INTRODUCTION:

Objective Structured Clinical Examination (OSCE) is a form of performance – based testing used to measure candidates’ clinical competence. During an OSCE, candidates are observed and evaluated as they go through a series of stations in which they interview, examine and treat standardized patients (SP) who present with some type of medical problems. Objective Structured Clinical Examination (OSCE) has proved to be so effective that it is now being adopted in disciplines other than medicine, like dentistry, nursing, midwifery, pharmacy.¹

Origin of OSCE:

OSCE is a form of multi- station examination for clinical subjects first described by Harden et al from Dundee (1975). It was first reported from Dundee and Glasgow (Harden and Gleeson, 1976). It was firstly adopted in North America in a widespread manner. Then it widely adopted in the UK in the 90s.The principal method for clinical skill assessment in medical schools and license bodies across USA, Canada, UK, Australia, New Zealand and other countries is now the Objective Structured Clinical Examination (OSCE).¹

Definition of OSCE:

According to Harden 1988, Objective Structured Clinical Examination (OSCE) is an approach to the assessment clinical competence in which the components are assessed in a well-planned or structured way with attention being paid the objectivity of the examination.²

Frame work of OSCE:

A frame work for the development of clinical competence has been described by Miller (1990) which outlines four levels at which a learner can be assessed: knows, knows how, shows how and does. The OSCE conforms to the third shows how the level of the miller’s pyramid which focuses on assessment of performance of specific skills in a controlled setting. This makes it particularly relevant for the early stage of undergraduate curricula, where assessment comprises compartmentalized exercises.²

Fig:1 The development of clinical skills/ competence/Performance (adapted fromMiller1990)²

OSCE is designed to be:

Objective- all candidates are assessed using exactly the same stations with the same marking scheme. In this candidates get marks for each step on the mark scheme that they perform correctly, which therefore makes the assessment of clinical skills more objective, rather than subjective. Examiners use a check list for evaluating trainers.¹

Structured:

Stations in OSCEs have a very specific task. Standardized patients or simulators can be used. Detail scripts are provided to the standardized patient including emotions that patient should use during consultation. Written instructions should be given to the candidates to complete the specific task during OSCE. The OSCE is structured to include parts from all elements of the curriculum as well as a wide range of skills.¹

· The marking scheme for each station is structured.

· A clinical skills or procedure is typically broken into component form in a structured way.

· Structured interaction between examiner and student.

· Stations are short, numerous, highly focused.²

Clinical:

Because the tasks are represented of those faced in real clinical situations²

Examination:

Skills are assessed in the form of examination.² The OSCE is designed to apply clinical and theoretical knowledge.

Purposes of OSCE:

1. Used in both formative and summative in health professional education.

2. Identify objective performance criteria for the skill being examined.

3. Structured the performance criteria in a checklist to facilitate the identification of desired clinical skills.

4. A requirement for accreditation in many health professionals’ programs.²

OSCE Methodology:

An Objective Structured Clinical Examination (OSCE) usually comprises a circuit of short (15 minutes) stations, in which each candidate is examined on a one-to-one basis with two impartial examiners and either real or standardized patients.³

The OSCE examination consists of about 15-20 stations, each of which requires about 4-5 minutes of time. All station s should be capable of being completed at the same time. The students rotate through all stations and moves to the next station at single. Each candidate is examined on a one-to-one basis with one or two impartial examiners on each station. They are marked by the examiners each, 15 students can complete examination within 1 hour.³

Points to be remember to organize OSCE:

Harden’s 12 tips help us to organize an OSCE.³

Fig: 2 Harden’s 12 tips for organizing an OSCE³

Uses of OSCE:⁴

OSCE can be used for under graduate as well as post graduate nursing students to assess their clinical competencies.

The following practical skills are assessed in OSCE:

1. Inter personal and communication skills

2. History – taking skills

3. Physical examination of specific body systems

4. Mental health assessment

5. Clinical decision making including the formation of different diagnosis

6. Clinical decision making, including the formation of different diagnosis

7. Clinical problem-solving skills

8. Interpretation of clinical findings and investigations

9. Management of a clinical situation, including treatment and referral

10. Patient education

11. Acting safely and appropriately in an urgent clinical situation

12. Basic and advanced nursing care procedure practices.⁴

Advantages of OSCE:⁴

· More valid than the traditional approach to clinical examinations.

· Examiners can decide in advance what is to be tested and can then design the examination to test theses competencies

· Examiners can have better control on the content and complexities.

