Objective Structured Clinical Exam (OSCE)
What is an OSCE?
An OSCE is an Objective Structured Clinical Exam. It is a test (summative evaluation) in which clinical skills, such as history taking, use of a stethoscope, proper placement of finger tips, etc. are evaluated. In contrast to a written exam, which evaluates knowledge and, possibly, analytical skills, an OSCE evaluates hands-on capabilities -- the skills a medical student (or more advanced learner) is expected to acquire during training. A surgery OSCE might involve knot tying and use of a scalpel; an OB/GYN OSCE might involve a breast exam and doing a PAP smear. An OMM OSCE may evaluate performance of a palpatory exam and execution of a manipulative technique. Any OSCE might involve history taking, development of a treatment plan, counseling the patient, and documentation. The terms “objective” and “structured” make reference to the fact that the evaluation is built around a set of pre-determined skills for which criteria have been established. These criteria are incorporated into checklists which are used to evaluate the skills. To evaluate all of the targeted skills, students usually engage in more than one scenario or encounter during an OSCE. At SOM, some OSCEs include only two encounters while others are composed of as many as seven or eight encounters. These encounters are staged using a combination of carefully trained patient actors (standardized patients) and mannequins, so that each student’s experience is identical (“standardized”) while closely approximately a real-life scenario.
Where will the OSCE take place?
All OSCEs are staged in the 10-exam room suite of the Clinical Education & Assessment Center in the University Doctors Pavilion. The suite is equipped with observation equipment – one-way class and digital recording devices – so that student performance may be evaluated in real time or later via recording.
What should I review prior to the OSCE?
OSCE content rarely comes as a surprise to students. In fact, students are often told exactly what will be covered in an OSCE. However, knowing what will be evaluated does not guarantee competence in performing the skill. Students are advised to practice the various skills to be tested – basic physical assessment and patient communication skills as well as more complex procedures. Students are also advised to inquire of faculty how specific skills are evaluated – in other words, what are the important elements of the skill which must be mastered. Students may also derive benefit from reviewing textbook entries and watching instructional videos. Students are also welcome to use the CEAC, by appointment, by themselves or with classmates, to practice on the equipment or with one another. Of course, getting experience with the skill in a real clinical setting on a real patient under the careful guidance of an instructor is of greatest value.
What is the purpose of the OSCE?
The purpose of an OSCE to evaluate the student’s competence in performance of various clinical skills.
Whom should I contact if I have a question prior to the OSCE?
Questions about OSCE content should be directed to the course or clerkship directors. Questions about logistics and scheduling should be directed to CEAC staff Sima Bennett at email@example.com or 856-566-66172 or Kathleen Roderique at firstname.lastname@example.org or 856-566-6074.
Will there be an orientation?
Details about OSCEs are usually covered in course or clerkship orientation sessions or in a class before the OSCE date. In many instances, “Learner/Examinee Instructions” are emailed or posted electronically in advance of the OSCE. When the student arrives at the CEAC, there is always opportunity to ask additional questions or obtain clarification, and students are welcome to contact CEAC staff in advance to address concerns.
What should I do during the OSCE?
Never disregard email from the CEAC; it always contains important content or logistical information. Follow all instructions and guidelines provided in advance and upon arrival to the CEAC. Never miss an appointment or arrive late to the CEAC. Once the OSCE begins, the student is essentially treating a patient based on the instructions provided in advance (email / electronic posting), on arrival to the CEAC, or at the door to the patient’s exam room. Typically, a patient chart is part of these instructions. Instructions usually read like this: You are a physician in a [setting is specified.] Jane Smith presents complaining of… Take a history and perform a focused physical exam. You have ___ minutes.
May I discuss the OSCE cases with other students after the OSCE?
An OSCE is a test. Because of logistics, unlike a written exam, students may not all be “taking” the OSCE at the same time. Students are expected to uphold the honor code. That means there should not be any discussion of what went on in the testing environment among students until all students have tested.
Will I have a SOAP worksheet to take notes? Will I be required to write a SOAP note?
No. Not all faculty require documentation as part of an OSCE.
What should I include in the SOAP note?
S = Subjective (what the patient tells you—essentially, the answers to the history questions posed to the patient), O = Objective (patient data – height, weight, vital signs, pertinent positive and negative findings from the physical examination conducted by the student or provided by the patient chart), A= Assessment (your impression of what is going on with the patient based on the Subjective information and Objective data. Sometimes this is merely a list of differential diagnoses. In some instances, additional comments regarding the patient’s condition are also appropriate. P=Plan (what needs to be done for the patient or what you already did do during the encounter -- including additional testing or prescriptions, referrals, plans for follow-up, treatments rendered.)
Is drug information available?
