OSCE

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Workshop for assessing clinical competence

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• MD-MPH- MS.c Medical education
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• Evaluation is for
• Improvement
• Not
• Provement

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Professional Competence

• The habitual and judicious use of communication,
  knowledge, technical skills, evidence based
  decision making, emotions, values, and reflection
  to improve the health of the individual patient
  and the community.
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  ?????????? ???????? ????? ??????? ??????? ??????
  ?????? ? ????????? ?? ?????? ??????? ??????? ??
  ??? ???? ?? ??? ? ?????"

Epstein and Hundert, Designing and assessing
professional competence. JAMA 287226, 2002
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What is Clinical Competency?

• The ability to handle
• a complex professional task by
• integrating knowledge, skills and attitudes.

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????? ?? ????? ?????? ??????
Reference Van der Vleuten, C. The assessment of
professional competence developments,research
and practical implications Advances in Health
Science Education 1996, Vol 1 41-67
Rice et al., Competency-based objectives for
clinical training. Can. J. Med. Technol. 57136,
1995
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What is the best way to evaluate Clinical
Competency?

Performance assessment Masked SP
Behavior Skills attitudes
Competency assessment OSCE
Clinical based tests MCQ
Knowledge
Knowledge tests MCQs
Millers Pyramid of Competenc
Miller GE. The assessment of clinical skills,
competence, performance Acad Med, 1990
65(Suppl.)S63-S67.
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A simple model of competence
Performance or hands on assessment
Does
Shows how
Written, Oral or Computer based assessment
Knows how
Knows
Miller GE. The assessment of clinical
skills/competence/performance. Academic Medicine
(Supplement) 1990 65 S63-S7.
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Model of competence
Miller GE. The assessment of clinical
skills/competence/performance. Academic Medicine
(Supplement) 1990 65 S63-S67.
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climbing the pyramid
Does
Shows how
Knows how
Knows
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Validity of testing formats
Professional practice assessment
Performance assessment OSCEs, long/short cases,
etc
Problem-solving assessment PMP? MCQs,..
Knowledge assessment MCQs...
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Millers Pyramid for Assessing Clinical
Competence
Action
Work
OSCE
Performance
PMPs
Competence
Knowledge
MCQs
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Expanding our toolbox..
Does
Shows how
Knows how
Knows
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Expanding our toolbox..
Does
Knows how
Knows
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Expanding our toolbox..
Does
Shows how
Knows how
Knows
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Expanding our toolbox..
Does
Shows how
Knows how
Knows
Domain specific skills
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ACGME Core Competencies(The 6 Competencies)

1. Patient Care
2. Medical Knowledge
3. Professionalism
4. Interpersonal Communication Skills
5. Practice-Based Learning and Improvement
6. Systems-Based Practice

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????? ???????

• 1- ???????? ?????? (Formative)
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  (feedback) ????? ????? ???? ??????
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  ?? ????.
• 2- ???????? ????? (Summative)
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  ?????? ??????? ?? ???? .
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What are assessment tools?
Uncued questions
Cued questions
????? ?????? Assignments
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What are assessment tools?
????????? ???? Practical
PBA(Procedure based Assessment) 
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What are assessment tools?
????????? ?????? ?Clinical
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What are assessment tools?
?????
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??????? ??? ?? ??? ????Workplace Based
Assessment) )

• Mini-CEX) Clinical Evaluation Exercise)
• CBD ?? CSR (Chart Stimulated Recall)
• DOPS ) Direct Observation Of procedural Skills)
• PBA (Procedure based Assessment) 
• )   ??????? 360 Mini-PAT (
• OSCE (objective structured clinical examination)
• GRF(Global Rating Form )

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Climbing the Pyramid
Does
Shows how
Knows how
Knows
MCQ
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???????? ?????? ??????
?? ????? ????? ?????? ????????? ???? (OSCE)
(Objective Structured Clinical Examination)
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Whats in a name?
Objective Structured Clinical Examination
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OSCE
Objective
Structured
Clinical
Examination
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?????????
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  ?????.
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OSCEs - Structured

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  ????? ??? ???.
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  ?????? ????.
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• History taking
• Interpersonal communication
• Clinical examination
• Procedures

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• OSCE????? ??????? ????? ???????? ?????? ???.
• Students have to demonstrate their skills, not
  just describe the theory

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Clinical Examination

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  ????? ?? ????? ??? ??.

