An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives

Figures & data

Table 1 OSCE stations in medicine and therapeutics

● Paediatrics: 5 stations	● Adult Medicine: 9 stations
∘ History taking [P]	∘ History taking [S3]
∘ Cardiovascular examination [P]	∘ Respiratory examination [HV, E]
∘ Abdominal examination [P]	∘ Neurologic examination [HV, E]
∘ Neurologic examination [P]	∘ Cardiovascular examination [HV, E]
∘ Technical skill [S]	∘ Abdominal examination [HV, E]
	∘ Dermatological examination [HV, E]
● Community Health: 1 station	∘ Rheumatology station [HV, E]
∘ Counselling skills [S2] or	∘ Funduscopic examination station
∘ Community health problems [S2]	∘ Basic life support (BLS) [M]
	● Psychiatry: 2 stations
	∘ Psychiatric case evaluation

Abbreviations: P, real patients; S1, simulated patient and/or parents; S2, simulated patients with predefined case scripts; S3, simulated patients; M, mannequin; HV, healthy volunteer; E, examiner.

Table 2 Student perception of attributes and organization of OSCE (N=54)

Attributes of OSCE	Chi-squared	Median (IQR)	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
Examination was fair	77.91*	4 (0)	0	1 (1.9%)	10 (18.5%)	37 (68.5%)	6 (11.1%)
Wide knowledge area covered	70.76*	4 (0)	0	3 (5.6%)	5 (9.3%)	36 (66.7%)	10 (18.5%)
Needed more time at stations	15.60*	4 (2)	2 (3.7%)	6 (11.1%)	10 (18.5%)	21 (38.9%)	15 (27.8%)
Examination well administered	73.66*	4 (0)	0	0	10 (18.5%)	36 (66.7%)	8 (14.8%)
Examination very stressful	40.22*	5 (1)	0	2 (3.7%)	10 (18.5%)	12 (22.2%)	30 (55.6%)
Examination well structured and sequenced	59.31*	4 (1)	1 (1.9%)	2 (3.7%)	2 (3.7%)	32 (59.3%)	17 (31.5%)
Examination minimized chance of failing	53.54*	3 (0)	1 (1.9%)	11 (20.4%)	32 (59.3%)	8 (14.8%)	2 (3.7%)
OSCE less stressful than other examinations	40.94*	2 (1)	23 (42.6%)	20 (37.0%)	8 (14.8%)	1 (1.9%)	2 (3.7%)
Allowed student to compensate in some areas	37.43*	3 (1)	1 (1.9%)	6 (11.1%)	26 (48.1%)	18 (33.3%)	3 (5.6%)
Highlighted areas of weaknesses	36.93*	4 (1)	1 (1.9%)	3 (5.6%)	13 (24.1%)	28 (51.9%)	9 (16.7%)
Examination intimidating	24.62*	4 (2)	0	4 (7.4%)	12 (22.2%)	23 (42.6%)	15 (27.8%)
Student aware of level of information needed	39.43*	4 (1)	0	5 (9.3%)	15 (27.8%)	28 (51.9%)	6 (11.1%)
Wide range of clinical skills covered	58.82*	4 (0)	0	1 (1.9%)	11 (20.4)%	33 (61.1%)	9 (16.7%)
Organization of OSCE	Chi-squared	Median (IQR)	Excellent	Above average	Average	Below average	Very poor
Orientation of OSCE before examination	27.18*	4 (2)	15 (27.8%)	18 (33.0%)	20 (37.0%)	1 (1.9%)	0
Announcement of venue and known to student	31.16*	4(2)	18 (33.0%)	22 (40.7%)	14 (25.9%)	0	0
Timetables were available and known to student	18.82*	4.5 (2)	27 (50.0%)	12 (22.2%)	11 (20.4%)	2 (3.7%)	2 (3.7%)
Revision of clinical procedures before OSCE	15.08*	3 (2)	8 (14.8%)	13 (24.1%)	21 (38.9%)	10 (18.5%)	2 (3.7%)
Staff answered queries related to OSCE	20.86*	4 (1)	16 (29.6%)	17 (31.5%)	18 (33.3%)	3 (5.6%)	0
Quality of OSCE rooms ie setup, lightening etc.	28.91*	4 (2)	22 (40.7%)	19 (35.2%)	12 (22.2%)	0 (0%)	1 (1.9%)
Availability good equipment including simulators	29.91*	4 (1)	15 (27.8%)	23 (42.6%)	15 (27.8%)	0 (0%)	1 (1.9%)

Note: *Values were statistically significant P<0.01.

