OBJECTIVE STRUCTURED CLINICAL EXAMINATION
THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION
KEEPING IT REAL with the OSCEs! – in Medical Education
Faculty Training WEBINAR
Hosted by the
Department of Anaesthesiology
in collaboration with
The Medical Education Unit and The Skill & Simulation Lab
JSS Medical College
JSS Academy of Higher Education & Research
Date: 19.07.2024, Friday
Time: 05:00PM – 07:00PM
DR. PAAYAL CHANDRASHEKAR 1
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Pre-Webinar Handout
INDEX
CONTENT PAGE NUMBER
SECTION 1
Execution 4
How to organise 5
Committee 6
Blueprint 7
Matrix 8
SECTION 2
The script 14
Candidate 15
Simulated Patient 16
Examiner 18
SECTION 3
Checklist 19
Standard Setting 23
DR. PAAYAL CHANDRASHEKAR
MBBS, MD Anaesthesiology, EDAIC, FRCA (UK)
Overseas fellowship in Anaesthetics & Critical Care, UK
Senior Resident, Department of Anaesthesiology
JSS Medical College, JSS AHER, Mysuru, India
Special thanks to
DR. ZAKIYA MARYAM
MBBS, MD & DNB Anaesthesiology, EDAIC, FRCA (UK)
Specialty Registrar Anaesthetics
United Kingdom
DR. MEGHNA MUKUND
MBBS, MD Anaesthesiology and Critical Care
Overseas fellowship in Critical care & Simulation, UK
Professor & Head of the department, Emergency Medicine
Professor (Anaesthesiology) & Consultant (Critical Care)
Chief Co-ordinator Skills & Simulation (ACTS-YEN)
Yenepoya Medical College, Yenepoya University, Mangaluru, India
DR. PAAYAL CHANDRASHEKAR 2
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
SECTION 1
DR. PAAYAL CHANDRASHEKAR 3
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
EXECUTION
Development:
Phase I
Organisation and Design
Phase II
Train the Trainer
Phase III
Guidance to Trainees
Deployment:
Phase IV
Implementation
DR. PAAYAL CHANDRASHEKAR 4
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Phase I
Organisation and Design
Form an OSCE Committee
Define roles
Guidance to station designer on writing instructions
Design stations
Standardization of Examiners and Simulated patients
Pilot test/ Validate
Marks system and Setting pass mark
DR. PAAYAL CHANDRASHEKAR 5
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
OSCE Committee
ROLES
OSCE Coordinator / OSCE Lead
Simulation Coordinator
Subject Experts
Panel of Subject experts
The panel to decide the intended learning competency to be
tested.
OSCE Station Designer +/- Expert to revise
Experts To Validate
OSCE Facilitators
OSCE Examiners
DR. PAAYAL CHANDRASHEKAR 6
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
OSCE BLUEPRINT
Make a Note…
Competencies
Jot down…
Stations & Concepts
Strike off…
Tasks
Add on…
Issues
DR. PAAYAL CHANDRASHEKAR 7
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Creating a MATRIX
Example
Stations
• History Taking
• Examination
• Communication Skills
• Data Interpretation
• Clinical Problem Solving
• Procedural Skills
DR. PAAYAL CHANDRASHEKAR 8
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Creating a MATRIX
Example
Concepts
• Cardiovascular system
• Respiratory system
• Cranial nerves
• Joint examination
• Gastrointestinal system
• Ear, nose and throat
DR. PAAYAL CHANDRASHEKAR 9
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Creating a MATRIX
Example
Task/ System CVS RS GI CNS ENT Joint
History X
Communication X X
Examination X
Data X
Interpretation
Clinical problem X
solving
Procedural skills X
DR. PAAYAL CHANDRASHEKAR 10
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Creating a MATRIX
Example
Task/ System CVS RS GI CNS ENT Joint
History High blood
pressure
Communication Consenting Informing
a patient the
for an patient
inguinal that
hernia he/she
surgery has been
diagnosed
with brain
tumour
Examination Joint
Examination,
Range of
movements,
abnormalities
Data Chest
XRay
Interpretation
Clinical Sinus
Bradycardia
problem
solving
Procedural Laryngoscopy
&
Intubation
skills
DR. PAAYAL CHANDRASHEKAR 11
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Creating a MATRIX
Example
Task/ System CVS RS GI
History High blood -
pressure
of an anxious
patient
Communication - Consenting a
needlephobic patient
for an inguinal hernia
surgery
DR. PAAYAL CHANDRASHEKAR 12
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
SECTION 2
DR. PAAYAL CHANDRASHEKAR 13
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
How to design?
