Objective Structured Clinical Examination (OSCE)
An Objective Structured Clinical Examination (OSCE Exam) is an assessment designed to measure performance of tasks, typically medical, in a high-fidelity way. It is more a test of skill than knowledge. For example, I used to work at a certification board for ophthalmic assistants; there were 3 levels, and the top two levels included both a knowledge test (200 multiple choice items) and an OSCE (level 2 was a digital simulation, level 3 was live human patients).
OSCE exams serve a very important purpose in many fields, forging a critical bridge between learning and practice. This post will cover some of the basics.
What is an Objective Structured Clinical Examination?
An OSCE exam typically works by defining very specific tasks that the examinee is required to do, while examiners (often professors) watch them while grading them via a rubric or checklist. Each of the tasks is often called a station, and the OSCE will often have multiple stations. Consider the components of the name:
- Objective: We are trying to be as objective as possible, boiling down a potentially very complex patient scenario and task into a checklist or rubric. We want to make it quantitative, measurable, and reliable.
- Structured: The task itself is very boxed, such as using retinoscopy to measure astigmatism (perhaps one thing of 20 that might happen at a visit to your ophthalmologist).
- Clinical: The task is something to be done in a clinical setting; this is to increase fidelity and validity.
A great summary is provided by Zayyan (2011):
The Objective Structured Clinical Examination is a versatile multipurpose evaluative tool that can be utilized to assess health care professionals in a clinical setting. It assesses competency, based on objective testing through direct observation. It is precise, objective, and reproducible allowing uniform testing of
students for a wide range of clinical skills. Unlike the traditional clinical exam, the OSCE could evaluate areas most critical to performance of health care professionals such as communication skills and ability to handle unpredictable patient behavior.
There are a few key points here.
- It is a clinical setting, rather than a lecture hall setting (though in non-medical fields, “clinical setting” is relative!)
- It is assessing competency of clinical skills
- It is based on observation, where examiners rate the examinee
- It will often include assessment of “soft skills” or other non-knowledge aspects
Where are OSCE Exams used?
OSCE exams are very important in the medical professions. This report shows that many medical schools use it, though it curiously does not say how many schools were part of the survey.
However, it is most certainly not limited to medical fields. You don’t hear the term very often outside medical education, but the approach is used widely. Professions where someone is physically doing something are more likely to use OSCEs. An accountant, on the other hand, does no physically do something, and their equivalent of an OSCE is more like a complex accounting scenario that needs to be completed in MS Excel and then graded.
Examples of OSCE exams
Of course, there are many medical examples. I work with the American Board of Chiropractic Sports Physicians™, who have a practical exam. Check out their DACBSP webpage and scroll down to the Practical Exam resources, including instructional videos for some stations.
I once worked with a crane operator certification. They had a performance test where you had to drive the crane into a certain position, lift and place certain objects, and then move a wrecking ball through a path of oil drums without knocking anything over – all while being rated by an examiner with a checklist. Sounds a lot like an OSCE?
Perhaps the most common OSCE is one that you have likely taken: a Driver’s test. In addition to taking a knowledge test, you were also likely asked to drive a car with an examiner armed with a checklist while he told you to do various “stations” like parallel parking, perpendicular parking, or navigating a stoplight.
Tell me more!
There are dedicated resources in the world of medical education and assessment, such as Downing and Yudkowsky (2019) Assessment in Health Professions Education (https://www.routledge.com/Assessment-in-Health-Professions-Education/Yudkowsky-Park-Downing/p/book/9781315166902). You might also be interested in my Lecture Notes from a course taught using that textbook.
Nathan Thompson, PhD
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