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Competencies The SIX Domains
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Objective Structured Clinical Examination

• Medical authorities faculties started to
  implement the OSCE exams for clinical and
  communication skills assessment of medical
  students, clerks, interns, residents, and
  graduates since the 1980s.
• It is a standardized method of clinical
  evaluation that eliminates bias.

www.OSCEhome.com
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Objective Structured Clinical Examination

• OSCE is a form of performance-based testing used
  to measure candidates clinical competency. 
• 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 a medical problem.

www.OSCEhome.com
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Objective Structured Clinical Examination

• The OSCE is an approach to the assessment of
  clinical competence in which the components of
  competence are assessed in a planned or
  structured way with attention being paid to the
  objectivity of the examination. Harden, 1988

www.OSCEhome.com
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Objective Structured Clinical Examination

• The curriculum tells the staff what to teach...
• The OSCEs tells the students what to learn !
• And that is the point.
• What OSCE candidates should learn?
• What candidates can do rather than what they
  know.

www.OSCEhome.com
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Objective Structured Clinical Examination

• The application of their knowledge rather than
  the recall of knowledge.
• The WHAT to ask and do.
• The HOW they ask and do.
• The WHEN they ask and do.
• How do they organize themselves.
• How do they communicate with patients.

www.OSCEhome.com
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Objective Structured Clinical Examination

• The OSCE has offered a strikingly new and exiting
  way of making valid assessment of clinical
  performance of medical student ,resident, and
  fellows .

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What is the purpose of the OSCE?

• Provide feedback on performance
• Evaluate basic clinical skill
• Measure minimal competency

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What is OSCE?

• It is some sort of student evaluation that
  examinee will go through several stations to be
  evaluated in clinical fields by special rating
  scales and checklists.

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OSCE is Useful to Evaluate

• Clinical skill
• Practical attitudes
• Practical knowledge

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OSCE Performance-Base assessment
(Skill Based Assessment)

• Actual Performance of clinical skills
• is
• observed in order to adjudicate the competence of
  Health professionals

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What is the format of OSCE?
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What is the format of OSCE?

• It consists of several Stations
• (12-20 each lasting 5 to 15 minutes not more than
  30 seconds rest between each).

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OSCE

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• ???? blueprint
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OSCE

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• 12?? 20 ??????? ? ?? ??????? 5 ?? 15 ?????

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???? ??????? ??? ?? 9 ??????? OSCE
Start
2
1
4
3
5
End
6
8
9
7
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10 9 8 7 6 5 4 3 2 1
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10 9 8 7 6 5 4 3 2 1
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• ???? ????. Observe ?????? ? ?????? ?????? ?

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What is the stations contents?
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What is the stations contents?

• History taking
• Clinical procedure
• Radiographs
• Slide presentation

• Case history
• Physical exam
• Real patient
• Standardize pt.
• Simulated pt.

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OSCE

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  ????? ?...

??????? ??? manned
??????? ??? unmanned
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???????? ???? ??????? ???????? OPG

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How do you evaluate the examinee?
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How do you evaluate the examinee?

• Checklist
• Rating scale
• Short answered questions

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?????? ??????? OSCE

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  ????? ?? ????.
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  ?? ???.

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Who are the Raters?
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Who are the Raters?

• Simulated pt.
• Standardized pt.
• Clinical staff
• Non clinical staff
• Non expert raters

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OSCE

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• ???? ?????
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• ?????(???)

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How to Develop OSCE?

1. Consider the relevant objectives
2. Write them down
3. Is the OSCE a suitable format to evaluate the
   objectives?
4. Consider each station for only one objective

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How to Develop OSCE?

1. Write a scenario for each station
2. Develop a suitable rating tool for each station
3. Write an instruction for examinee
4. Write an instruction for standardized patient

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How to Develop OSCE?

1. Design certain prompts to conduct the examinees
2. Try to simulate nearer to the real situation
3. Have several rehearsals
4. Have a pilot study or design for testing
   reliability and practicality

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How to Develop OSCE?

1. Run OSCE
2. Have a suitable feedback after examination to
   promote both students performance as well as
   core curriculum

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OSCE is suggested the first best method for
evaluation of

• Interviewing
• Counseling educating pts families
• Performing procedures
• Physical examination
• Preventive health services
• Creation of therapeutic relationship with
  patients
• Listening skills
• Respectful altruistic behaviors
• Sensitive to cultural, age, gender disability
  issues

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?????? ?????? ?? OSCE

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   ???? ???.
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   ???.
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   ????? ?????? ?? ???.
5. ??????? ??? ???.
6. ???? ?? ?? ?????? ?????.

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?????? ?????? ?? OSCE

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?????????? ?????? ?? OSCE

1. ??? ?????? ?????? ??????? ??? ? ??????? ??? ????
   ???? ???? ?? ??? ?? ???.
2. ???????? ??? ??? ???? ????? ???? ?????? ???? ???.
3. ??????? ?? ????? ????? ?????? ???? ????.
4. ????? ? ???? ?? ???? ? ??? ??? ???.

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?????????? ?????? ?? OSCE

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  ??????? ?? ????.
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  ???? ????.
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  ????? ????? ???? ???.
• 7- ????????? ? ????? ?? ??????? ????? ??????
  ????? ???.
• 8- ?? ???? ????? ???? ? ???? ????? ?? ???.

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GRF, 360-degree
DOPS, Mini-CEX
OSCE
MCQ