· Emphasis can be moved away from testing factual knowledge to testing a wide range of skills including advanced clinical skills.

· More reliable because variables of the examiner and the patient are remo0ved to a large extent.

· The use of check lists by examiners and use of MCQs results in a more objective examination.

· More practical because it can be used with large numbers of students⁴

Disadvantages of OSCE:⁵

· OSCEs require significant resources, including standardized patients, clinical simulation facilities, and trained examiners.

· The development and administration of OSCEs can be time – consuming, especially for large groups of students.

· Although OSCEs aim to be objective, there can be some subjectivity in the scoring process, particularly when assessing communication skills and clinical judgment.

· OSCEs may not fully assess complex clinical situations or Long-term patient management skills.

· OSCEs can be stressful for students, which may negatively impact their performance.

· The development and implementation of OSCs can expensive, especially for institutions with limited resources.

· Students may have limited opportunities to practice OSCE Scenarios, which can affect their performance.⁵

Steps in Taking OSCE as Examination for Students²

Fig :3 Steps in taking OSCE as examination for students²

1. Registration:

Ask the student to show examination hall ticket and identification card. General instructions are provided invigilator will inspect articles and prohibit those which are not allowed in examination. Example: Mobile Phone. Provide necessary paper for the exam.

2. Orientation:

Exam format, procedures and policies will be reviewed Introduce to your team and team leaders Instructed about your starting station and hoe to proceed Students can ask their queries regarding OSCE exam.

3. Escorting to Exam Position:

after briefing and orientating students to rules and procedure of OSCE, students will be escorted to stations. Students will be instructed about the time at each station and about time buzzer. Students will start exam as soon as long bell or buzzer announce the start of the exam.

4. Station Instruction time:

This is one or two minutes to read the instruction about the station, the situation, and patient required task. Students read carefully and entre the room at the next bell.

5. The Encounter:

start your encounter with the standardized patient. There is a 5 to 20 minutes encounter. Perform the required task. Stop at the next bell.

6. Post Encounter Period:

Some OSCE will have no post encounter period. Some will have 1-2 minutes of the encounter period assigned to an oral question asked by the examiner inside the examination room. No more communication is allowed on a paper or computer outside the exam room for 5 – 10 min. at the next bell, first station ends as well as next station starts. Student proceeds s to the next station quickly.

7. Repeat Steps: 4-6:

steps 4-6 will repeated until student have been in all the stations. Some OSCE will offer 1 or 2 short rest period.

8. Exam ended:

exam is over. Student will be escorted back to dismissal area for signing out. He will be asked to handle back all what he has received on signing in; he may be asked to stay for some time for exam security reason.²

Simulated Versus real – life OSCE Stations⁴:

Simulators and real life OSCE stations have their unique positive aspects as follows:

The positive aspects of simulated OSCE stations are as follows

The positive aspects of real- life OSCE stations are as follows

· They are controlled and safe

· Feedback from modern sophisticated simulators can be obtained

· Simulators are readily available when required

· Simulated stations can be tailored to the level of skill to be assessed

· Scenarios that are distressing to real patents can be simulated

· Simulated stations, the patient variable in examination in uniform across trainees.

· Real – life satiations provide actual competence of a person on [performance because idealized text book scenarios may not mimic real- life situations

· They allow assessment of complex skills which may not be possible at simulated stations

· Real – life situations may be more cost effective

CONCLUSION:

OSCE (Objective Structured Clinical Examination) training prepares healthcare professionals, especially nurses and midwives trained abroad, for practical licensing exams by simulating real clinical scenarios in stations with standardized patients and equipment, focusing on skills like communication, patient safety, critical thinking, and procedures to meet regulatory standards for safe practice. Training involves practicing skills, receiving feedback, and learning documentation within timed conditions. OSCE stations which comprises practical station tom perform nursing procedures and followed by response stations related to writing MCQS. This is a modern type of examination often used in health sciences now a day.

REFERENCE:

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2. Jaspreet Kaur Sodhi. Comprehensive Text Book of Nursing Education. 2^nd ed. New Delhi: Jaypee; 2022

3. Balasubramanian. N. Text book of Educational Technology; Nursing Education 1^st ed. Bhubaneswar: Vision Health Science. 2023

4. Suresh K Sharma, Reena Sharma. Nursing Education and Educational Technology. 3^rded. New Delhi: Elsevier; 2024

5. Doli Deori. Punum Debbarma. Educational Technology; Nursing Education for B. Sc. Nursing Students. 1^st ed. Jalandhar: Lotus. 2025