Observed Clinical Skills Examination (OSCE)

Definition

The term OSCE refers to the objective structured clinical examination. It is a simulated student doctor-patient encounter designed to test a particular clinical skill or set of skills.

Explanation

Let’s start with an example from a future experience. During your senior year of medical school you will probably take an Advanced Cardiac Life Support (ACLS) course. This typical two-day course will go over cardiac arrhythmias, emergency cardiac care, and how to run resuscitation on a patient in cardiac arrest (from, for example, ventricular fibrillation). It is a powerful learning experience, and, as part of it, you will be asked to run several make-believe resuscitations on patients, who are really just plastic mannequins attached to a rhythm simulator. Admittedly, running a code, even a mock code, is scary. But, it is also a wonderful way to learn and a great confidence booster. Well, those make-believe resuscitations are, in fact, examples of sample OSCEs – make-believe clinical experiences that model what physicians are expected to know how to do in real life. OSCEs are focused sample clinical packages where, at the bedside, you are evaluated by what you say and do in the setting of a student-simulated patient encounter.

Medicine is not a passive profession - although that may be the impression one often develops during the first two years of medical school sitting in large lecture rooms. Medicine has always been an active and living experience that takes place at the bedside, in the clinic, in the hospital - where doctors actively evaluate and care for patients. As educators, the more we recognize that, the more we make our evaluations as close to reality as possible; the better for the student and, ultimately, the better for the patient.

How It Works

At the end of the second year you will have to pass a series of OSCEs. These will be based on your clinical evaluation skills: history-taking skills, physical examination skills, and assessment of your early differential diagnosis generating abilities. The goal is to make sure you have the necessary skills to begin your third-year rotations with the appropriate clinical tools and confidence to “shine” on the wards.

Each OSCE station will last about 10 minutes with brief breaks in between each. You should plan on rotating through about 7 to 8 of them all on the same day. You will be asked to perform some segment of a history or physical examination and your skills will be simultaneously assessed. Any of the following would be reasonable OSCE stations:

• Evaluate a patient’s pain complaints. (For example, a person in a room with a headache, chest pain, abdominal pain, or back pain.)

• Perform some aspect of a careful physical examination. (For example, a person in an examination room on whom you will be asked to perform a quality neurological examination, an abdominal examination, or a head and neck examination.)

• Perform a directed patient interview. (For example, a substance abuse history, a sexual history, or a quality psychosocial history.)

• Evaluate a patient with a straightforward complaint (for example, a cough), for which you are asked to look at radiographs, listen to and interpret heart sounds, listen to and interpret lung sounds, and then generate a limited but appropriate differential diagnosis.

Empathetic Closure

All of us know how scary and painful it can be to be evaluated in this format - the demons of fear of failing, performance anxiety, and self-doubt all come to the surface. We have all been there at one time or another, and not just in the setting of the OSCEs. Similar situations will occur throughout your training. We already discussed the Advanced Cardiac Life Support course example in the introductory comments above. After medical school, the American College of Surgeons offers a wonderful course called the Advanced Trauma Life Support Course (ATLS). At the completion of that course, you are asked to run the simultaneous evaluation and resuscitation of a simulated major trauma patient. Similar evaluations will be part of your residency training. Many Specialty Board Examinations include similar skills station demonstrations as part of completing your Boards. The OSCEs are here to stay - and will become a recurrent theme throughout your training.

All of us acknowledge the sage words of the British writer and cleric C.C. Colton:

Examinations are formidable even to the best prepared, for thegreatest fool may ask more than the wisest man can answer.

Please remember the following: The OSCEs that you must pass at the end of your second year are not designed to make your lives harder than they already are. They are designed as an evaluation exercise to make sure you are ready for the third year. Your College mentor in ICM II will work tirelessly with you and on your behalf to make sure you are ready for the OSCEs. Without exception, the pilot OSCE students from last year (admittedly, they were volunteers - about 45 of them) thought the evaluation was an exceptionally worthwhile learning experience, and the students expressed to the faculty their wish that they had had more exposure to the OSCEs over the second year. Guess what? Every student passed!