Objective Structural Clinical Examination

Abstract

EM ElGamri, Objective Structural Clinical Examination. 1992; 12(2): 223-224 To the Editor: We have had experience with the use of the objective standard clinical examination (OSCE) for assessment of medical students at various levels in the Faculty of Medicine, University of Gezira in Sudan. I would like to reflect my personal view on its use based on this experience.The main rationale for introducing a new examination tool was an attempt to overcome the many disadvantages of the conventional oral and clinical examination, mainly the lack of standardization of examiner, patient [1] and questions asked.We have used a 20 to 30 station test for a number of students averaging 40. The material included patients, photographs, x-rays, pathological samples and electrocardiograms (ECGs), etc. The test was found to be acceptable and enjoyable for medical students and teachers.The test is useful in the immediate assessment of the students' interactions with the patient. However, history taking skills, in my opinion, cannot be adequately assessed in the limited time available in the OSCE or by the use of a checklist.The objectivity claimed by enthusiasts is not always easy to achieve. The checklist divides a particular clinical skill into its components. For example, if a candidate omits the examinations of the jugular venous pulse (JVP) his score will be zero. The candidate will obtain a score from one to three depending on whether the candidate has performed the manuever poorly, moderately well, or very well, which is of course still subjective.Standardization is not helped by having to change patients in a particular station when examining a relatively large number of students. History and physical signs, are of course, more easily elicited in some patients than others. Attempts to obtain patients with similar signs will not eliminate this constraint.The main question remains: how much weight in the overall assessment of the students are medical educators prepared to give to this innovative examination tool? In our setting, OSCE has contributed approximately 15% to the total mark in any given subject. This is a modest figure given the cost of the examination in terms of financial, human and time resources.Proponants' answers to this question range between describing the test as an "acceptable alternative" [2] and an "integral component" [3] to the overall clinical assessment. Students' scores were found to correlate with the conventional clinical examination [2]. This finding poses yet another question: why use a new examination tool if we are to achieve the same result?For all of its advantages, I do not see OSCE replacing clinical and oral examination. ElRadi Mohammed ElGamri, MBBS, DTM&H, MRCP