Additional Information
Book Details
Abstract
The new book is the definitive text on the Objective Structured Clinical Examination (OSCE), providing an easily accessible account of the breadth and depth of experience gained worldwide from its use in a wide range of contexts and in different phases of education. The lessons learned from these diverse experiences are included throughout the text.
Used globally in all phases of education in the different healthcare professions, the OSCE was first described by the lead author, Harden, in 1975 and it is now the gold standard for performance assessment.
The new book is the definitive text on the Objective Structured Clinical Examination (OSCE), providing an easily accessible account of the breadth and depth of experience gained worldwide from its use in a wide range of contexts and in different phases of education. The lessons learned from these diverse experiences are included throughout the text.
Used globally in all phases of education in the different healthcare professions, the OSCE was first described by the lead author, Harden, in 1975 and it is now the gold standard for performance assessment.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| The Definitive Guide to the OSCE | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Foreword | vii | ||
| References | ix | ||
| Preface | xi | ||
| About the Authors | xiv | ||
| Contributors to Case Studies | xvi | ||
| Acknowledgements | xix | ||
| A An introduction to the OSCE | 1 | ||
| 1 What is an OSCE? | 1 | ||
| A definition | 1 | ||
| Objective | 1 | ||
| A number of stations | 2 | ||
| Uniform examination | 4 | ||
| Specification of what is assessed | 4 | ||
| A number of examiners | 5 | ||
| Specification of standards required | 5 | ||
| Structured | 5 | ||
| OSCE blueprint | 5 | ||
| Clinical | 6 | ||
| A flexible format | 8 | ||
| The OSCE and the eight Ps | 9 | ||
| OSCE variations | 10 | ||
| Objective Structured Practical Examination (OSPE) | 10 | ||
| Objective Structured Practical Veterinary Examination (OSPVE) | 10 | ||
| Clinical Assessment of Skills and Competencies (CASC) | 10 | ||
| Practical Assessment of Clinical Examination Skills (PACES) | 10 | ||
| Objective Structured Assessment of Technical Skill (OSATS) | 10 | ||
| Multiple Mini-Interview (MMI) | 11 | ||
| Group Objective Structured Clinical Experience (GOSCE) | 11 | ||
| Team Objective Structured Clinical Examination (TOSCE) | 11 | ||
| Team Observed Structured Clinical Encounter (TOSCE) | 11 | ||
| Team Objective Structured Bedside Assessment (TOSBA) | 11 | ||
| Interprofessional Team Objective Structured Clinical Examination (ITOSCE) | 11 | ||
| Objective Structured Teaching Encounter (OSTE) | 12 | ||
| Take-home messages | 12 | ||
| 2 The inside story of the development of the OSCE | 13 | ||
| The traditional clinical examination | 13 | ||
| Problems with the clinical examination | 13 | ||
| Evidence of the unreliability of the clinical examination | 15 | ||
| The development of the OSCE | 16 | ||
| The OSCE as the final qualifying examination | 17 | ||
| Dissemination of the OSCE approach | 18 | ||
| Increasing popularity of the OSCE | 19 | ||
| Regional variations | 21 | ||
| Why the OSCE has been adopted widely | 21 | ||
| Take-home messages | 22 | ||
| 3 The OSCE as the gold standard for performance assessment | 23 | ||
| The gold standard | 23 | ||
| Characteristics of a good assessment | 23 | ||
| Reliability and the OSCE | 24 | ||
| Validity and the OSCE | 25 | ||
| Feasibility and the OSCE | 26 | ||
| Flexibility and the OSCE | 27 | ||
| Fairness and the OSCE | 28 | ||
| Acceptability and the OSCE | 29 | ||
| Feedback and the OSCE | 30 | ||
| The OSCE and educational impact | 30 | ||
