Implementation of the objective structured clinical examination (OSCE) in the assessment of medical students

The traditional evaluation of the clinical examination performed by medical students has some strengths but significant limitations, in terms of validity and reliability. The advent of the objective structured clinical examination (OSCE) has enabled some of the limitations to be overcome. Its basic structure consists of a circuit of assessment stations, where a range of practical clinical skills are assessed in a simulated environment with simulated patients, models and manikins by an examiner using a previously determined, objective marking scheme. Consequently, the OSCE is more reliable and fairer than the traditional approach. In the Medical School of the Aristotle University of Thessaloniki (AUTH) a pilot OSCE was introduced for 42 final year medical students at the end of their Internal Medicine clerkship. This group of students had also attended the program of a Clinical Skills Laboratory. The OSCE was developed in several steps. The first key aspect of developing the OSCE was the construction of a blueprint, which helped the selection of an appropriate and adequate sample of the competence intended to be assessed, and guided selection of the tasks to be performed. The next stage in developing the OSCE involved designing stations around the problems identified in the blueprint. The essential elements of the OSCE stations were: precise and clear instructions to students, examiners and patients; a rating form or marking sheet and a list of requirements. Once each station was designed, it was tested in order to produce instructions clear enough to validate the time allocated to each particular station. The OSCE was conducted in the Emergency Department of the "AHEPA" University Hospital during the hours it was closed. This is a clinical environment with an adequate number of rooms to permit the circuit of assessment stations. Developing and implementing an OSCE is a complex process. Essential requirements for success are thorough planning, strong support by the administration, faculty participation and well-trained simulated patients. Running an OSCE requires a commitment of time and personnel, both for preparation and on the day of the examination. The positive results of the first pilot OSCE will provide support for its introduction in the assessment of the medical students of AUTH, and assure that the students are gaining the necessary clinical skills to provide quality patient care.