Typically in a final year OSCE there may be anywhere between individual stations. Stations aim to sample across a wide range of clinical competencies Figure 2. For example:. At each station candidates are assigned a specific clinical task to perform. In these stations they may encounter a real or simulated patient, manikin, part-task manikin i. Each station has a predefined structured marking scheme or checklist.
There usually is an assessor in each station who observes the candidate and scores their performance according to the checklist. After a set time period, a bell will signal for candidates to move on to the next station. The circuit of stations is followed in sequence by all candidates. In circumstances where there are a large number of candidates, the OSCE may run across different examination venues and sometimes over the course of one day or more.
There are many attributes of a good and useful test. Van der Vleuten described five such criteria — namely: reliability, validity, educational impact, cost efficiency and acceptability of the test. Reliability of a test is a measure of its reproducibility and accuracy. In other words the degree to which a test consistently measures what it is intended to measure. OSCEs are widely considered to be a reliable form of assessment.
There are many features of OSCEs that contribute to their reliability. Assessor consistency is improved by the use of highly structured marking schemes. Individual assessor bias is reduced by the use of multiple assessors. Ultimately having multiple cases, and sufficient test time, are the most important features that contribute to the reliability of OSCEs. The validity of an OSCE is determined by its ability to actually measure what it is intended to measure. In other words an OSCE is considered valid if it succeeds in measuring competencies that it was originally designed to test.
There are different types of validity evidence. Blueprinting an OSCE i. Assessment provides a crucial role in the educational process. Not only does it check that learning has occurred but it can provide a powerful influence on future learning. Students often focus their studies on what they predict will occur in an OSCE. The challenge for faculty is to encourage students not to focus on predictions but the stated learning outcomes of the course.
Such as effect is known as consequential validity. A criticism of OSCEs is that they can promote students to learn the checklist rather than having a deeper understanding of the skill. Overall introduction with patient: good, adequate or poor? Use of such rating scales can improve the reliability of an OSCE. OSCEs are expensive and sophisticated forms of assessment. They are highly resource-dependent and require contributions from a large number of individuals.
For example, a 16 station OSCE for over medical students could require in excess of examiner days. Of course there are also patients, faculty staff and other supporting personnel required for the assessment. Considerable effort is also required prior to the OSCE. In terms of planning the logistics of the exam also in development of the stations and training of assessors and patients.
Costs regarding equipment, venue hire, catering and other sundry costs also need to be taken into account. Given the current economic imperative on academic institutions to make cost savings, there has never been a greater need to rationalise resources used in assessment.
Later in this article I will discuss sequential OSCEs and their potential to reduce the number of examiners slots required - whilst maintaining the reliability of the assessment.
OSCEs need to be acceptable by all stakeholders. Therefore it is important to seek feedback from candidates, examiners and patients involved in the OSCE. Future employers of the candidates also need to have an active role. Given the perceived unfairness of the long case , OSCEs have become widely accepted and popular in undergraduate medical education. In OSCEs, all candidates should experience the same assessment experience and conditions. To establish creditable standards, faculty must use a systematic approach in gathering expert judgments about acceptable levels of competency.
In such methods of standard setting, competent candidates may fail to progress if the cohort are of above average ability. Therefore norm referencing methods of standard setting are generally unacceptable in undergraduate medical OSCEs. Methods that define a cut-off score, thereby identifying candidates who are competent and eligible for progression, are preferred in undergraduate OSCEs - i.
The BLR method is generally considered robust and defendable. In the BLR method - assessors directly observe candidates performing the clinical task in each station. They score the various components of the clinical task on the predefined checklist. Assessors then provide a separate overall rating or a global score of the candidate's performance for example: Outstanding, very good, pass, borderline or fail.
Graphical representation of the borderline regression method of calculating an OSCE station pass mark i. Making such an adjustment reduces the probability of passing an incompetent candidate. Protecting patients from incompetent doctors would support the argument for making such adjustments. Assessors play a vital role in delivering a robust and fair OSCE. Ultimately the decision to pass or fail a candidate in an OSCE does not fall on one assessor but on the entire panel of assessors.
There is an imperative that institutions ensure assessors are competent to undertake their role. Therefore in order for assessors to carry out their role consistently, they require training and feedback on their judgements and behaviour. Users are also provided the opportunity to practice scoring on an OSCE checklist and awarding global scores using online videos.
In an anonymised fashion they can calibrate their decisions by comparing their awarded scores with that of their peers. However there remains a need for research in this area particularly on the effect that training has on assessor variance in OSCEs.
Most OSCE stations allow the observation of candidates interacting with patients. Patients may be either real or simulated. There are, however, significant issues regarding the use of real patients in OSCEs. Furthermore real patients, and their clinical features, are often difficult to standardise - which can lead to candidates experiencing differences in OSCEs.
Because of these challenges there ultimately has been a reduction in the use of real patients in undergraduate medical OSCEs. Faculty need to meet the challenges of using real patients in OSCEs and widen their participation. All Languages. More filters. Sort order. Mary McNamara rated it really liked it Oct 15, Sam Harrison rated it it was amazing Dec 02, Lilacponies added it Jan 07, Hani added it Jul 14, Nazmi Rozlan marked it as to-read Jul 25, Nurin Shina marked it as to-read Sep 06, Nurynjae is currently reading it Sep 07, Wonder added it Oct 03, Ooisk marked it as to-read Oct 06, Random books marked it as to-read Oct 06, Sook Fun marked it as to-read Oct 07, Nur Fatihah marked it as to-read Oct 07, Sue Hong marked it as to-read Oct 07, Kei Nyien marked it as to-read Oct 07, Nandini Sharma added it Oct 09, Halogen added it Oct 09, Mandy Tan marked it as to-read Oct 09, Nur Afiqah marked it as to-read Oct 11, Some features of WorldCat will not be available.
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