1988

The student is assessed at a series of stations with one or two aspects of competence being
tested at each station. The examination can be described as ‘focused’ examination with each
station focusing on one or two aspects of competence.

OSCE is the form of performance based testing used to measure candidates clinical
competence. During OSCE candidates are observed and evaluated as they go through the
series of station in which they interview, examine and treat standardized patients who present
with the some kind of problems.

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OSCE includes series of 12-20 stations, each testing one or two components of clinical
competencies for 3-5 minutes. students are rotated to each stations. The process is repeated
till all students are examined. Taking clinical history, physical examination, critical thinking
in patient management, problem solving and communication interpersonal relationships are
some of the competencies examined in these station.

In OSCE a series of stations in an examination room is set up to examine the students. At

each station, students may be asked to carry out a procedure, which may involve taking
history, performance preset clinical tasks and diagnosis patient’s problems. When performing
the clinical tasks, students may often interact with ‘patients;, who may be healthy volunteers
or mock patients. Students also have to answer questions based on their findings and their
interpretation. Students are observed and scored at some stations by examiners with
checklists.

Stations in OSCE

There are two types of stations in this assessment method:

Practice-based: students are given a written instruction and have to carry out a procedure.

Question-based: students have to answer questions about their findings at the previous station
and interpret these findings. The questions may be open-ended or of multiple-choice type.

PURPOSES OF OSCE

 Used in both formative and summative assessment in health professional education

 Identify objective performance criteria for the skill being examined
 Structure the performance criteria in a checklist to facilitate the identification of
desired clinical skills
 A requirement for accreditation in many health professional programs

USE OF OSCE
Interpretation and communication skills
History taking skills
Physical examination of specific body system
Mental health assessment
Clinical decision making including formation of differential diagnosis
Clinical problem solving skills
Interpretation of clinical findings and investigations
Management of clinical situations including treatment and referral
Patient education
Health promotion
Basic and advance nursing care procedures

OSCE Methodology: The OSCE examination consists of about 15-20 stations, each of which
requires about 4-5 minutes of time. All students should be capable of being completed at the
same time. The students rotate through all stations and moves to the next station at the signal.

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Each candidate is examined on a one basis with one or two impartial examiners on each
station they are marked by the examiner on standardized mark sheet. Using 15 stations of 4
minutes each, 15 students can complete examination within 1 hour.

STEPS OF OSCE

Registration: the first step is registration in this step you will go through the following
process

 Show your roll number or identify card

 General instructions are provided regarding examination
 Invigilator will inspect articles and prohibit those which are not allowed in
examination e.g. use of mobile
 Receive your exam envelop which contains your ID, stickers, pencil, notebook or
clipboard.

Orientation: the next step after registration is orientation

 Exam format, procedures and policies will be reviewed

 Introduce to your team and team leader.
 Instructed about your starting station and how to proceed
 Student can ask their queries regarding OSCE exam.

Escorting to exam position: after briefing the orienting students to rules and procedure of
OSCE, students will be escorted to stations. Students will be instructed about time at each
station and about time buzzer. Students will start exam as soon as long bell or buzzer
announce the start of the exam.

Station instruction time: there is one or two minutes to read the instruction about the station,
the situation, patient and required task. Students read carefully and enter the room at the next
bell.

The encounter: starts your encounter with the standardize patient. There is a 5-20 minutes
encounter. Perform the requires task. Stop at the next bell.

Post encounter period: some OSCE will have no post encounter period. Some will have 1-2
min of the encounter period assigned to an oral question asked by the examiner inside the
examination room. No more communication is allowed with the patient, and the written
questions to be answered on a paper or computer outside the exam room for 5-10 min. At the
next bell, first station ends as well as next station starts. Student proceeds to the next station
quickly.

Repeat step of station instruction time, the encounter and post encounter period:

Step of station instruction time, the encounter and post encounter period will be repeated until
student have been in all the situations. Some OSCE will offer 1 to 2 short rest period.

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Exam ended: exam is over. Student will be escorted back to dismissal area for singing out.
He will be asked to handle back all what he has received on signing in, he may be asked to
stay for some time for exam security reason.

ADVANTAGES OF OSCE

 Provides for a high fidelity and valid assessment

 Measures clinical competence cross sectionally using standardized means
 Focus on observable behavior
 Allow for assessing complex competencies without endangering patients
 Setting is more controlled
 Has a potential for peer feedback and assessment
 Provides more insights about students clinical and interacting competencies
 Time saving
 Minimize the effect of cueing
 Result in more objective examination

LIMITATION OF OSCE
 Require careful organization and it is challenging to create and administer
 Costly and require effort. It is cost-effective when many individuals are examined at
one administration
 Require high demand of other resources as standardized patients, assessors. Time
commitment and physical resources.
 Risk of observer fatigue if the observer has to record the performance of many
individual
 All station must invariably demand only equal time.
 It is considered by many that breaking clinical skills into individual competencies is
artificial and not meaningful.
 It may discourage students from looking at the patient as a whole because the
student’s knowledge and skills are being put into compartments.

OBJECTIVE STRUCTURED PRACTICAL EXAMINATION

The term OSPE is derived from OSCE in 1975 which was later extended to practical exam
and modified by Harden and Gleeson. OSPE is traditional system of practical examination in
nursing consists of either assigning a procedure to a student or patient for identifying the
needs and problems. This depends upon student’s ability and availability of the patient for a
particular procedure.

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Definition

It is a new pattern of practical examination, in which each components of clinical competence

is tested uniformly and objectively for all the students who are taking up a practical
examination at a given place. It can be used for formative and summative evaluation.

