Objective structured clinical exam

Objective structured clinical/practical examinations (OSCE/OSPE) are a type of exam usually used to test applied knowledge and (practical) abilities. This could involve technical abilities, e.g. the procedure of taking a blood sample, or more complex abilities, e.g. diagnosing, or apply knowledge, e.g. in the form of communication with patients.

The student proceeds to various stations (and/or rooms) in a specified sequence, where a particular task and an examiner with an assessment form are waiting. The student performs the task (e.g. taking blood pressure, providing a consultation) within the given timeframe (usually between 5 and 20 minutes) and is then sent on to the next station.

A complete OSCE/OSPE usually lasts between 2 and 6 hours per student, depending on the number of learning targets to be tested.

Learning objective that can be addressed using this assessment method
Knowledge of theory, method and practice  
Understanding and reflecting on theory, method and practice  
Applying methods and tools X
Assessing problem definitions and selecting solution models (X)
Communicate and discuss academic issues  
Dealing with complex situations – in the context of studying or work (X)
Ability to independently initiate collaboration  
Taking responsibility for personal learning and development  

X indicates that this assessment method is suitable for testing the learning outcome. (X) indicates that this assessment method is of only limited use for this.

Evaluating the method of assessment

Assessment Criteria
Validity The content and construct validity of this type of test depend on the ratio of assignment stations to learning targets, the variation of competency targets involved in the individual station assignments as well as the academic content of the assignments.

In addition, it is crucial in terms of validity for the assessment forms/checklists to be appropriate to the individual station assignments. Checklists (“the student does/does not…”) must be used for assessing unambiguous abilities (e.g. introduces himself/herself to the patient), whereas assessment scales (“to what extent does the student…”) must be used for assessments of more complex abilities (e.g. advising on stopping smoking).
Reliability The more detailed the assessment form/checklist, the higher the reliability. The more stations, the greater the reliability – in practice, this means it is important to weigh up the number of stations against the amount of time available in order to ensure both reliability and validity.
Backwash effect from testing to teaching This type of testing inherently signals that surface-level knowledge will suffice; this can encourage students to superficial instead of deep learning. There will also be a risk of the teacher focusing on the students’ acquisition of rote knowledge and of planning the teaching around delivery of information if this is the only assessment method used.
Resources This is very resource-intensive and logistically challenging.
Digitisation Enables electronic media to be used, e.g. images, simulations, audio.
Acceptance Broadly accepted on health sciences study programmes as an authentic type of exam that reflects future working life situations with a high level of reliability and validity.


Additional reading:

Harden, R. M., & Gleeson, F. A. (1979). Assessment of clinical competence using an objective structured clinical examination (OSCE). Medical Education, 13(1), 41–54.