OSCEs at a Glance

Adrian Blundell, Richard Harrison

• Publisher: Wiley-Blackwell
• Year: 2013
• ISBN:
  9781118274194
• Edition: 2
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Following the familiar, easy-to-use at a Glance format, OSCEs at a Glance 2nd Edition is both a revision guide and a comprehensive introduction to objective structured clinical examinations for medical students. Fully revised to suit the current curriculum, and written with student feedback and experiences in mind, this full-colour textbook contains brand new and comprehensively indexed chapters which include 32 new OSCE stations, covering distinct areas of specialisation as well as broader practical and communication skills covered in the exams. This new edition of OSCEs at a Glance is also supported by a companion website at www.ataglanceseries.com/osces containing downloadable OSCE checklists - perfect for testing knowledge in the run-up to exams.

This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from Google Play or the MedHand Store.

1

The OSCE Examination

The OSCE has been increasingly used over the last 15 years, although one of the first descriptions was way back in 1979 by Harden and Gleeson [1]. This form of examination is now used extensively in medical schools in the UK. The main advantage is that it can be used to examine many different clinical skills with all students performing the same tasks, marked against explicit criteria by the same examiners.

Set Up

An OSCE consists of a series of timed stations that each student rotates through. Each station involves a candidate carrying out a well-defined task. The time allocated for each station will vary with the required task, but in general each station lasts 5–10 minutes. The majority of stations have an examiner (or pair of examiners) who will assess the candidate’s performance using a structured marking sheet. If the station is purely data interpretation, then it is not always necessary to have an examiner present and the candidate will be required to complete a written task.

Each station will have an accompanying instruction for the candidate to follow. The instructions can be presented in different ways:

• The examiner may ask the student to carry out a task
• The instructions may be posted at the station (e.g. on a poster near the patient)
• The candidate may receive the instructions prior to entering the station
• A rest station could be used to read through material relevant to the next station

OSCEs can be used at any stage during medical school. The exams in the earlier years concentrate on assessing the basic clinical skills and the emphasis is on the demonstration of correct technique, rather than interpreting the signs. This usually involves simulation-based cases rather than ‘real’ patient contact.

Types of Station

The possibilities for individual OSCE stations are huge but generally they are divided into clinical, practical and data interpretation:

1 Clinical stations: These involve various aspects of communication or examination:

• Obtaining and presenting medical histories
• Performing a physical examination
• Communication skills
• Combination stations (e.g. history and examination)

These usually involve interaction with a patient who may be real or simulated (e.g. a student/actor/the examiner). The simulated patients rarely have abnormal clinical signs.

2 Practical stations:

• Clinical skills (e.g. resuscitation, blood pressure measurement)
• Procedural skills (e.g. cannula insertion, urethral catheterisation)

Mannequins or anatomical models are often substituted for the patient.

The student may be required to explain and perform the procedure, gain consent or act on a result.

3 Data interpretation stations: These involve written or verbal discussion of a variety of results:

• Examiner-led structured viva (e.g. discussion of laboratory results, interpretation of radiographs or electrocardiograms (ECGs))
• Written station (e.g. ‘Please interpret the following full blood count and answer the attached questions’)

With the advent of improved information technology facilities, this type of knowledge can be adequately assessed during written exams, although some medical schools still include them in OSCEs.

The Instructions

• Written or verbal instructions will be given to each candidate at the beginning of the station
• The patient, where necessary, will have had a chance to study written instructions summarising their condition (this is essential for simulated patients but real patients may just give their own history)
• Examiners will have instructions outlining the purpose of the station and the task to be carried out
• The examiners will also have read the student and patient instructions

The Marks

Marking sheets will vary depending on the type of station and skill being assessed, but each task will be marked against explicit criteria. This will be in the format of a checklist of actions the student needs to perform. Patients may be asked their opinion of the candidate and it would be taken very seriously if the patient felt the student was rude or rough. Students may be examined by an individual or pair of examiners (who should mark independently). Once the station is completed an individual mark can be scored following agreement by the examiners and a statement as to the student’s global performance is often included.

Preparation

There is increasing emphasis from the General Medical Council (GMC) that the clinical competence of medical students needs to be assessed and recorded. OSCE-type stations, using either ‘real’ or simulated patients, are ideal for this purpose. Clinical competence is a combination of three domains – knowledge, skills and attitudes.

There are several documents published by the GMC that describe the attitudes and behaviour expected of future doctors; these behaviours need to be developed during university along with clinical competence and will be assessed in the OSCE examinations [2–4]. Students often underestimate the need to practise their clinical skills and bury their heads in the books until nearing the practical assessment, when there is a mad rush to the clinical skills laboratory to run through examination routines and a mad dash to the wards to see as many patients as possible. This behaviour remains common despite repeatedly reminding students of the practical nature of being a doctor and one of the main recommendations of Tomorrow’s Doctors 2003 stating ‘factual information must be kept to the essential minimum that students need at this stage of medical education’ [2]. Start practising your clinical skills as early as possible, preferably with an ‘OSCE buddy’ or even ‘OSCE group’. The skills tested in the OSCE and also the skills necessary to embark on life as a Foundation doctor are best learnt in the clinical environment and not the library.

1 Harden RM, Gleeson FA. Assessment of Medical Competence. Using an objective structured clinical examination (OSCE). ASME Medical Education Booklet No. 8. Association for the Study of Medical Education (ASME), Edinburgh, 1979.

2 General Medical Council. Tomorrow’s Doctors. General Medical Council, London, 2009. Available at www.gmc-uk.org.

3 General Medical Council. Medical students: professional values and fitness to practise. General Medical Council, London, 2009. Available at www.gmc-uk.org.

4 General Medical Council. Good Medical Practice. General Medical Council, London, 2006. Available at www.gmc-uk.org.

2

The Stable Patient

Patients seen in medical student exams are not acutely unwell and so can be assessed in a logical manner in order to determine a diagnosis and management plan. The approach is summarised opposite. This system helps a clinician make a diagnosis no matter what the presenting problem might be. This approach is also utilised in real life on the wards, although the process is dynamic, and the different areas can overlap, for example practical procedures can be performed while taking parts of the history.

History and Examination: Hints and Tips

See Chapter 4.

Differential Diagnoses, Problem Lists and Management Plans: Hints and Tips

When assessing a patient, try and formulate a list of differential diagnoses (ΔΔ). Next organise your thoughts into a problem list, taking into account other aspects of the history and examination rather than just the presenting complaint (e.g. non-urgent referrals, possible future investigations, impact of the illness on the patient and relatives, social problems, patient education). From the problem list it will be possible to determine a management plan (Mx). The main aspects of a management plan are described opposite.

Example

A 72-year-old female patient (weight 48 kg) with a known history of chronic obstructive pulmonary disease (COPD) is admitted to hospital with increasing shortness of breath (SOB) and a productive cough. Her blood tests have shown a ↑ white cell count and her chest radiograph shows consolidation in the right lower lobe. She has been on long-term steroids which cannot be weaned. She has had six admissions in the last 4 months but continues to smoke five cigarettes a day. She has rheumato...

Table of contents

• Cover
• Contributors
• Title page
• Copyright page
• Companion website
• Preface
• Preface to the first edition
• Acknowledgements
• Selected list of abbreviations
• Part 1: Introduction
• Part 2: Medicine
• Part 3: Surgery
• Part 4: Specialties
• Index of OSCE stations