We do not provide the students with any drug information. That's covered in course work or clerkships. When a drug is mentioned in a patient chart, it is presumed that the students are familiar with the drug(s), as any information provided in patient charts originates from the faculty of the sponsoring course/clerkship. When students need to order medication for a patient -- for instance, as part of a therapeutic plan for the patient -- some faculty will require the naming of specific drugs, while others may be satisfied with the student referring to the class of drug or the drug's action, i.e. antihypertensive medication, medication to contol blood sugar.
Are abbreviations acceptable?
Course and clerkship directors establish grading criteria for SOAP notes. Whatever abbreviations are acceptable to them are acceptable are therefore acceptable on their test. However, when students face the COMLEX Level 2PE during 4th year, the NBOME allows only specific abbreviations. These approved abbreviations are available on their website and generally cover abbreviations so universally established and well known that all health care providers find them familiar. The list is revised yearly and is the safest list of abbreviations to use. All other terms should probably be written out long-hand.
What do I wear and bring to an OSCE exam?
Typically, students are expected to “dress professionally.” However, this term is non-specific, and we have found that it is interpreted differently by different students. Other than students’ wearing their white coats – and having them cleaned and pressed – students should form a picture in their minds of the professional image they wish to project and then dress accordingly. For women, this should eliminate “party/club” clothing, including plunging necklines, short skirts, spike heels, novelty hose (i.e. fishnets) and distracting jewelry, cosmetics and hair styles. Long hair should be out of the way. For men, a collared shirt and necktie are expected. Students should also be wary of clothing that is too sporty or relaxed. Students who wear head coverings for religious reasons should be careful to have these garments appear clean, pressed and polished enough to match the tone set by the rest of their clothing. Grooming for both men and women is critical, including hair, nails, skin and facial hair. Students who have multiple piercings or tattoos should consider covering these or leaving them home, where possible. While styles change with the times, and while different styles are more acceptable in some communities than in others, students should keep in mind that the metro-Philadelphia region is relatively conservative, and patients want their health care providers to look the part.
Students are expected to arrive with, at the very least, a stethoscope and a writing implement. Telephones are not considered appropriate time pieces, and a phone can not be taken out during an OSCE. For some programs, student may be required to have special equipment, such as tuning forks or reflex hammers, or they may be required to bring a laptop computer. While standard diagnostic equipment is available in each of the CEAC’s exam rooms (blood pressure cuff, ophthalmoscope, otoscope and thermometer), some students choose to bring their own. If students are expected to bring specific paperwork or equipment with them, this information is provided in advance by electronic posting or email.
What is the arrival time?
The CEAC schedules each program individually, and students are notified in advance when to arrive. In other words, arrival time is when the CEAC sets it. Being late can have serious negative consequences, such as a student’s missing valuable last minute instructions or even missing part or all of a first encounter. Typically students do not receive full credit even if their testing session is rescheduled. In most instances, the CEAC allows students to self select an appointment slot to complete an OSCE; rarely, a course or clerkship director directs a specific order or time slots for students. When we allow students to self select, we set a cut-off date after which we will no longer honor requests. At that point, there is often still a grace period during which students can trade appointment times with one another if our switching guidelines are carefully followed. When the grace period ends we will no longer allow any changes, and students must follow the schedule as published. At no time may a student arrive in another student’s place. The arriving student will not be given admittance, and the student originally slated for that time slot will me marked a no-show.
Are OSCEs videotaped?
Typically, yes. If students are being evaluated in real time, the recording is used as back-up. If there is no live evaluation, grading is done completely from the recordings.
What is the grading system for an OSCE?
The CEAC does not establish grading policies; grading for OSCEs is determined by the course or clerkship director and can range from a single test score to 30% or more of the course/clerkship grade. Hence, questions regarding grading, or challenges to grading, should be handled accordingly. The exception to this is the end-of third-year Clinical Skills Competency Exam, in which case the CEAC is involved in the grading process and can address student concerns.
How is the grading system determined?
OSCEs are grading using performance checklists, in which students score points for checklist items (elements of performance) properly executed. Where SOAP notes are scored, a rubric is used to award points for specific content included in the note. In some instances, too, checklists completed by standardized patients are also taken into consideration. How these components are weighed is determined by the course or clerkship director.
Whom do I ask if I have questions during the exam?
The CEAC staff is always willing to address student concerns and accept student suggestions. Issues of logistics or problems involving completion of the exam can often be handled directly by the CEAC staff immediately. Issues involving grading or clinical content must be directed to the course or clerkship director and may not be able to be addressed immediately.
Any tips or guidelines for success on the OSCE?
Be prepared regarding clinical knowledge and skills. While you can often get lucky with a guess on a written exam, guessing is of no value when you are asked to perform. Treat the standardized patient, and even a mannequin, as a real patient with fears, concerns and ailments; treat them the way you would want yourself or someone important to you treated. Keep in mind that while you may feel awkward at first, every experience you have with a patient – real or simulated – prepares you for your next encounter – real or simulated.
CEAC Staff Contact Information
Sima Bennett at email@example.com or 856-566-6172
Kathleen Roderique at firstname.lastname@example.org 856-566-6074