What are OSCEs?

Objective Structured Clinical Examinations (OSCEs) were first described in 1979. Their development was to help address the unreliability and lack of authenticity of traditional forms of clinical assessment - namely the 'long case' and the 'short case'. Since then they have gained wide popularity in the assessment of clinical competency.

Millers Triangle - does, shows how, knows how, knows

Miller described a conceptual 'pyramidal' model of the various facets of clinical competence. Students are required not only to display that they 'know' the facts that underpin clinical practice but also 'know how' to apply these facts into practice. Crucially they also need to 'show' that they can carry out clinical tasks and apply what they have learnt into the actual work place. The 'shows how' layer of this triangle is important in clinical practice and learning. This facet of clinical competence is more behavioural rather than just cognitive knowledge. OSCEs are a common method of assessing the 'shows how' layer of Miller's triangle. However it is acknowledged that OSCEs only capture one dimension of assessing clinical competency. In order to assess the full scope of clinical competency multimethod and longitudinal assessments are required. By using multiple methods of assessment the flaws of individual assessment formats can be overcome.

In a controlled environment, OSCEs present all candidates with the same clinical tasks, in the same amount of time and marked using a structured checklist. Typically OSCEs comprise of at least 10 individual assessments or timed 'stations'. Therefore each candidate will have at least 10 examiners form an opinion on their clinical performance. Stations sample a wide range of competencies such as:

  • history taking (e.g. taking a chest pain history)
  • physical examination (e.g. examination of the praecordium)
  • communication and explanation skills (e.g. instructing a patient in how to use a meter dosed inhaler)
  • clinical reasoning skills (e.g. interpreting clinical information and then prescribing intravenous fluids)
  • practical / technical skills (e.g. insertion of a peripheral venous cannula)

Each station may last from 5-20 minutes and have either a 'real patient' with 'real' clinical signs (e.g. a patient with a cardiac murmur), an actor (or simulated patient)(e.g. an actor who has been trained to give a standardised cardiac history) or a manikin (e.g. a resuscitation manikin to carry out basic life support on).

Candidates read the instructions then enter the station and proceed to perform the clinical task. Examiners observe the candidate carrying out the task and their performance is scored by using a predefined checklist. After candidates have finished in the defined period of time they all then rotate onto the next station in sequence.