OSCE is an acronym for Objective Structured Clinical Exam.  It describes a form of performance-based testing used to measure a student’s clinical competence. During an OSCE, trainees are observed and evaluated as they go through a series of stations in which they interview, examine and treat standardized patients who present with some type of problem.

What is an OSCE?

The Objective Structured Clinical Exam (OSCE) is a performance-based exam. During the exam, trainees are observed and evaluated as they go through a series of stations where they interview, examine and treat standardized patients presenting with some type of problem.

An OSCE is:

• objective, because examiners use a checklist for evaluating the trainees;
• structured, because every trainee sees the same problem and performs the same tasks in the same time frame;
• clinical, because the tasks are representative of those faced in real clinical situations; and
• an examination.

Where will the OSCE take place?

Will I need a parking pass?

What should I review prior to the OSCE?

Prior to the OSCE visit http://www.nbome.com. This 27 minute video provides an overview of the OSCE process as well as sample SOAP notes.  Click on “Orientation Guide to P.E. (next to picture of training site).

What is the purpose of the OSCE?

• Provide feedback on performance
• Evaluate basic clinical skills
• Measure minimal competencies
• Provide practice for the NBOME COMLEX-PE

Who should contact if I have a question prior to the OSCE?

For questions or for further information, contact your CORE administrator or Joanne Bray @ 740 593-2513 or Bray@ohio.edu.

Is the third-year OSCE mandatory for OU-COM students?

Successful completion of the Objective Structured Clinical Exam (OSCE) is a graduation requirement for OU-COM students, as described in the year 3 and 4 manual.  The exam is scheduled in the third year to avoid conflicts with elective rotation schedules and to help in preparation for COMLEX Level II-PE.

Will there be an orientation?

Prior to the exam, you will receive a 30-45 minute orientation.

How is an OU-COM OSCE typically structured?

• There are 4 standardized patient cases and a special Evidence Based Medicine case  (Note:  NBOME COMLEX-PE consists of 12 encounters)
• You will have 23 minutes at each station. 
• 14 minutes to read the scenario sheet on station door, then evaluate and treat the patient as appropriate.
• At 12 minutes, there will be an announcement indicating two minute remaining.
• At 14 minutes, there will be an announcement to leave the room. You may leave the room early, but you will not be able to reenter.
• 9 minutes to write a SOAP note outside the room.
• At 7 minutes there will be an announcement indicating two minutes remaining.
• At 9 minutes you will be instructed to move to the next station and repeat the process.

The 4-station exam, EMB case orientation and debriefing is completed in approximately 3 hours.

What should I do during the OSCE?

• DO ONLY WHAT IS REQUESTED.
• No talking during the OSCE, This is an examination
• Use your history to guide the scope of your examination, since a complete exam is not required in all cases.
• Elicit psychosocial, occupational, past medical/surgical history, medications and allergies as appropriate.
• Explain to the patient what you do before doing it, particularly while setting up OMM.
• If you are not sure what is wrong, do not say, “I will get back to you after I have discussed this with the attending.”  This does not evaluate your knowledge or skill.

Will I be expected to do OMM during the OSCE?

Utilize OMM practices and principles as appropriate.  Because standardized patients may not have real osteopathic findings, but present with symptoms, develop a likely OMM scenario for history and physical findings.  Gently position the patient and show 2 OMM techniques.  Perform OMM for 3-5 minute, with an evaluation and reassessment.

Any OMM tips?

May I discuss the OSCE cases with other students after the OSCE?

You will be asked to sign the honor code statement at the OSCE.  Disclosure or discussion with others about the OSCE cases or assessment materials is strictly forbidden and a violation of the honor code.

What is in the chart?

The chart contains:

• Instructions
• The setting: outpatient, primary care or Emergency Department
• Patient demographics
• Vital signs
• What is expected to be done
• SOAP note worksheet
• SOAP note sheet

Will I have a SOAP worksheet to take notes?

A worksheet will be provided in the chart, if you wish to take notes. The worksheet will be left in the chart, but will not be graded.

What should I include in the SOAP note?

S= Subjective/patient input regarding the problems(s)
O= Objective findings, physical exam, lab data, etc.
A= Assessment—include differential diagnosis (at least 3 possible etiologies). Rank in order of likelihood.  For well visits, list at least 3 problems or risk factors.
P= Plan for diagnostic investigations and/or treatment

How will the patient know my name?

You may identify yourself as student Dr. _____. At the completion of the encounter, you will give the patient two name labels. This may be presented as “Here is my card. Please call for your return appointment.”

Is drug information available?

Drug information will not be available. Students will not be required to write for specific drugs and drug dosages.

Are abbreviations acceptable?

NBOME accepted abbreviations may be used.  They are found on the inside of the chart and on the NBOME website.

What do I wear and bring to an OSCE exam?

Dress professionally; bring a clean white lab coat, nametag, and stethoscope. Scrubs are not considered professional attire. No pocket guides, cell phones or PDAs are permitted.  Each exam room is equipped with a treatment table and  diagnostic equipment needed.

What is the arrival time?

You are expected to arrive 15 minutes prior to the start of the exam.

Are OSCEs videotaped?

Yes.

What is the grading system for an OSCE?

You will receive a pass/fail grade.  You must score 75% or better to pass.

How is the grading system determined?

OSCE score sheets allow for ratings of specific content items based on core competencies.  A checklist will be utilized to assess:

•  interviewing/interpersonal skills (history taking)—information gathered by the standardized patient.

• patient care (physical exam)—information gathered by standardized patient.

• professionalism (rated by the standardized patient on organization, courtesy, compassion, appropriate draping, listening  skills, eye contact, language used, demeanor, dress, hand washing, patient education and whether or not the standardized patient would select you as their personal physician.)—information gathered by the standardized patient.

• medical knowledge (SOAP notes)—graded by physicians

• OMM (no HVLA techniques)—graded by physicians.

Standardized patients and physician evaluators will rate your performance utilizing their judgment and the checklist. Failing ratings are given based on any of the following:

 a.  illogical sequencing
 b.  deficient knowledge base
 c.  lack of ability to focus
 d.  excessive prompting
 e.  interpersonal skills deficits
 f.   other

Whom do I ask if I have questions during the exam?

Proctors will be available to answer your questions during the exam.

Any tips or guidelines for success on the OSCE?

• Since 25% of the cases involve D.O. examiner scoring of OMM, points will be lost for failure to utilize any form of OMT when it is appropriate to do so, rather than for the techniques chosen or how they are applied.

• Read the doorway instructions and take them at face value to be correct.

• Introduce yourself and allay patient apprehension.

• Communicate using clear layman’s terminology.

• Treat each patient with respect.

• Use your history to guide the scope of your examination, since a complete exam is not required in all cases.

• Elicit psychosocial, occupational, past medical/surgical history, medications and allergies as appropriate.

• Explain to the patient what you going to do before doing it, particularly while setting up OMM.

• Be sure you have considered osteopathic principles in all cases.