Objective Structured Clinical Examination Continous Assessment

“For the things we have to learn before we can do them, we learn by doing them.” 
― AristotleThe Nicomachean Ethics

For those of you who may not be familiar with the British system of medical education, Objective Structured Clinical Examination also known amongst medical students throughout the Caribbean, the UK and anywhere an MBBS degree is offered as OSCE, consists of a short circuit of clinical examination stations (literally between 5-10 minutes long), in which each student is examined on a one-on-one basis by an examiner and either with the use of real or simulated patients. It is designed to be as the name suggests firstly: objective, secondly structured and thirdly a clinical examination that was taught during medical school "Clinical Skills" course.

When I entered medical school back in 2013, rumor had it that the Skills department would be implementing a continuous skills assessment at the end of the year where we will be introduced to the OSCE process and marks attained would contribute to a course in year 3. This however didn't happen during our first year, but with the start of my second academic year of medical school incoming medical students as well as my class saw the implementation of a continuous skills assessment (insert panic music here!).

During year one of medical school we are taught a number of clinical skills and this continues throughout the first three years of medical school. Here's a breakdown of the skills we are taught at the UWI:

Year I Semester I

Year I: Semester II
History Taking                            

History Taking for the Cardiovascular Examination

Basic Life Support                      
Blood Pressure                            Intramuscular Injection

Cardiovascular Examination               
History Taking for the Abdominal Examination

Abdominal Examination

Digital Rectal Examination

Year II: Semester I
Year II: Semester II
History Taking for the Respiratory Examination              

History Taking for the Thyroid Examination

Respiratory Examination                                                  

Thyroid Examination

Ear, Nose and Throat Examination                                  

Breast Examination
Peak Expiratory Flow                                                        

Prostate Examination
Bag and Mask                                                                    

Blood Pressure

History Taking for the Cranial Nerves Examination

Cranial Nerves Examination                                            

Bandages and Slings
Upper Limb (Motor and Sensory) Examination              

Basic Orthopaedic Examination
Lower Limb (Motor and Sensory) Examination              

Cervical Immobilization

Year III: Semesters I & II
HPI Model (History, Physical Examinations and Investigations)
Urinary Bladder Catherisation
Digital Rectal Examination
Blood Pressure Measurement
Intramuscular Injection
Intravenous Infusion
Basic Life Support
Interpretive Skills

The course is designed to introduce us to fulfilling our duties once we reach the wards (in our fourth and fifth years) in a timely and efficient manner, although I am still trying to wrap my head around understanding how OSCE is going to teach me to build patient rapport, perform a thorough physical examination on my patient while giving a running commentary all in 5 minutes. The taking of a patients history and performing of an examination is a vital component of the doctor-patient relationship and during OSCE this skill is lost and we find ourselves regurgitating almost verbatim what we have practised for weeks or watched in OSCE preparation videos on YouTube. All in all, as it is a new component of the curriculum, it can only get better...right?!?

Two weeks has transpired since our last continuous assessment and we've yet to get our results. In a way I'm a bit worried, however, I appreciate the opportunity of being examined over my clinical skills. It was an experience that I plan to use as my last semester of the pre-clinical part of my academic training comes to an end and as I prepare for the paraclinical years ahead. It was nice to get my feet wet a bit and to see where my strengths and weaknesses lie.

Are you a medical student? How are you examined at your University on your clinical skills? Is it a separate course? I'd like to know how other schools test their students, so feel free to comment below.

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