THE SCRIPT
The Candidate
The Surrogate
The Examiner
DR. PAAYAL CHANDRASHEKAR 14
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Example
STATION: COMMUNICATION
Instruction to the CANDIDATE / STEM
SAMPLE SCENARIO
Sample question
INFORMATION FOR THE CANDIDATE
STATION: COMMUNICATION
Time allotted: 5 minutes
Please ignore the patient actor until the examiner indicates you should begin.
The examiner cannot comment on a candidate’s performance
The examiner cannot comment on any details of the scenario
CASE: This is Mrs Ashwini Rai. She is a 28-year-old software engineer. She has been listed
for tibial nailing tomorrow. She is otherwise fit and well. She has a fear of needles. It terrifies
her and she has refused to have her bloods taken to send for tests prior to the procedure.
Candidate’s role: You are the intern doctor who has been requested to speak to the patient and
counsel the patient.
(OR)
Candidate’s role: You are the anaesthetist post graduate doctor who has been requested to
speak to the patient and help plan the anaesthetic management.
DR. PAAYAL CHANDRASHEKAR 15
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Instruction to the PATIENT ACTOR/ SIMULATED PATIENT
SAMPLE SCENARIO
Sample question
Not to be seen by candidates
INFORMATION FOR THE SURROGATE
You are scheduled to have an operation tomorrow (having her right shin bone fixed by nails).
You had a fall at home and broke your right shin bone. You did not sustain any other injuries
nor hit your head. You did not faint or throw a fit after neither did you feel and puke.
You do not smoke neither do you drink alcohol.
You have had an XRAY of your right leg taken. The bone doctors have had a look and
explained that your right shin bone is broken or displaced and you need to have an operation
for it heal and reunite well without problems. You have not had any other tests done.
You do not have any medical conditions. You do not take any regular medications. You do not
have allergies. You have never had an operation before and never had any sort of anaesthesia.
Nobody in your family has had any anaesthesia related problems that you know of. No other
major medical problems in your family either.
You are terrified of needles.
You refuse to have bloods taken before going to sleep under anaesthesia.
You say you are fit and well and you feel your blood work will be normal.
Ask if this is really necessary.
Ask if there is any other way to go off to sleep.
Ask if you have the cannula taken out before you wake up.
DR. PAAYAL CHANDRASHEKAR 16
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Instruction to the PATIENT ACTOR/ SIMULATED PATIENT
SAMPLE SCENARIO
Sample question
Not to be seen by candidates
INFORMATION FOR THE SURROGATE
Following discussion with the intern/ anaesthetic doctor who
Tells you that the cannula has needle and is itself not a needle and once it is, needle is
taken out.
Explains that the cannula is a thin plastic tubing which remains inside to provide
medications, however the needle is removed and discarded and doesn’t stay in
Provides you options
of applying a numbing cream to the back of her hand before inserting a cannula and
taking bloods,
using a very small cannula to take bloods or put her off to sleep,
going off to sleep with the gas (which can be risky!),
get a senior experienced anaesthetic doctor to do it who might not cause much
discomfort.
Offers tablet to calm your nerves.
Putting a drip (cannula) and sending off bloods after putting her off to sleep with the
gas (which poses risk again!!) as the lab results take time, she might be anaemic (low
haemoglobin levels) and during the procedure she might bleed as many bone
operations tend to and in case this bleeding is more than expected she may require
blood
In which case arranging for the blood can get delayed as the blood tests take time to
get processed which might put her life in danger.
Absolutely refuse to have the cannula put or bloods taken before being put to sleep
(anaesthetised)!!!