Abbreviation: OSCE, objective structured clinical examination.

Table 3 Student perception of quality and validity/reliability of OSCE performance (N=54)

Quality of OSCE performance	Chi-squared	Median (IQR)	To a greater extent	Somewhat	Very little	Not at all
Aware of the nature of the examination	44.51*	4 (1)	30 (55.6%)	23 (42.6%)	1 (1.9%)	0
Tasks reflected those taught	40.53*	3 (1)	23 (42.6%)	29 (53.7%)	1 (1.9%)	1 (1.9%)
Time at each station was adequate	19.00*	3 (1)	10 (18.5%)	27 (50%)	14 (25.9%)	3 (5.6%)
Setting and context at each station felt authentic	14.69*	3 (2)	18 (33.3%)	23 (42.6%)	11 (20.4%)	2 (3.7%)
Instructions were clear and unambiguous	48.80*	4 (1)	33 (61.1%)	20 (37.0%)	0	1 (1.9%)
Tasks asked to perform were fair	44.54*	4 (1)	32 (59.3%)	20 (37.0%)	2 (3.7%)	0
Sequence of stations logical and appropriate	38.83*	4 (1)	30 (55.6%)	21 (38.9%)	2 (3.7%)	1 (1.9%)
Examination provided opportunities to learn	13.39*	3 (2)	18 (33.3%)	22 (40.7%)	12 (22.2%)	2 (3.7%)
Validity and reliability of OSCE	Chi-squared	Median (IQR)	To a greater extent	Somewhat	Very little	Not at all
OSCE scores provide true measure of essential clinical skills	20.96*	3 (1)	9 (16.7%)	29 (53.7%)	11 (20.4%)	5 (9.3%)
OSCE scores are standardized	60.10*	3 (0)	10 (18.5%)	39 (72.2%)	5 (9.3%)	0
OSCE is a practical and useful experience	23.84*	3 (1)	15 (27.8%)	29 (53.7%)	4 (11.1%)	6 (11.1%)
Personality, ethnicity and gender will not affect OSCE scores	17.21*	3 (1)	9 (16.7%)	25 (46.3%)	17 (31.5%)	3 (5.6%)

Note: *Values were statistically significant P<0.01.

Abbreviation: OSCE, objective structured clinical examination.

Table 4 Students’ perception of assessment format

Which of the following formats is easiest?	N	Chi-squared	Median (IQR)	Difficult	Undecided	Easy
MCQ	52	10.89*	2 (0)	9 (17.3%)	28 (53.8%)	15 (28.8%)
Essay/SAQ	48	13.88*	2 (1)	15 (31.3%)	27 (56.3%)	6 (12.5%)
OSCE	49	19.14*	1 (1)	25 (51%)	22 (44.9%)	2 (4.1%)
Clerkships ratings	49	14.74*	2 (0)	10 (20.4%)	29 (59.2%)	10 (20.4%)
Which of the following formats is fairest?				Unfair	Undecided	Fair
MCQ	51	11.41*	2 (1)	6 (11.8%)	20 (39.2%)	25 (49%)
Essay/SAQ	44	14.23*	2 (1)	3 (6.8%)	22 (50%)	19 (43.2%)
OSCE	48	9.13**	2 (1)	7 (14.6%)	24 (50%)	17 (35.4%)
Clerkships ratings	45	20.93*	2 (1)	2(4.4%)	27 (60%)	16 (35.6%)
From which of the following formats do you learn most?				Learn very little	Undecided	Learn a lot
MCQ	50	7.24**	2 (1)	8 (16%)	19 (38%)	23 (46%)
Essay/SAQ	45	18.53*	3 (1)	2 (4.4%)	18 (40%)	25 (55.6%)
OSCE	48	10.50*	2.5 (1)	6 (12.5%)	18 (37.5%)	24 (50%)
Clerkships ratings	48	9.13**	2.5 (1)	7 (14.6%)	17 (35.4%)	24 (50%)
Which of the following formats should be used more often in the clinical years?				Used much less	Undecided	Used much more
MCQ	49	9.84*	2 (1)	6 (12.2%)	21 (42.9%)	22 (44.9%)
Essay/SAQ	44	3.05	2 (1)	11 (25%)	20 (45.5%)	13 (29.5%)
OSCE	48	4.88	2 (1)	9 (18.8%)	18 (37.5%)	21 (43.8%)
Clerkships ratings	45	12.13*	3 (1)	5 (11.1%)	16 (35.6%)	24 (53.3%)