| What an educational assessment must do | 31 | ||
| Take-home messages | 33 | ||
| 4 How the OSCE can contribute to the education programme | 35 | ||
| Uses of the OSCE | 35 | ||
| Evaluating the learner | 35 | ||
| Summative assessment | 36 | ||
| Formative or diagnostic assessment | 37 | ||
| Assessment of the learner’s progress | 37 | ||
| Predicting a learner’s future performance | 38 | ||
| Selecting students for admission to medical studies | 39 | ||
| Evaluating the curriculum | 40 | ||
| Reinforcing the specified learning outcomes and directing learning | 40 | ||
| Faculty development | 41 | ||
| Subjects and disciplines assessed | 42 | ||
| Phases of education | 42 | ||
| Undergraduate education | 42 | ||
| Postgraduate education | 43 | ||
| Continuing education | 44 | ||
| Use in healthcare professions and other fields of practice | 44 | ||
| Nursing and midwifery | 44 | ||
| Dentistry | 45 | ||
| Veterinary medicine | 45 | ||
| Pharmacy | 45 | ||
| Other healthcare professions | 45 | ||
| Fields outside the healthcare professions | 46 | ||
| Use around the world | 47 | ||
| Take-home messages | 48 | ||
| 5 What is assessed in an OSCE? | 49 | ||
| An assessment of clinical competence | 49 | ||
| Learning outcomes and competencies | 50 | ||
| Clinical skills | 52 | ||
| Practical procedures | 53 | ||
| Investigation of a patient | 53 | ||
| Health promotion and disease prevention | 54 | ||
| Communication skills | 54 | ||
| Handling and retrieving information | 56 | ||
| Creative problem solving and decision making | 56 | ||
| Attitudes and professionalism | 58 | ||
| Competence as a member of a team | 60 | ||
| The OSCE and core tasks | 61 | ||
| Take-home messages | 61 | ||
| B Implementation of an OSCE | 65 | ||
| 6 Choosing a format for an OSCE | 65 | ||
| Factors influencing the format | 65 | ||
| Variables in designing an OSCE | 66 | ||
| Number of stations | 66 | ||
| Sequential testing | 68 | ||
| Time allocated to a station | 69 | ||
| Number of circuits | 71 | ||
| Test security | 73 | ||
| ‘Procedure’ and ‘question’ stations | 74 | ||
| Double stations | 75 | ||
| Linked stations | 75 | ||
| Feedback during the examination | 78 | ||
| The organisation of stations in a circuit | 78 | ||
| Group OSCE (GOSCE) | 80 | ||
| Take-home messages | 80 | ||
| 7 The setting for an OSCE | 83 | ||
| The venue | 83 | ||
| Choosing a location | 83 | ||
| Multisite OSCEs | 85 | ||
| Options for an OSCE venue | 85 | ||
| A custom-designed suite in a clinical skills unit or simulation centre | 85 | ||
| Patient care areas | 86 | ||
| Teaching accommodations | 86 | ||
| Enhancing realism in an OSCE venue | 87 | ||
| Online OSCE | 87 | ||
| Take-home messages | 88 | ||
| 8 The patient | 91 | ||
| The patient as a variable in the clinical examination | 91 | ||
| Representation of patients in an OSCE | 92 | ||
| The real patient | 93 | ||
| Simulated patients | 95 | ||
| Use of simulated patients | 95 | ||
| Reliability of simulated patients | 96 | ||
| Realism and the simulated patient | 96 | ||
| The patient narrative | 96 | ||
| Patient characteristics | 96 | ||
| Faculty and students as simulated patients | 97 | ||
| Simulated patient as examiner | 98 | ||
| Level of interaction with simulated patients | 98 | ||
| Training programmes and quality assurance | 99 | ||
| The advantages of using a simulated patient | 100 | ||
| Simulated patients as a valuable resource | 100 | ||
| Simulators | 101 | ||
| Hybrid simulation | 101 | ||
| Video recordings | 102 | ||
| Patient medical records and investigations | 102 | ||
| Take-home messages | 103 | ||
| 9 The examiner | 105 | ||
| Examiners and the OSCE | 105 | ||
| Who is the examiner? | 106 | ||
| Senior and junior doctors | 106 | ||
| Other healthcare professionals | 107 | ||