DR. PAAYAL CHANDRASHEKAR 17
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Instruction to the EXAMINER
SAMPLE SCENARIO
Sample question
Not to be seen by candidates
INFORMATION FOR THE EXAMINER
Guidance:
Systemic empathetic approach. Use of layman terms.
These stations are about the passage of information and seeking a response from it.
Marks are awarded for good communication skills, being polite and using appropriate
language, however the majority of marks are reserved for obtaining relevant information.
All communication stations should start with the candidate introducing self to the patient,
confirming patient identity and confirming what the candidate is there to talk about and try to
ascertain the exact issue/concern.
All communication stations should end with the candidate tests the patient understanding and
check they have no further questions at the end of the station.
Typical scenario involves explaining a procedure or complication, taking consent or
discussing treatment options.
This is not a history station, hence not required to elicit any component of routine history
unless related to the issue or problem in this case needle phobia.
This is not a physical examination station; hence candidate should not examine the patient.
The candidates task here to find out about the ideas, expectations and concerns in relation to
the cannula, any measures that can be taken to put the patient at ease and help plan the
anaesthetic by negotiating all the options with the patient. Patient safety is paramount.
Candidate’s task is to discuss options as well as explain the risks of alternative options and
consequences of not having prior bloods taken to run blood tests and explain that it may not
be appropriate to proceed with anaesthesia and surgery without an IV access!
Further reading:
Needle Phobia - Professionalism Based Simulations
https://rcoa.ac.uk/sites/default/files/documents/2023-
10/Communication%20-%20Needle%20Phobia%200923.pdf
DR. PAAYAL CHANDRASHEKAR 18
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
How to score?
DOMAIN - RUBRICS
CHECKLIST - ITEMS
DR. PAAYAL CHANDRASHEKAR 19
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Global Scoring system
Sample question
Not to be seen by candidates
INFORMATION FOR THE EXAMINER
Examiner Marks sheet and guidance
Question Tick as appropriate
Global Scale Inadequate Adequate Good
Introduces him/herself to the patient and explains his/her role
Confirms that he/she is talking to the right person and here to talk
about her fear of needles
Try to ascertain exactly what she frightened of
Manages an anxious patient, gives reassurance without making
false promises
Empathises with her about her fears and build rapport
Explain cannula itself is not a needle and once it is in needle is
taken out.
Ability to consider all the management options for the needle
phobic patient whilst providing safe anaesthetic options within
limits of competence
Explains the technique employed such as
EMLA cream,
small cannula/needle and
having the most experienced skilled anaesthetist insert the
cannula
Offer oral sedative medication as anxiolysis
Good Pass Pass Borderline Fail
Examiner signature:
DR. PAAYAL CHANDRASHEKAR 20
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
Numerical Scoring system
Sample question
Not to be seen by candidates
INFORMATION FOR THE EXAMINER
Examiner Marks sheet and guidance
Question Score
Introduces him/herself to the patient and explains his/her role 0 1
Confirms that he/she is talking to the right person and here to talk 0 1
about her fear of needles
Try to ascertain exactly what she frightened of 0 1
Manages an anxious patient, gives reassurance without making 0 1
false promises
Empathises with her about her fears and build rapport 0 1
Explain cannula itself is not a needle and once it is in needle is 0 1
taken out.
Ability to consider all the management options for the needle 0 1
phobic patient whilst providing safe anaesthetic options within
limits of competence
Explains the technique employed such as 0 1 2
EMLA cream,
small cannula/needle and
having the most experienced skilled anaesthetist insert the
cannula
Offer oral sedative medication as anxiolysis 0 1
Station MAXIMUM score: 20 Marks
Candidate score: __________
Examiner signature:
DR. PAAYAL CHANDRASHEKAR 21
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
How to score?
Which method to choose?
DR. PAAYAL CHANDRASHEKAR 22
OBJECTIVE STRUCTURED CLINICAL EXAMINATION
How to Set the standard?
Borderline Group Method
Borderline Regression Method
Modified Angoff’s Method
Normative (Relative)
Absolute (Criterion)
What to choose?
To be continued…
DR. PAAYAL CHANDRASHEKAR 23
