Health education, which is a process that is not limited to theoretical knowledge but also includes the practical application of this knowledge, requires future doctors, dentists, and nurses to know how to use the knowledge they have learned in clinical settings. Objective Structured Clinical Examination (OSCE) objective assessment methods have been developed to meet the needs of these groups. Widely used in medical, dental, and nursing faculties, these examinations aim to systematically measure students’ clinical skills, communication abilities, and how to apply their theoretical knowledge in practice. OSCEs bring objectivity to the assessment processes in health education and ensure that students graduate equipped and competent.
This article will discuss structured oral and clinical exams, rubrics, and the benefits of digital exam systems in these exam types.
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Structured oral exams are an important assessment method used in various academic disciplines such as health education to assess students’ theoretical knowledge, thinking, and clinical decision-making skills. In these exams, often referred to as “Viva Voce”, students are presented with real clinical situations using real patient scenarios, and their knowledge and skills are assessed through these situations.
An important feature of these exams is that the assessment process is carried out within the framework of a specific structure and checklist (blueprint/checklist). These lists predetermine the scope of the questions to be asked in the exam, which topics will be assessed, and which competencies of the students will be measured. Thus, the examination process is made more objective and standardized.
Using Bloom’s Taxonomy and Blueprint Tables
In structured oral exams, questions are prepared using Bloom’s cognitive domain classification.
- Knowledge (Recall): The learner’s ability to recall and retrieve basic information.
- Comprehension (Understanding): The ability to understand and interpret information.
- Application (Application): The ability to apply knowledge in new situations.
- Analyze (Analysis): The ability to dissect and analyze information.
- Synthesis: The ability to put information together to form new ideas.
- Evaluation (Assessment): The ability to make decisions by evaluating information.
In structured oral exams, blueprints and checklists are critical to ensure the scope and standardization of the exam. These tables detail which topics the exam will cover and which competencies will be measured. For example
- Must Know: The basic knowledge and skills that learners need to know.
- Nice to Know: Additional knowledge and skills that learners should know.
These lists ensure that the exam is conducted fairly and objectively. In addition, all faculty members participating in the exam process agree on the preparation of these tables and the correct answers, increasing the reliability of the exam.
Examod Digital Exam & Assessment Platform supports online, paper-based, performance, structured clinical, and oral exams with advanced question bank software that supports associating questions with topics, question attributes, learning objectives, and keywords. It also allows you to identify gaps at the intersection points that match your goals and achievements with blueprint tables in online exams.
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Real Patient Scenarios and Residency Training
During the examination process, students are presented with scenarios of real patients, and their clinical approach, diagnostic, treatment planning, and clinical decision-making skills are assessed through these scenarios. For instance, the examiner tells the student about a patient’s medical history, symptoms, and current condition. The student is expected to make decisions about the management of the patient based on this information and interpret the clinical findings. In this process, not only the student’s ability to recall information but also their analytical thinking and problem-solving skills are measured.
Scenario Preparation and Assessment Process
In structured oral exams, usually 3-4 different scenarios are prepared and a certain number of question pools are created for each scenario. The questions are randomly selected and asked to the students and the answers are evaluated by at least two independent evaluators. This increases the objectivity and reliability of the exam. During the exam process, students are given feedback at the end of each question and when the results are announced, it is possible to see where students have succeeded and where they have fallen short.
Unlike traditional oral exams, this method offers a more systematic, fair, and objective assessment process. It also reduces students’ anxiety levels and prepares them for real clinical situations. Structured oral examinations are recognized as an effective assessment tool in health education and more accurately measure the clinical competencies of specialty students.
What is structured clinical exam?
The Objective Structured Clinical Examination (OSCE) is an innovative examination format used in medicine and health sciences to assess students’ clinical competencies objectively and systematically. The OSCE provides students with a variety of clinical scenarios, allowing them to demonstrate their knowledge, skills, and attitudes in a realistic environment. This exam format consists of a series of stations where students must perform specific clinical tasks. Each station contains structured tasks where students must manage a specific clinical situation, perform a procedure, or communicate with a patient. The main features of the OSCE are:
Structured Stations: The test consists of stations, each with a specific task. At each station, students complete their tasks within a set time limit and then move on to the next station. This ensures that the test is conducted in a systematic and controlled manner.
Standardized Patients: In OSCE, the patients that students encounter are commonly known as standardized patients (SP). These are trained actors who act out predetermined scenarios and assess students’ clinical skills. This increases the objectivity and reliability of the exam.
Multiple Assessment: The OSCE includes multiple stations to assess students’ various clinical skills. This enables students to demonstrate a wide range of knowledge and skills. Different areas of competence such as communication, clinical reasoning, technical skills, and emotional intelligence are assessed.