| Simulated patient | 107 | ||
| Student | 108 | ||
| Familiarity of examiner and examinee | 108 | ||
| The distant examiner | 108 | ||
| Number of examiners | 109 | ||
| Role of the examiner | 109 | ||
| Before the OSCE | 109 | ||
| During the OSCE | 109 | ||
| After the examination | 110 | ||
| Instructions for examiners | 110 | ||
| Training of the examiner | 111 | ||
| A challenging role | 113 | ||
| Take-home messages | 113 | ||
| 10 Implementing an OSCE | 115 | ||
| Plan for a successful OSCE | 115 | ||
| Advance planning for an OSCE | 116 | ||
| Implementing the OSCE on the day | 121 | ||
| Problems during the examination | 124 | ||
| Take-home messages | 124 | ||
| 11 Evaluating the examinee’s performance | 127 | ||
| The challenge | 127 | ||
| Collecting the evidence | 128 | ||
| Checklists | 130 | ||
| Advantages of a checklist | 131 | ||
| Disadvantages of a checklist | 132 | ||
| Rating scales | 132 | ||
| Advantages of rating scales | 133 | ||
| Disadvantages of global rating scales | 134 | ||
| Checklists versus global ratings | 134 | ||
| Narrative comments | 136 | ||
| Assessment by the simulated patient | 137 | ||
| Red flags | 137 | ||
| Linked product or ‘post-encounter’ stations | 137 | ||
| Deciding about the student’s performance | 138 | ||
| Cumulative score | 139 | ||
| A pass is required in a specified number of stations | 140 | ||
| Penalty points | 140 | ||
| A competence profile | 140 | ||
| Hybrid approaches | 141 | ||
| Process and product | 142 | ||
| Standard setting | 143 | ||
| Borderline group method | 144 | ||
| Advantages of the borderline group method – | 144 | ||
| Implementing the borderline group method – | 144 | ||
| Problems with the borderline group method – | 145 | ||
| Borderline regression method | 145 | ||
| Data processing | 145 | ||
| Take-home messages | 148 | ||
| 12 Providing feedback to the learner | 149 | ||
| The importance of feedback | 149 | ||
| Feedback and the OSCE | 150 | ||
| Feedback during the OSCE | 150 | ||
| Feedback at a procedure station | 151 | ||
| Feedback immediately following a procedure station | 152 | ||
| Feedback after the OSCE | 153 | ||
| Feedback given as part of a group exercise | 154 | ||
| Individual feedback without score sheets | 154 | ||
| Individual score sheets | 155 | ||
| Viewing a personal video recording | 155 | ||
| Meetings with individual examinees | 155 | ||
| Feedback and students in difficulty | 155 | ||
| Feedback and a variety of approaches | 156 | ||
| The amount, nature and specificity of feedback | 156 | ||
| Feedback and the educational climate | 157 | ||
| Feedback and summative OSCE | 158 | ||
| Take-home messages | 159 | ||
| 13 The examinee’s perspective | 161 | ||
| Examinees’ attitude to the OSCE | 161 | ||
| Briefing of students | 163 | ||
| Briefing of students prior to the OSCE | 163 | ||
| Briefing on the day of the examination | 163 | ||
| Advice to students | 164 | ||
| Before the examination | 164 | ||
| On the day of the examination | 164 | ||
| After the examination | 166 | ||
| The underperforming student | 166 | ||
| The student with a disability | 166 | ||
| Student engagement in an OSCE | 166 | ||
| Take-home messages | 168 | ||
| 14 Evaluating an OSCE | 169 | ||
| The importance of evaluation | 169 | ||
| The concept of evaluation | 169 | ||
| The purpose of evaluation | 170 | ||
| Different approaches | 170 | ||
| Questions to be addressed | 171 | ||
| Who should contribute to the evaluation? | 172 | ||
| Validity | 173 | ||
| Content validity | 174 | ||
| Criterion-related validity | 175 | ||
| Predictive validity | 176 | ||
| Reliability | 176 | ||
| Classical test theory | 177 | ||
| Generalisability theory | 178 | ||
| Item-response theory | 178 | ||