It is an assessment tool in which the competence of a student is evaluated for general

experiments; in terms of: identification of equipment/accessories of an experiment, procedure
of the experiment, handling of instruments, making observations/results, interpretation of
results, conclusion.

Features of OSPE

 Separate assessment of process and product through observation of performance and

assessment of result.
 Adequate sampling of skills and content to test.
 An analytical approach to the assessment.
 Objectivity
 Feedback to teacher and student.

TYPES OF STATIONS

For comprehensive appraisal of the student performance during OSPE, different type of
stations are planned and organized alternatively, that includes:

Procedure station: student has to perform a task. When student perform a task ,
simultaneously she is observed and marked against the check list being prepared in
advance, by a silent but vigilant examiner. Student gets a score according to the skill
demonstration by her.

Question station/response station: the student answer the question being asked on answer
sheet provided and leaves it in the place specified. Usually the question station may have
a question related to procedure station.

Methodology of OSPE:

 During this exam student pass through a number of stations.

 OSPE exam ideally consists of 15-20 stations for exam of a particular course. Number
of stations may be reduced according to higher number of students to be evaluated.
But in order to maintain the validity of the exam, the time for each station should not
be less than four minutes.
 All the station should be completed in the same period of time. Students are rotated
through all the station and move to the next station on the ring of the bell. Thus 15
stations of four minutes duration each, 15 students can complete the exam within one
hour. Each station is designed to test experimental competences.

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  At some stations called the procedures station students are given tasks to perform on
subjects. At all stations there is a observer with an agreed checklist to mark the
student performance.
 At other station called ‘response station’ student writes answer of objective type
question or record their findings of the previous procedure station.

Demonstration practical skills: demonstration of any practical skills for example monitoring
and recording oral temperature, blood pressure, converting centigrade to Fahrenheit and
testing urine and sugar etc can be given.

Make accurate observation: competence of student about normal and abnormal ECG or CTG.

Analyze and interpret data: analyze of any blood reports, urine, liver function or sugar
reports.

Identify the patient’s problems: student has to identify patient’s problem. Example dyspnea,
rigor.

Plan alternative nursing interventions: student has to give nursing interventions according to
problems.

ADVANTAGES OF OSPE

 It is more objective, reliable and valid than the traditional system of examination.
 All students are subjected to the same standardized test.
 Emphasis is shifting from testing factual knowledge to testing of skills, that too in a
short time.
 It helps to ensure the wide coverage of all practical skills.
 It ensures interactions of teaching and learning.
 There is increased faculty and student interaction.
 A large number of students can be tested within a relatively short time.

LIMITATIONS OF OSPE

OSPE is used only in simulated situations due to not availability of patients for the same
procedure.

 The simulated situation may not reflect the real life situation.
 Students cannot be assessed for different skills, such as intra personal relationship,
communication skills and dexterity in handling equipment.
 Empathy towards the patients cannot be evaluated.
 Providing holistic nursing care cannot be assessed.
 It is time consuming to construct an OSPE.
 It cannot be used by single person, it needs more resources in term of manpower, time
and money.
 There is no interaction between the examiner and the student.

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  There is risk of fatigue.
 Breaking clinical skills into individual compentencies may be artificial and not
meaningful.
 Careful organization is required since all stations require equal time.

DIFFRENCE BETWEEN OSCE/OSPE

OSPE OSCE

Domain Higher level of knowledge Psychomotor

Test ability Demonstrate practical skills, Structural knowledge to perform procedure

to accurate observation, identify
patients needs and problems

Time 2-4 minute/station More than 4 minutes

Space One big hall Isolated room that close to each other

Examiner 2 to 3 person per hall Expert examiner for each station

FORMAT OF OSCE/OSPE

CONCLUSION

OSPE/OSCE is practicable and have good reliability and validity tool to assess the clinical
competencies.

A cross sectional study was conducted on in Maharashtra Institute Of Medical Sciences and
Research in 2013 on the perception of the teachers and students for using OSCE/OSPE. The
study setting was the medical college and the study population was the all 7th semester
students and all teachers of community medicine. The study has highlighted many interesting
findings, most of the participants were in favour of using this assessment method in future.
OSCE/OSPE can provide a valid and reliable means of assessing the clinical skills of
students. So it is recommended that OSCE/OSPE should be used on pilot basis before being
fully adopted. A good assessment requires continuous efforts and sufficient resources like
manpower, money and time.

BIBLIOGRAPHY

1. Jaspreet kaur sodhi “Comprehensive textbook of Nursing Education” jaypee

publishers, first edition page(219-223)
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2. R Sudha “Nursing Education Principles and Concepts” jaypee publishers, first edition
page(185-188)
3. “Textbook of Nursing Education-Communication and educational technology” jaypee
publishers, page(274-278)
4. Wadde SK, Deshpande RH, Madole MB, Pathan FJ. Research article assessment of
III MBBS students using OSPE/OSCE in community medicine: Teachers’ and
students’ perceptions. Sch j app med sci. 2013;1:348-53.
5. Davis MH, Ponnamperuma GG, McAleer S, Dale VH. The objective structured
clinical examination (OSCE) as a determinant of veterinary clinical skills. Journal of
veterinary medical education. 2006 Dec;33(4):578-87.
6. Yaqinuddin A, Zafar M, Ikram MF, Ganguly P. What is an objective structured
practical examination in anatomy?. Anatomical sciences education. 2013
Mar;6(2):125-33.