Objective Structured Clinical Exam

The Objective Structured Clinical Exam is a performance-based exam. During the exam, students are observed and evaluated as they go through a series of stations where they interview, examine and treat standardized patients presenting with some type of problem.

An OSCE is:

• objective, because examiners use a checklist for evaluating the trainees;
• structured, because every student sees the same problem and performs the same tasks in the same time frame;
• clinical, because the tasks are representative of those faced in real clinical situations; and
• an examination.

• Provides feedback on performance
• Evaluates basic clinical skills
• Measures minimal competencies
• Preparation for the NBOME COMLEX-PE

Directions to the Heritage College, Athens

In Athens, the OSCE will take place at Ohio University Heritage College of Osteopathic Medicine Clinical Training and Assessment Center (ground floor) Grosvenor West.

Directions to the Heritage College, Cleveland

In Cleveland, the OSCE will take place on the 4th floor of Building A. Please meet in the lobby, to be escorted to the 4th floor.

Directions to the Heritage College, Dublin

In Dublin, the OSCE will take place at Ohio University Heritage College of Osteopathic Medicine Clinical Training and Assessment Center (ground floor), 6775 Bobcat Way, Medical Education Building (MEB) 2, Dublin, Ohio 43016

If driving, be sure to take into account bad weather and traffic.

In Athens, students will need a parking pass. To obtain a parking pass, stop by the Visitors Center (Corner of Richland Ave and South Shafer Street) with a photo ID and a license plate number. Students are to inform staff that they are in Athens for a Heritage College OSCE.

In Dublin, no parking pass is needed.

In Cleveland, parking is available in Lot A-6. View Parking Map.

Students should be on site 20 minutes before their scheduled time.

For questions or for further information, contact your Academic program administrator or Rich Latham at rlatham@ohio.edu.

As described in the year 3 and 4 manual, successful completion of the Objective Structured Clinical Exam is a graduation requirement for Heritage College students. The exam is scheduled in the third year to avoid conflicts with elective rotation schedules and to help in preparation for COMLEX Level II-PE.

Prior to the exam, students will receive a brief 5 minute orientation to familiarize them with the exam room and equipment. After the OSCE a short debrief will take place. Students will also be asked to complete a feedback form in E-value.

The OSCE is structured like the COMLEX PE except that there are only 6 standardized patient cases. The 6 station exam, orientation and debriefing are completed in approximately 3 hours.

• Be aware of the passage of time; students often are surprised by how quickly time goes.
• DO ONLY WHAT IS REQUESTED.
• Use the history to guide the scope of the examination, since a complete exam is not required in all cases.
• Even if the student immediately knows what the diagnosis is, the student should complete an appropriate physical exam.
• Elicit psychosocial, occupational, past medical/surgical history, medications and allergies as appropriate.
• Explain to the patient what is being done, particularly while doing OMT.
• If unsure what is wrong, do not say , “I will get back to you after I have discussed this with the attending.” This does not evaluate your knowledge or skill.
• See also: Example SP Check Sheet [Word]

Utilize OMM practices and principles as appropriate. Because standardized patients may not have real osteopathic findings, but present with symptoms, develop a likely OMM scenario for history and physical findings. Gently position the patient and verbalize the OMM technique. Perform OMM for 3-5 minutes, with an evaluation and reassessment.

OMT SKILLS EVALUATION SHEET

In a family practice or ER setting, OMM must be combined efficiently with the rest of the examination and treatment. Most of the time, the chief complaint and history will lead the student to a focused musculoskeletal exam in either the upper half or the lower half of the body.

Lower half of the body: screen leg length, sacrum (parasympathetics), lumbars, etc. (if time allows, think of the low back pain treatment sequence as a guide to areas that deserve evaluation in light of the patient’s complaint).

Upper half of the body: thoracics are a gold mine for a problem’s treatable (OMT) sympathetic manifestations; look for a rib dysfunction at the level of a thoracic dysfunction, too; superior thoracic aperture dysfunction (T1-2, associated ribs, sternum) affects lymphatic drainage for the whole body; Chapman’s reflexes can be quick for diagnosis and treatment; etc. Knowledge of sympathetic and parasympathetic innervations for viscera potentially related to chief complaint can guide the focus of inquiry for axial spine involvement. (E.g. If GERD is suspected, be particularly interested in thoracic segments 5 through 9 and associated rib linkage.) Choose two or three most likely locations of somatic dysfunction for evaluation in this setting. The number of areas treated will be dictated by the assessment of importance and time limits. Remember post treatment reassessment is part of any office visit.

Immediately after the OSCE students will be asked to log into E*Value and complete the OSCE honor code course work. Disclosure or discussion with others about the OSCE cases or assessment materials is strictly forbidden and a violation of the honor code.

