OSCE

I’ve learned a few things during the last 4 years of hosting an OSCE for each group of M3s rotating through the OBGYN Department.

Some of it has to do with learning issues, and a lot of it has to do with logistics.

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What can you do?

I set up the OSCE (Objective, Structured, Clinical Examination) to test “What can you do?” This is in contrast to standardized “Shelf” exams that test “What do you know?” That’s a good theoretical distinction, but in real life, it’s not so easy to completely separate those two capabilities. I still strive to test student skills, but recognize that there will always be some component of student knowledge testing that is part of that. I’m not a purist.

[wlm_private ‘Professional’]Formative or Summative?

I prefer formative. From its’ inception, our student performance at each OSCE station has been graded, but only after the first year did those scores count for anything. I wanted the grading to be helpful to the educators (me, my colleagues, and my bosses), and was mostly indifferent as to whether the grades would count for or against the students.

From my own personal perspective, I would prefer that the grades not count in the students’ final grade. This would turn the OSCE into a pure learning (and hopefully inspirational) experience for the students. There is a lot of self-imposed stress on the students trying to prepare for this exam, and I’d rather avoid all that by telling them that the grades don’t count.

But others disagree, and so the OSCE scores at my institution do count for the final grade. But they don’t count much – 15%. This means that a poor performance in any of the 8 OSCE stations is so diluted that it doesn’t really change anything very much in the final grade for the student.

Structure of the OSCE

I hold the 2-hour OSCE in our in-house simulation lab, decorated to create the “LakeSide Regional Medical Center.”

The Fictitious LakeSide Regional Medical Center
The Fictitious LakeSide Regional Medical Center

The students are given 8 challenges or modules, each lasting 15 minutes. Half the modules are staffed by faculty, and the other half are individual stations in a large room. The latter are supervised by one faculty, and involve the students moving from station to station to complete certain tasks.

This is an example of the stations we used at a recent OSCE:

Large Room Stations  Task
EFM Interpretation Interpret 5 EFM tracings, and write down your interpretation.
Surgical Skills Suture a lacerated chicken wing, using 3 interrupted sutures, tied with surgeon’s knots.  (video-taped)
Prenatal Labs Given a set of routine prenatal lab results, identify any abnormalities and make recommendations for followup.
Phone Call from Sister Answer (by email) student’s sister’s questions about a friend with abnormal bleeding.
Faculty-Staffed Stations  Task
Vaginal Discharge Evaluate a manikin pelvis with a vaginal discharge. Prepare a wet mount and make a diagnosis, based on a video image of bacterial vaginosis. Recommend a treatment.
Check patient in L&D Term patient arrives in L&D ready to push. No one else is available to attend the delivery. Deliver the manikin baby.
Routine OB Visit OB patient at 32 weeks with questions about postpartum contraception options. Student counsels the “patient” (faculty).
Attending Discussion 25 year old with an asymptomatic 8 cm adnexal mass. Discuss the DD, workup, and management plans with the attending.

Logistics

We usually have 10-12 students in each rotation.

This leaves basically two options:

  1. Move the students through sequentially (12 students, 15 minutes per station, will take 3 hours, and require 5 faculty (4+1).)
  2. Move the students through in parallel, employing two duplicate stations for each faculty-staffed module. (12 students, 15 minutes per station, will take 2 hours, and require 9 faculty (8+1).

We have always opted for the shorter OSCE, employing duplicate faculty stations, but we’ve always had enough faculty to do that.

The faculty enjoy the interaction, and are encourage by the administration to engage as part of their teaching responsibilities. But unexpected things can occur, and at times, we’ve been short of faculty, requiring a lot of switching around of coverage to make this all work out.

Particularly troublesome are the last-minute faculty no-shows (usually because of a good reason, but still troublesome.) For this reason, when structuring the OSCE and assigning faculty to different stations, I try to have a backup plan in the event one or more faculty is unexpectedly not present.

I’ve changed modules, at times because of logistics issues. To fully staff a manikin delivery requires a faculty evaluator in the delivery room, a manikin “voice”, a “nurse” in the room (to operate the delivery manikin), and someone in the control room to manage the vital signs monitor and sounds (baby crying after delivery). In contrast, a different L&D module might only require a single faculty.

In addition to the time set aside for the OSCE, there is considerable setup and takedown time, during which the simulation lab is not really usable by others. This requires careful coordination with other potential users of this popular facility.

It takes me approximately 8 hours to set up each OSCE, writing the script, preparing the schedules, writing or updating the modules, preparing a student descriptor for each module, and preparing a faculty grading sheet for each module. It takes me another 8 hours (approximately) to grade and review all the students’ performance, prepare an “afteraction report”, and distribute the report, along with scanned pdf’s of all the original student documents and grading sheets.

Here are some OSCE Modules we have used, with necessary documents. Please feel free to copy and use these modules, or modify them to make them better or to meet your own educational needs.

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Notes from a Medical Educator