History of OSCE | Importance of OSCE | PM&R OSCE Development & Research

The OSCE is a means of assessing clinical competency, based on objective testing through direct observation. Described by Harden in 1975, the OSCE is comprised of several "stations" in which examinees are expected to perform a variety of clinical tasks within a specified time period perform a variety of clinical tasks within a specified time period against criteria formulated to the clinical skill, thus demonstrating competency of skills and/or attitudes (Hamadeh, 1993). Such stations could involve several methods of testing, including use of multiple choice or essay tests, and in most cases, use of "standardized patients". Standardized patients are individuals who have been trained to exhibit certain signs and symptoms of specific conditions under certain testing conditions. Advantages of this method of testing include the ability to assess a large number of clinical behaviors in a relatively short period of time, its formative ability (use in the teaching process) and its summative ability (use in determining outcomes).

Studies have shown positive results utilizing the OSCE for evaluating those areas most critical to performance of health care professionals, such as the ability to obtain/interpret data, problem-solve, teach, communicate, and handle unpredictable patient behaviors (Barrows, 1987; Hamadeh, 1993; Jain, 1997, 1998, 2000). The OSCE is a versatile multipurpose evaluative tool that can be utilized to evaluate health care professionals in a clinical setting, students within training programs, training programs themselves, and health care services offered to consumers.

Importance of OSCE

The primary goal of the program is to produce competent physicians. Written examinations test cognitive knowledge, only one aspect of the competency issue. It is equally important to test how the residents take patient histories, perform physical examinations, communicate, and master technical skills. Equally important are their problem solving, decision making, and patient management abilities. Our view of professionalism also includes excellence, commitment to lifelong learning, accountability, honor, integrity, and respect for others. The OSCE allows educators to establish standardized clinical evaluation tools using controlled grading criteria. The skills and traits evaluated by the OSCE are not only desirable, but essential for physicians-in-training.

PM&R OSCE Development & Research

In 1993, Drs. Jain, DeLisa, and Campagnolo surveyed the Program Directors of all PM&R Residency Training programs in the United States. The following abstract is taken from their article "Methods Used in the Evaluation of Clinical Competency of Physical Medicine and Rehabilitation Residents", published 1994: PMID: 8043244

In physical medicine and rehabilitation, Kessler Medical Rehabilitation Research and Education Corporation (KMRREC) and the Department of Physical Medicine and Rehabilitation at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School are at the leading edge of the OSCE movement. For the past seven years, faculty have been developing a program to train and test the clinical competency of PM&R residents. Faculty write the scripts - each designed to represent a musculoskeletal or neurological problem commonly encountered in physiatric practice, including the patient's personal, physical, and family history. Training of the standardized patient can take anywhere from 4 to 12 hours, depending upon the complexity of the case. Ideally, cases are pilot tested on faculty members before being used as part of an examination.