The chart contains:

• Instructions
• The setting: outpatient, primary care or Emergency Department
• Patient demographics
• Vital signs
• Blank white piece of paper to take notes

If the student wishes to take notes, a blank white worksheet will be provided in the chart. The worksheet must however be left in the chart. It will not be graded.

The eSOAP note will be typed into Learning Space.

Prior to the OSCE an email will be sent to all students with detailed instructions to check their login access to Learning Space (computer system for OSCE) and complete a sample test (to familiarize them with the Learning Space user interface). This must be done prior to coming to campus on the day of the OSCE.

If a student does not receive an email two weeks prior to the scheduled OSCE date (check junk/trash folder to be sure it has not been diverted), please contact Rich Latham at rlatham@ohio.edu.

S = Subjective/patient input regarding the problem(s)
O = Objective findings, physical exam, lab data, etc.
A = Assessment—include 3 potential differential diagnoses or etiologies. Rank in order of likelihood. For well visits, list at least 3 problems or risk factors.
P = Plan for diagnostic investigations and/or treatment.

See Also:

SOAP NOTE GRADING GUIDE

BLANK COMPUTERIZED SOAP NOTE FORM

Sample Communication and Professionalism form

The student may identify themselves as Student Dr. (Surname).

Drug information will not be available. Students will not be required to write for specific drugs and drug dosages.

NBOME accepted abbreviations may be used. They will be posted at the SOAP note desk.

Dress professionally; bring a clean white lab coat, nametag, pen and stethoscope. Scrubs are not considered professional attire. No pocket guides, cell phones, watches, or PDAs are permitted. Each exam room is equipped with a treatment table and diagnostic equipment.

Yes. The 3rd year OSCE is recorded.

• Grades will be "Met expectation" or "Did not meet expectations"
• In order to pass, the student must score 70% or better in history taking skills, physical exam skills, communication/professionalism skills and Soap note writing skills.
• The student must score 80% or better on the OMM portion of the OSCE.
• Grades will be reviewed with the student by the Assistant Dean.
• Recordings, SP feedback, faculty feedback and grades will be available to the student online approximately one month after completion of the last OSCE.

OSCE score sheets allow for ratings of specific content items based on core competencies. A checklist will be utilized to assess:

• Interviewing/interpersonal skills (history taking)—information gathered by the standardized patient.
• Patient care (physical exam)—information gathered by standardized patient.
• Professionalism (organization, courtesy, compassion, appropriate draping, listening skills, eye contact, language used, demeanor, dress, hand washing, patient education and whether or not the standardized patient would select you as their personal physician.)—information graded by the standardized patient. (See: Example Professionalism Grading Guide ).
• Medical knowledge (SOAP notes)—graded by physicians
• OMM (no HVLA techniques)—graded by physicians.
• Standardized patients and physician evaluators will rate student performance utilizing their judgment and the checklists. Failing ratings are given based on any of the following:
  1. illogical sequencing
  2. deficient knowledge base
  3. lack of ability to focus
  4. excessive prompting
  5. interpersonal skills deficits
  6. other

Proctors will be available to answer questions during the exam.

Students may access their video, graded SOAP notes and check sheets via "Learning Space.”

• Before entering the room, write down the headings on the blank piece of paper in the chart (CC, PMH, PSH, Meds, Allergies, Family Hx, Social, Immunization, VS, Gen, Heart, Lungs, plus other headings pertinent to the case). Then while in the room, fill in the fields while the patient is talking. This saves valuable time when it comes time to type the soap note in the hallway and also allows the student to remember everything needed.
• Read the doorway instructions and take them at face value.
• Be confident walking into the room. Introduce yourself, shake hands with the patient and allay patient apprehension.
• Before the physical exam, wash your hands. You can say "I'm going to wash my hands before doing the physical exam."
• Communicate using clear layman’s terminology. Let the patient know everything that you are doing. E.g. I am going to listen to your heart and lungs now.
• Listen on skin. Make sure you listen to all areas of the heart and lungs.
• Explain to the patient what you are going to do before doing it, particularly while setting up OMM
• Have a brief 1-2 sentence description of OMT prepared so you can share this with the patient if they request treatment or ask about it. Be sure you have considered osteopathic principles in all cases.
• When documenting somatic dysfunction in the plan, be sure to include the region (cervical spine, thoracic spine, etc.) and technique use. e.g. "Somatic Dysfunction cervical spine. Muscle energy performed and patient tolerated well."
• Memorize the Red Flag questions for the top presenting complaints and the physical exam components that correspond with them. This saves valuable time and allows you to be more succinct with the patient. By knowing what you need to do, you will be able to finish with extra time to write a more thorough assessment and plan.
• Consider the First Aid Step 2 Clinical Skills book to help organize what you need to know for each case.
• Consider the OSCE as preparation for the PE exam. RELAX and learn from it!