SCHOOL OF MEDICAL REHABILITATION

Department of Physical Therapy

OSCE Handbook
Standardized
Patients
 Table of Contents:

1. General Information ............................................................................................... 3

1.1. Introduction of OSCE ........................................................................................ 3
1.2. Stakeholders of OSCE ...................................................................................... 3
1.3. Blueprint of the PT Department OSCE ............................................................. 3
1.4. Training of Stakeholders ................................................................................... 4
1.5. Evaluation of OSCE’s ....................................................................................... 4
1.5.1. Analysis of student performance:............................................................... 4
1.5.2. Analysis of OSCE station performance...................................................... 4
1.5.3. Analysis of item-specific performance........................................................ 5
1.5.4. Evaluation of Department of Physical Therapy OSCE Structure, Process
and Outcome:........................................................................................................... 5
2. Role of the Standardized Patient .......................................................................... 6
3. Training for the Standardized Patient .................................................................. 6
4. The Day of the OSCE ............................................................................................. 6
4.1. The Examining Process .................................................................................... 7
4.1.1. Student Rotation ........................................................................................ 7
4.1.2. Standardization of OSCE Station............................................................... 8
4.2. Standardized Patient General Feedback .......................................................... 8
4.3. The Backup SP ................................................................................................. 8
4.4. The Exam Timer ............................................................................................... 9
4.5. Nutritional Breaks.............................................................................................. 9
5. References............................................................................................................ 10

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1. General Information

1.1. Introduction of OSCE

There are a number of methods to evaluate the knowledge, skill and attitudes of
students in the Physical Therapy (PT) academic program such as written
examinations, project/papers/presentations, and clinical examinations. The
Objective Structured Clinical Evaluation (OSCE) is a clinical examination, utilizing a
simulated patient setting in order to test the student’s understanding and
performance of applied physiotherapy knowledge, skills and attitudes. In order for a
student to pass a course, the student must pass both the written examination and
the OSCE component of the course. Most Physical Therapy courses with clinical
skills include an OSCE.

1.2. Stakeholders of OSCE

OSCE’s involve the Year Coordinators, Instructors, Examiners, Standardized
Patients and the Physical Therapy Students. Each of these stakeholders has a
particular role and set of responsibilities towards an OSCE. A description of each
stakeholder’s role, responsibilities and timing of essential tasks is described in
handbooks found in the PT Department Teaching Handbook. Individuals may also
undergo specific training to fulfill their responsibilities.

1.3. Blueprint of the PT Department OSCE

The students enrolled in the Physical Therapy Program, School of Medical
Rehabilitation, encounter OSCE in the musculoskeletal (46%), neuromuscular
(27%), and cardiorespiratory (27%), areas of practice. In addition to these areas of
care, PT Department OSCE’s may include various fields of care (e.g., preventative,
maintenance or restorative), different patient age groups and genders, and various
practice settings (e.g., acute care facility, private practice, rehabilitation centre,
community care and extended care facility) (Cooper, 2006). During an OSCE, the
skills sets of communication, assessment and treatment, safety and patient
feedback and education skills of students are evaluated.

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 1.4. Training of Stakeholders
The Department of PT endeavours to provide continuing education opportunities to
all faculty members regarding research-based student evaluation practices, which
include OSCE. Examiners and Standardized patients receive additional training to
ensure continual quality of the OSCE. Students also receive an orientation each
year to the OSCE format of evaluation, and are given class time to prepare for their
OSCE’s.

1.5. Evaluation of OSCE’s

The Year Coordinator/Course Coordinator/delegate and Instructor evaluate each
course OSCE including the:

1.5.1. Analysis of student performance:

A student must pass both the OSCE and the written portions of evaluation to
pass the entire course. A passing OSCE score is 62%. A student’s OSCE
station score may be removed from the total course OSCE results if an incident
occurs. An incident is defined as an occurrence with the personnel (examiner,
student or simulated patient) or environment (incomplete equipment or supplies
required for demonstration) which prevents or interferes with the student
participating in the OSCE station (Modified Cooper, 2006).

1.5.2. Analysis of OSCE station performance

An OSCE station or question may be entirely discarded if the examiner/instructor
felt that the confidentiality of the question was compromised or for some
unforeseen event occurred (e.g. the examiner or standardized patient were
unable to complete the entire OSCE without having a replacement). The Year
Coordinator/Instructor may suspect a breach of confidentiality if the OSCE
station’s students’ scores show a trend of improving as the schedule continues.

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 1.5.3. Analysis of item-specific performance
A specific item in an OSCE may be identified and removed from all the students’
scores at the discretion of the instructor and Year Coordinator. If an OSCE item
has not been correctly completed by at least 2 standard deviations of all students
(or less than 19% of the students (D. Schonwetter, personal communication, Fall
2006) the instructor may:
a. Leave the item in the exam as he/she believes that the item is
difficult and is designed to challenge the stronger student; or
b. Remove the item from the exam as he/she believes that the
teaching of the item content was problematic.