| Further information | 179 | ||
| Number of failures | 179 | ||
| Circuit equivalence | 180 | ||
| Take-home messages | 180 | ||
| 15 Costs and implementing an OSCE with limited resources | 181 | ||
| Cost as a cause of concern | 181 | ||
| Estimates of costs | 181 | ||
| Cost elements | 183 | ||
| Examiner | 184 | ||
| OSCE Lead | 184 | ||
| Simulated patients | 184 | ||
| Support staff | 184 | ||
| Resources and other costs | 184 | ||
| Approaches to costing | 185 | ||
| Comparative costs | 185 | ||
| Containing the costs or implementing an OSCE with limited resources | 186 | ||
| Lack of experience and expertise | 186 | ||
| Other steps to be taken | 187 | ||
| Technical support | 188 | ||
| Design of the OSCE | 188 | ||
| Examiners | 188 | ||
| Simulated patients | 189 | ||
| OSCE venue | 190 | ||
| Other resources | 190 | ||
| Conclusions | 190 | ||
| Take-home messages | 191 | ||
| C Some final thoughts | 193 | ||
| 16 Limitations of the OSCE | 193 | ||
| The examiner’s toolkit | 193 | ||
| Limitations of the OSCE | 193 | ||
| Not a holistic approach | 194 | ||
| A limited sample | 196 | ||
| Resource intensive | 196 | ||
| A prescribed role for the examiner | 197 | ||
| A test of minimum competence | 198 | ||
| Some learning outcomes are difficult to assess | 198 | ||
| Student behaviour is influenced by the context of the examination | 199 | ||
| The OSCE is stressful and tiring for students | 200 | ||
| Failure to integrate with the curriculum | 200 | ||
| Take-home messages | 200 | ||
| 17 Conclusions and looking to the future | 203 | ||
| Assessment and the future of the OSCE | 203 | ||
| The OSCE as an integral part of the curriculum | 205 | ||
| Assessment for learning and assessment as learning | 206 | ||
| Assessment of different competencies | 207 | ||
| The OSCE as a progress test | 207 | ||
| Adaptive and sequential testing | 207 | ||
| Student engagement and the OSCE | 208 | ||
| Effective use of technology | 209 | ||
| Greater collaboration | 209 | ||
| Areas for discussion | 210 | ||
| Conclusions | 210 | ||
| Take-home messages | 211 | ||
| D Case studies | 213 | ||
| Case Studies | 213 | ||
| Undergraduate medicine | 213 | ||
| Postgraduate medicine | 214 | ||
| Other healthcare professions | 215 | ||
| Nursing | 215 | ||
| Dentistry | 215 | ||
| Veterinary medicine | 215 | ||
| Pharmacy | 216 | ||
| Specialised areas | 216 | ||
| Patient safety | 216 | ||
| Ultrasound | 216 | ||
| Selection | 216 | ||
| 1 Case Study | 217 | ||
| 2 Case Study | 224 | ||
| 3 Case Study | 229 | ||
| 4 Case Study | 239 | ||
| 5 Case Study | 245 | ||
| Station 16: Double station on explaining medical condition and treatment plan with a relative | 248 | ||
| 6 Case Study | 252 | ||
| 7 Case Study | 263 | ||
| 8 Case Study | 272 | ||
| 9 Case Study | 278 | ||
| 10 Case Study | 283 | ||
| 11 Case Study | 287 | ||
| 12 Case Study | 294 | ||
| 13 Case Study | 302 | ||
| Stations 7 and 8 – Linked stations: team skills and patient in respiratory distress/admission order writing | 304 | ||
| 14 Case Study | 306 | ||
| 15 Case Study | 315 | ||
| E | 323 | ||
| References | 323 | ||
| F | 345 | ||
| Bibliography | 345 | ||
| Aspects explored in more depth | 345 | ||
| Books and reports on the theme of the OSCE | 347 | ||
| Examples of OSCE stations | 348 | ||
| A broader perspective of assessment methodology | 349 | ||
| Videoclips | 350 | ||
| Index | 353 | ||
| A | 353 | ||
| B | 353 | ||
| C | 353 | ||
| D | 354 | ||
| E | 355 | ||
| F | 356 | ||
| G | 356 | ||
| H | 357 | ||
| I | 357 | ||
| J | 357 | ||
| K | 357 | ||
| L | 357 | ||
| M | 357 | ||
| N | 358 | ||
| O | 358 | ||
| P | 360 | ||
| Q | 361 | ||
| R | 361 | ||
| S | 361 | ||
| T | 363 | ||
| U | 363 | ||
| V | 363 | ||
| W | 363 | ||
| Y | 363 |