Notes: Values are statistically significant *P<0.01. **P<0.05.

Abbreviations: MCQ, multiple choice questions; SAQ, short answer questions; OSCE, objective structured clinical examination.

Table 5 Examiners' perception of OSCE (N=22)

	Chi-squared	Median (IQR)	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
Overall, the examination was fair	16.49*	4 (1)	2 (9.1%)	0 (0%)	1 (4.5%)	13 (59.1%)	6 (27.3%)
Wide range of clinical skills and knowledge covered	10.69**	4 (1)	2 (9.1%)	1 (4.5%)	3 (13.6%)	12 (54.5%)	4 (18.2%)
Examination was well-organized and well-administered	11.69**	4 (1)	2 (9.1%)	0 (0%)	1 (4.5%)	9 (40.9%)	10 (45.5%)
Students were aware of level of information needed	10.19**	4 (1)	2 (9.1%)	1 (4.5%)	1 (4.5%)	11 (50%)	7 (31.8%)
Instructions at each station were clear and unambiguous	7.19	4 (1)	2 (9.1%)	2 (9.1%)	1 (4.5%)	7 (31.8%)	10 (45.5%)
Setting and context at each station felt authentic	8.29	4 (1)	2 (9.1%)	1 (4.5%)	3 (13.6%)	11 (50%)	5 (22.7%)
Sequence of stations was logical and appropriate	9.29	4 (1)	3 (13.6%)	0 (0%)	4 (18.2%)	11 (50%)	4 (18.2%)
Tasks asked to perform at each station were fair	14.49*	4 (0)	1 (4.5%)	1 (4.5%)	3 (13.6%)	13 (59.1%)	4 (18.2%)
Time at each station was adequate	3.19	4 (2)	4 (18.2%)	2 (9.1%)	3 (13.6%)	9 (40.9%)	4 (18.2%)
OSCE scores provided true measure of essential clinical skills	3.09	4 (2)	3 (13.6%)	4 (18.2%)	3 (13.6%)	9 (40.9%)	3 (13.6%)
Examination were stressful for the students	7.49	3 (2)	1 (4.5%)	0 (0%)	7 (31.8%)	6 (27.3%)	8 (36.4%)
OSCE minimizes chances of failing	7.79	4 (1)	2 (9.1%)	2 (9.1%)	2 (9.1%)	11 (50%)	5 (22.7%)
OSCE has a positive impact on student learning	0.79	3 (2)	3 (13.6%)	5 (22.7%)	6 (27.3%)	4 (18.2%)	4 (18.2%)
OSCE is a standardized examination for all students	11.19**	4 (1)	1 (4.5%)	2 (9.1%)	2 (9.1%)	12 (54.5%)	5 (22.7%)
OSCE scores truly reflect competence in clinical skills	3.89	3 (2)	5 (22.7%)	5 (22.7%)	3 (13.6%)	8 (36.4%)	1 (4.5%)
OSCE is preferable to other formats of clinical examination	4.29	3 (1)	2 (9.1%)	2 (9.1%)	8 (36.4%)	6 (27.3%)	4 (18.2%)
OSCE should be used more often in the clinical years	1.99	4 (1)	3 (13.6%)	2 (9.1%)	5 (22.7%)	8 (36.4%)	4 (18.2%)

Note: Values are statistically significant *P<0.01. **P<0.05.

Abbreviation: OSCE, objective structured clinical examination.