Objectivity and Reliability: OSCE is based on objective assessment criteria. Each station has standardized checklists and scoring guides that assess students’ performance. This ensures that the assessment process is free from subjectivity.
Feedback and Learning: OSCE provides students with immediate feedback on their performance. This feedback helps students identify their strengths and weaknesses and supports the learning process.
Miller pyramid (professional competence and its testing)
The Miller Pyramid is a model used for student assessment in medical education and consists of four levels:
- Knowledge (Knows): Understanding of basic medical knowledge.
- Knows How: Knowing how to use knowledge in a clinical context.
- Shows How: Demonstrate clinical skills in a simulation or controlled environment.
- Does: Applying skills in the real clinical setting.
OSCE is directly related to the third level of the Miller Pyramid, “Shows How”. OSCE provides students with the opportunity to demonstrate their clinical skills and knowledge through real patient scenarios in a controlled environment. This is used to assess how students apply what they have learned in practice. OSCE measures not only the students’ theoretical knowledge but also how to use this knowledge in a clinical context and how to make decisions in patient management. In this way, it creates a bridge to the upper levels of the Miller Pyramid and helps prepare students to perform in a real clinical setting.
Implementation of OSCE
Planning and Preparation: The scope of the exam and the stations are determined in advance. Which clinical scenarios will be used, which tasks will take place at each station and the evaluation criteria are planned in detail.
Creating the Stations: Each station is designed according to a specific clinical task or scenario. Students perform tasks such as history taking, physical examination, interpretation of laboratory results, or patient education.
Education of Standardized Patients: Standardized patients are trained to act out exam scenarios accurately and consistently. These patients contribute to the assessment by observing students’ performance and scoring them according to specific criteria.
Evaluation and Feedback: Students’ performance is scored according to objective criteria by trainers or evaluators at the stations. At the end of the exam, students are given detailed feedback on their performance.
Avantajlar ve dezavantajlar
OSCEs are an effective method to objectively and systematically assess students’ clinical skills, communication abilities, and theoretical knowledge in medical, dental, and nursing faculties. These exams ensure that future health professionals are equipped and competent. As with any method, OSCE has its advantages and disadvantages.
Advantages
- Objectivity: Standardized questions and assessment criteria ensure that the assessment is no longer subjective.
- Comprehensiveness: Both theoretical knowledge and practical skills can be assessed in the same test.
- Realism: Clinical scenarios are designed to reflect real-life situations, allowing students to perform in a realistic environment.
Disadvantages
- Time and Resource Requirement: OSCEs are often time-consuming and require a large number of trainers and simulated patients.
- Stress: It can be stressful for students as both theoretical and practical skills are assessed at the same time.
Rubrics
A rubric is a tool used in the assessment process to rate students’ performance according to specific criteria. The rubric defines various levels of performance and provides specific indicators for each level. The assessment criteria are often elaborated in order to show the extent to which performance is in line with expected standards.
Taking the OSCE exams as an example, specific tasks are defined for each station and the criteria for successful completion of these tasks are defined. The rubric objectively evaluates the student’s performance based on these criteria. Rubrics evaluating performance on the OSCE sample usually include five or more levels:
- Excellent (5): Complete and error-free fulfillment of the task.
- Good (4): Performed the task largely accurately and effectively.
- Fair (3): Performing the task partially correctly but with some deficiencies.
- Poor (2): Inadequate fulfillment of the task, significant deficiencies and errors.
- Failure (1): Failure to fulfill the task.
This scoring system allows assessors to evaluate student performance in an objective and standardized way. Rubrics increase the reliability and validity of performance assessment, ensuring that students’ clinical competencies are measured fairly.
In today’s world where measurement and evaluation processes are digitalized, digital exam systems are frequently used to measure performance. In Examod, you can easily create, edit and associate rubrics with learning objectives to assess performance. Create performance exams with rubrics and evaluate candidates face-to-face, digitally, orally and in writing with devices such as tablets, etc. For more information, you can visit our Performance Exams with E-Rubrics page or find out how we do it all via the button below.
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Frequently Asked Questions
Structured oral exams are an important assessment method used to evaluate students’ theoretical knowledge, thinking, and clinical decision-making skills. These exams are conducted within the framework of a specific structure and checklist and are usually conducted using real patient scenarios.
The Objective Structured Clinical Examination (OSCE) is an examination format used to assess students’ clinical competencies in an objective and systematic way. It consists of a series of stations with various clinical scenarios and allows students to demonstrate their knowledge, skills, and attitudes in a realistic environment.
The Miller Pyramid is a model used for student assessment in medical education and consists of four levels: Knows, Knows How, Shows How, and Does. OSCE is associated with the “Shows How” level of this pyramid.
A rubric is a tool used to rate students’ performance against specific criteria. It defines various levels of performance and provides specific indicators for each level, thus ensuring objectivity and standardization of the assessment process.