1.5.4. Evaluation of Department of Physical Therapy OSCE Structure,

Process and Outcome:

A formal review and revision of the Department of PT OSCE structure and process
began in September, 2006. The intent of this review was to standardized OSCE
process between the three academic years and to begin enhancing the effectiveness
and efficiency of the administration of OSCE’s. A process to evaluate the overall
effectiveness of the structure, process and outcome of the PT academic program
OSCE’s will be developed in the future

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2. Role of the Standardized Patient

The standardized patient (SP) is an individual who has been trained in a specific patient
role to reliably and consistently reproduce a history and or physical findings of typical
cases. The use of standardized patients creates a clinically relevant and consistent
setting for the evaluation of students and makes the examination as objective as
possible.

An SP is also recruited to act as a timer for the OSCE’s. The instructor is responsible for
preparing the SP by writing the case notes and training the SP.

An SP is also recruited to act as a timer for the OSCE’s. A backup SP is recruited to act
on behalf of the other SP’s if they are unable to attend the OSCE. If the SP’s are in
attendance, the backup SP is responsible for transcribing the general comments from
the scored OSCE bubble sheets into a computerized document.

3. Training for the Standardized Patient

Four weeks prior to the OSCE, the SP will have been recruited and the case notes
given to the SP by the SP Coordinator. Two weeks prior to the OSCE, the instructor
will meet with the SP to review the schedule of the OSCE as well as review the case
notes and role he/she is to play in the OSCE. SP’s should be prepared for questions
other than the information provided in their SP case notes, with the guideline being they
can tell the student anything that doesn’t change the role they are playing and they are
consistent with each student.

4. The Day of the OSCE

Standardized patients are asked to arrive at least 30 minutes prior to the time an OSCE
is scheduled to commence so that the Examiner/Year Coordinator may finalize the
setting for the students as well as provide any last minute instructions to the SP.

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4.1 The Examining Process

4.1.1. Student Rotation

The OSCE commences when the first whistle sounds. This signals that the
student has read the question (which is posted outside the site door) and can
now enter the room. Evaluation begins as soon as the student engages the SP.
There is to be no conversation between the students and the SP’s outside the
role that the SP’s play between students. The second whistle indicates that the
student has two minutes remaining in the station. When two whistles occur, the
student must stop engaging with the SP and exit the station.

Whistle schedule overview

First group goes to appropriate door and reads question (1 minute)

1 whistle – Student enters room

1 whistle – Student has 2 minutes left
2 whistles – Student leaves the room and goes to next station
Students have 1 minute to read question at the next station
1 whistle – Student enters next station

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 4.1.2. Standardization of OSCE Station

During the OSCE it is the SP’s responsibility to maintain a standardized

environment to support fair evaluation of students. The SP’s are to:
1. Maintain his/her role playing throughout the course of an OSCE
2. Avoid conversing with Examiner regarding student performances
between student examinations
3. Avoid conversing with the student outside of playing the role.

4.2 Standardized Patient General Feedback

At the end of the OSCE’s the Examiner or Instructor may request the SP to
provide feedback regarding the OSCE station/process.

4.3 The Backup SP

During the exam, if there is no need for the back up SP to step into an OSCE station,
the backup SP will:
1. Retrieve the completed bubble sheets from the Examiners during breaks.
2. Review all bubble sheets to ensure:
a. The sheet is signed by the examiner
b. The student name label is affixed properly
c. Note that there are comments either next to the item or in the comments
section to reflect what was incomplete or not done. If there are no
comments near the incomplete items or in the Comments box, the backup
SP will alert the Year Coordinator during a break.
3. A laptop will be available to collate and type general comments for each station
under the general headings (communication, assessment/treatment, patient
education/feedback, and safety or other) in a word processed document.

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4.4 The Exam Timer

Before the start of the exam, the timer will:

1. Provide the students with a clipboard with paper and pencil
2. Give information regarding how the students rotate from one station to the
next.
3. For the first OSCE for year 1PT students, the timer has students sign
OSCE Confidentiality Forms.
4. For the year 2 and 3 PT students, the timer reminds the students about
previously signed confidentiality forms and that these are still in place
although signed with their first OSCE in year 1
5. Review the University of Manitoba policy of no electronic devices in OSCE
(General Calendar 2006-07, University of Manitoba, p. 26).

Once the students have their information, the timer checks the time, and directs
the students to the appropriate OSCE station door to allow the students 1 minute
to read the question. The timer then whistles once, and the students then enter
the room. With two minutes prior to the end of the station, the timer blows the
whistle a second time. When the station time has been reached, the timer blows
the whistle twice, signaling that the student must leave the station and go to the
next station. The whistle system continues in this cycle.

4.5 Nutritional Breaks

The Department of Physical Therapy will provide a small nutrition snack in the
morning and afternoon for the OSCE personnel on the full day OSCE’s. On shorter
days, a morning nutritional snack will be provided.

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5 References

Achtemichuk, M. (2004). Guidelines for the OSCE – Objective Structured Clinical

Examination: Handbook for Instructors, School of Medical Rehabilitation.

Cooper, A., Canadian Alliance of Physiotherapy Regulators, (2006), Clinical Skills

Assessment, 101, Presentation to PT Faculty.

Schonwetter, D. (2006). Personal conversation.

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