Charles Sturt University
Charles Sturt University

OSCE/ Online Practical Exam

The Objective Structured Clinical Examination (OSCE) was first introduced in 1975 and since then OSCE has been shown as an effective means of assessing clinical skills and clinical reasoning abilities in many disciplines (Daniels, & Pugh, 2018).  In an OSCE, a series of exam stations are set for students to complete. Students are required to spend a specific amount of time on each station and demonstrate their competency in obtaining & interpreting data, problem solving, communicating and handling unpredictable patient behaviour (Zayyan, 2011).

Pros and cons of OSCE as an assessment task

Some advantages:

  • OSCEs provide an innovative learning experience for students.
  • OSCE scan assess a broader range of knowledge and students’ abilities such as problem-solving, communication skills, decision making and patient management.
  • OSCEs provide a valid means to evaluate student's clinical performance in a holistic manner.
  • OSCEs have a series of stations, thus providing students with an opportunity to apply skills to develop a range of clinical competencies.
  • OSCEs provide uniform scenarios to all students.
  • As OSCEs are conducted in a simulated clinical context, the possibility of hazard or injury to real patient is not a concern.
  • OSCE provides an opportunity for the student to interact and receive personalised feedback from the examiner.
  • Recording online OSCE session and allowing student to look at the recording at their comfort can help with deep reflection and improvement on their performance.
  • OCSEs enable assessment of multiple students at a given time. When one student is carrying out a procedure, another student who has already completed that stage is answering the question at another station.
  • A well-designed OSCE can drive learning, and therefore, can have a positive educational impact.

Some limitations:

  • OSCEs can be perceived as a stressful experience to students.
  • Conducting OSCEs can be complex and time consuming, requires organizational training, adequate infrastructure and extensive resources.
  • The idealized ‘textbook’ scenario may not mimic real-life situations, so there is some question of authenticity.
  • It may discourage students from looking at the patient as a whole, because the students’ knowledge and skills are compartmentalised.
  • Requires a large number of qualified personnel to observe and evaluate students.
  • Time limits on each station do not provide a platform for students to have a comprehensive examination of one given patient rather student is required to examine different scenarios in different stations.

Steps in developing an Objective Structured Clinical Examination (OSCE)

  • Decide the types of assessment and skills to be examined
  • Create a blueprint:

    For example, if the goal of the OSCE is to assess clinical skills, such as history-taking and physical examination skills, then the blueprint should include a wide variety of stations that reflect this. This helps to ensure that one can generalize performance on these stations to the learner’s ability to perform other history and physical examinations in an OSCE.
  • Decide the number of stations needed. 10 to 15 stations are ideal with 6 -10 minutes/station.
  • Once a decision is made on what would be assessed via the OSCE, a case should be developed to represent the clinical problem of interest. Details such as presenting scenario, the task and the time frame for completion of task should be elements that needs to be taken in account while developing the case.
  • Ensure all resources for the examination are in place including marking rubric.  A rubric can be developed as a checklist or a rating scale. This can be either scored dichotomous (e.g. did or did not do) or a polytomous (e.g. done well, attempted but not done well, not done).
  • Prepare the staff resources needed. It is important to train the OSCE evaluators and provide them with information such as the purpose of OSCE, the level of skills expected from students and how should the evaluator interact with the student. Providing some sample rubric can be helpful.  Simultaneously provide relevant information to the timekeepers and patient/volunteers if applicable.
  • Determine/arrange the day/period of exam or allocate individualised time to students.
  • Review the arrangement of the exam. Consider taking help from subject expert/colleague to ensure that OSCE is reflecting the objective identified.

Developing the OSCE to be delivered online/ Online practical exam

Further information is currently being developed in relation to delivering OSCEs online. Please return to this page for information.

Additional resources

Bevan, J., Russell, B., & Marshall, B. (2019). A new approach to OSCE preparation - PrOSCEs. BMC medical education19(1), 126.

Krusen, N. E., & Rollins, D. (2019). Design of an OSCE to Assess Clinical Competence of Occupational Therapy Students. Journal of Occupational Therapy Education, 3 (1).

A Short Guide to the OSCE - University of Edinburgh