The Objective Structured Clinical Examination (OSCE) was first described by Harden in 1975 as an alternative to the existing methods of assessing clinical performance (Harden et al. 1975). The OSCE was designed to improve the validity and reliability of assessment of performance, which was previously assessed using the long case and short case examinations. Since then the use of the OSCE has become widespread within both undergraduate and postgraduate clinical education. We recognise that the introduction of the OSCE into an existing assessment programme is a challenging process requiring a considerable amount of theoretical and practical knowledge. The two parts of this Guide are designed to assist all those who intend implementing the OSCE into their assessment systems. Part I addresses the theoretical aspects of the OSCE, exploring its historical development, its place within the range of assessment tools and its core applications. Part II offers more practical information on the process of implementing an OSCE, including guidance on developing OSCE stations, choosing scoring rubrics, training examiners and standardised patients and managing quality assurance processes. Together we hope these two parts will act as a useful resource both for those choosing to implement the OSCE for the first time and also those wishing to quality assure their existing OSCE programme.

The organisation, administration and running of a successful OSCE programme need considerable knowledge, experience and planning. Different teams looking after various aspects of OSCE need to work collaboratively for an effective question bank development, examiner training and standardised patients' training. Quality assurance is an ongoing process taking place throughout the OSCE cycle. In order for the OSCE to generate reliable results it is essential to pay attention to each and every element of quality assurance, as poorly standardised patients, untrained examiners, poor quality questions and inappropriate scoring rubrics each will affect the reliability of the OSCE. The validity will also be influenced if the questions are not realistic and mapped against the learning outcomes of the teaching programme. This part of the Guide addresses all these important issues in order to help the reader setup and quality assure their new or existing OSCE programmes.

Aims and objectives To explore health care professionals' perspective of hospice at home service that has different components, individually tailored to meet the needs of patients. Background Over 50% of adults diagnosed with a terminal illness and the majority of people who have cancer, prefer to be cared for and to die in their own home. Despite this, most deaths occur in hospital. Increasing the options available for patients, including their place of care and death is central to current UK policy initiatives. Hospice at home services aim to support patients to remain at home, yet there are wide variations in the design of services and delivery. A hospice at home service was developed to provide various components (accompanied transfer home, crisis intervention and hospice aides) that could be tailored to meet the individual needs of patients. Design An evaluation study. Methods Data were collected from 75 health care professionals. District nurses participated in one focus group (13) and 31 completed an electronic survey. Palliative care specialist nurses participated in a focus group (9). One hospital discharge co‐ordinator and two general practitioners participated in semi‐structured interviews and a further 19 general practitioners completed the electronic survey. Results Health care professionals reported the impact and value of each of the components of the service, as helping to support patients to remain at home, by individually tailoring care. They also positively reported that support for family carers appeared to enable them to continue coping, rapid access to the service was suggested to contribute to faster hospital discharges and the crisis intervention service was identified as helping patients remain in their own home, where they wanted to be. Conclusions Health care professionals perceived that the additional individualised support provided by this service contributed to enabling patients to continue be cared for and to die at home in their place of choice. Relevance to clinical practice This service offers various components of a hospice at home service, enabling a tailor made package to meet individual and local area needs. Developing an individually tailored package of care appears to be able to meet specific needs.

Long waiting times and lack of knowledge of services are among several factors that may prevent lung cancer patients being offered rehabilitation. In order to improve the quality of care delivered to cancer patients, it is important to remove barriers that affect delivery of rehabilitation services.

BackgroundPromoting the choice to die at home is central to UK policies and strategies. Nationally, various models of Hospice at Home service support this choice. Locally a service was developed to fill gaps in, and work together with, existing community services providing a bespoke Hospice at Home Service outreaching from the hospice hub.MethodRetrospective cohort study and stakeholder evaluation during a 1 year pilot study in the North West of England. Data (demographic and service intervention) was collected on 201 service recipients. 55 Healthcare Professionals; (General Practitioners, District Nurses, Community Specialist Palliative Care Nurses and Hospital Discharge Coordinator) participated in semi-structured interviews, focus groups and electronic open end questionnaires.ResultsIn the first year, 201 received the service. 184 (92%) had cancer, 36% aged over 80 years. 57 (28%) lived alone. 181 (90%) recipients died. 73% (132) died at home (72% (120) with cancer), 6% (29) in the hospice, 12 (6.5%) care home, 1 (0.5%) in an ambulance on their way home, 7 (4%) hospital. 51 patients lived alone, 69% (35) died at home. Healthcare Professionals reported the impact of the different elements of the service (accompanied transfer home; multiprofessional (including doctors) crisis intervention team and a flexible sitting service) as being instrumental in helping patients to remain at home. The additional service supplements existing services, enables a speedier discharge home and supports carers to enable them to continue coping. It is of interest that in the second year a 73% home death rate has been maintained.ConclusionsThis novel bespoke service provides different elements of a Hospice at Home service, a tailor made package to meet individual and local area needs. This service appears to be having a major impact on place of death and is enabling patients to die in their place of choice