Kemahli S. Clinical teaching and OSCE in pediatrics.
Med Educ Online [serial online] 2001;6:10. Available from URL
http://www.med-ed-online.org
clinical examination (OSCE), first introduced by
Harden et al8, has been in use in many medical
schools throughout the world.4-6,9-15 In addition to
assessing the competency and performance of the
examinee, the OSCE has many advantages over more
traditional methods of evaluation such as the conven-
tional bedside examination. As an evaluation tool it
eliminates the luck of the draw, reduces variation in
marking standards from examiner to exa miner, and
can accurately reflect the real-life tasks of the doc-
tor.13
Apparently traditional written examinations test
a different kind of knowledge from that acquired dur-
ing clinical attachments. Clinical experience may be
better judged by the clinical supervisor than by as-
sessment of theoretical knowledge.1 A good assess-
ment of students should include both clinical skills
and factual knowledge, therefore an OSCE should be
complemented by other methods of evaluation.1,16
The use of OSCEs in pediatrics is not as com-
mon as in adult medicine. This is mostly due to the
difficulty in having standardized patients in the pedi-
atric age group. Using real patients in some instances
could be a solution, and has been utilized in least four
studies.9-12 In pediatric OSCEs or pediatric cases
within OSCEs both children and parents have been
used as standardized patients. In some OSCEs only
parents are used for history taking stations.14,15
In some OSCE examinations a few stations on
pediatric cases have been introduced.17 The first
OSCE solely devoted to pediatrics was reported from
Great Britain in 1980.4 It was an 18-station OSCE
with one station for history taking, three for physical
examinations (general and focused), four for labora-
tory examinations (urine, x-ray and 2 slides), five for
lab reports, one for problem solving and four for
questions related to the tasks performed on various
stations. This OSCE was performed in a pediatric
ward and took 80 minutes to assess 20 students.In
this report and two others from Great Britain real
patients were used on the three physical examination
stations.9,10
Since then a few pediatric OSCEs designed for
students or residents have been reported with 10 to 34
stations.5,13,18 In a study from Ontario, Canada, a 10-
station OSCE was used to assess four domains of
competence; clinical skills, problem-solving, knowl-
edge and patient management.13 This OSCE was
found to be an accurate measure of pediatric knowl-
edge and patient management skills. Significant cor-
relations were found between OSCE clinical skills,
problem-solving and knowledge, and the teachers’
evaluation of performance on the in-patient wards.
In almost all of the OSCEs positive correlations
have been observed between OSCE scores and other
examination methods, such as in-training examina-
tions and resident-performance-rating. Recently it has
been reported that adding a separate written test to an
OSCE increases the OSCE’s reliability.18 Verma and
Singh suggest that a comprehensive evaluation pack-
age containing both OSCE and clinical case presenta-
tion should be employed for clinical subjects like
pediatrics. On the other hand they state that it is pos-
sible to design OSCE stations which will test not only
psychomotor skills but other domains of learning as
well.6 That has been shown to be possible by design-
ing written stations for clinical reasoning or differen-
tial diagnosis .5
The more important point of introducing the
OSCE as an assessment tool in pediatric clerkship is
to make use of its “steering effect” on student learn-
ing. Thus, bearing in mind that they will be expected
to perform well on an OSCE, the students will really
have to learn the necessary skills.
Conclusion
The current clinical training of students has some
problems, especially with regard to the teaching of
clinical skills. Although a lot of time is devoted to the
teaching of these skills, most students learn and prac-
tice by themselves.
1. A well-designed program to observe and give
feedback to students for clinical skills is neces-
sary.
2. Students should also have the opportunity to
practice in a variety of clinical and community
settings to learn as much as possible about the
common disorders.
3. Another way to ensure that students acquire ap-
propriate behavior and skills is using the steering
effect of examinations. Thus, objective struc-
tured clinical examinations, which are used ex-
tensively in most U.S. and Canadian medical
schools, should be one of our evaluation meth-
ods.
An OSCE is not intended to be the single method for
clinical evaluation. More traditional methods such as
written (essay-type or multiple choice questions) and
oral exams should be used as complementary modes
of assessment.