The Objective Structured Clinical Examination is a versatile multipurpose evaluative tool that can be utilized to assess health care professionals in a clinical setting. It assesses competency, based on objective testing through direct observation. It is precise, objective, and reproducible allowing uniform testing of students for a wide range of clinical skills. Unlike the traditional clinical exam, the OSCE could evaluate areas most critical to performance of health care professionals such as communication skills and ability to handle unpredictable patient behavior.
Frequently Asked Questions (FAQs)
OSCE will take place on the campus of Marian University, Evans Center Building, Hill-Rom Simulation Center Suite 250.
If driving, be sure to take into account bad weather and traffic.
At Marian it is safest to have a parking pass. Students will utilize their student parking pass and visitors/groups will be granted day passes by the simulation center for parking. Tips for parking on campus: park anywhere there isn’t a restricted sign in front of your vehicle.
Students should be on site 15-20 minutes before their schedule.
Prior to the OSCE, students should review the NBOME COMLEX Level 2-PE guide.
Provide feedback on performance
Evaluate basic clinical skills
Measure minimal competencies
Provide practice for the NBOME COMLEX-PE
For questions or for further clinical and assignment specific information, contact your course leader.
For Simulation Center specific questions contact David Patterson, Simulation Center Director at 317-955-6277 or dpatterson@marian.edu
Prior to your assigned OSCE you should stop by the Simulation Center to familiarize yourself with the OSCE Room, equipment and resources provided. Prior to entering your exam, a period of time will be allotted for questions.
The OSCE is structured like the complex physical OSCE. The cases are leveled from easier to complex concepts.
Documentation is a part of the OSCE process and you will receive specifics of documentation during the course leading up to the OSCE.
Be aware of the passage of time; students often are surprised by how quickly time goes.
DO ONLY WHAT IS REQUESTED.
Use the patient history to guide the scope of the examination, since a complete exam is not required in all cases.
Even if the student immediately knows what the diagnosis is, the student should complete an appropriate physical exam.
Elicit psychosocial, occupational, past medical/surgical history, medications and allergies as appropriate.
Explain to the patient what is being done, particularly while doing OMT.
If unsure what is wrong, do not say, “I will get back to you after I have discussed this with the attending.” This does not evaluate your knowledge or skill.
For the purposes of OSCE’s: students will be told which case is an OMM case. (Students will not be told at the COMLEX PE). Utilize OMM practices and principles as appropriate. Because standardized patients may not have real osteopathic findings, but present with symptoms, develop a likely OMM scenario for history and physical findings. Gently position the patient and show the OMM technique. Perform OMM for 3-5 minutes, with an evaluation and reassessment.
In a family practice or ER setting, OMM must be combined efficiently with the rest of the examination and treatment. Most of the time, the chief complaint and history will lead the student to a focused musculoskeletal exam in either the upper half or the lower half of the body. Lower half of the body: screen leg length, sacrum (parasympathetic), lumbar, etc. (if time allows, think of the low back pain treatment sequence as a guide to areas that deserve evaluation in light of the patient’s complaint). Upper half of the body: thoracic are a gold mine for a problem’s treatable (OMT) sympathetic manifestations; look for a rib dysfunction at the level of a thoracic dysfunction, too; superior thoracic aperture dysfunction (T1-2, associated ribs, sternum) affects lymphatic drainage for the whole body; Chapman’s reflexes can be quick for diagnosis and treatment; etc. Knowledge of sympathetic and parasympathetic innervations for viscera potentially related to chief complaint can guide the focus of inquiry for axial spine involvement. (E.g. If GERD is suspected, be particularly interested in thoracic segments 5 through 9 and associated rib linkage.) Choose two or three most likely locations of somatic dysfunction for evaluation in this setting. The number of areas treated will be dictated by the assessment of importance and time limits. Remember post treatment reassessment is part of any office visit.
Disclosure or discussion with others about the OSCE cases or assessment materials is strictly forbidden and a violation of the honor code.
Information and materials provided:
Instructions
The setting: outpatient, primary care or Emergency Department
Patient demographics
Vital signs
Blank white piece of paper to take notes
The SOAP note will be typed into ExamSoft or BLine.
The student may identify themselves as Student Dr. (Surname).
Drug information will not be available. Students will not be required to write for specific drugs and drug dosages.
NBOME accepted abbreviations may be used.
Dress professionally with a clean white lab coat and name tag Scrubs are not considered profession attire.
Each exam room is equipped with:
Exam Table
OMM Table
Blood Pressure Cuff
Otoscope
Ophthalmoscope
Rosenbaum Pocket Vision Screener
Tongue Blades
Cotton Tipped Applicators
Ink pen
Stethoscope
Tuning Fork
Reflex Hammer
Pocket guides
Cell phones
PDAs are permitted
Smart/Sophisticated watches
Yes. OSCE’s are recorded. Self-evaluation sessions after an OSCE will be scheduled later. Usually one week following the OSCE.
Follow the course syllabus information regarding grading and posting of grades.
Proctors will be available to answer questions during the exam.
Students may access their video through the BLine recording system.
Graded SOAP notes and check sheets will be accessed through ExamSoft/Canvas
Before entering the room, write down the headings on the blank piece of paper in the chart (CC, PMH, PSH, Meds, Allergies, Family Hx, Social, Immunization, VS, Gen, Heart, Lungs, plus other headings pertinent to the case). Then while in the room, fill in the fields while the patient is talking. This saves valuable time when it comes time to type the soap note in the hallway and also allows the student to remember everything needed.
Read the doorway instructions and take them at face value.
Be confident walking into the room. Introduce yourself, shake hands with the patient and allay patient apprehension.
Before the physical exam, wash your hands. You can say "I'm going to wash my hands before doing the physical exam."
Communicate using clear layman’s terminology. Let the patient know everything that you are doing. E.g. I am going to listen to your heart and lungs now.
Listen on skin. Make sure you listen to all areas of the heart and lungs.
Explain to the patient what you are going to do before doing it, particularly while setting up OMM
Have a brief 1-2 sentence description of OMT prepared so you can share this with the patient if they request treatment or ask about it. Be sure you have considered osteopathic principles in all cases.
When documenting somatic dysfunction in the plan, be sure to include the region (cervical spine, thoracic spine, etc.) and technique use. e.g. "Somatic Dysfunction cervical spine. Muscle energy performed, and patient tolerated well."
Memorize the Red Flag questions for the top presenting complaints and the physical exam components that correspond with them. This saves valuable time and allows you to be more succinct with the patient. By knowing what you need to do, you will be able to finish with extra time to write a more thorough assessment and plan.
Use the First Aid Step 2 Clinical Skills book to help organize what you need to know for each case.
Consider the OSCE as preparation for the PE exam. RELAX and learn from it!
S = Subjective/patient input regarding the problem(s) O = Objective findings, physical exam, lab data, etc. A = Assessment—include 3 potential differential diagnoses or etiologies. Rank in order of likelihood. For well visits, list at least 3 problems or risk factors. P = Plan for diagnostic investigations and/or treatment.
