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Education And Debate

How To Do It: Set up and run an objective structured clinical exam

BMJ 1995; 310 doi: (Published 06 May 1995) Cite this as: BMJ 1995;310:1187
  1. Colin Selby, lecturer in medicinea,
  2. Liesl Osman, lecturer in medical educationb,
  3. Margery Davis, senior lecturer in medical educationc,
  4. Michael Lee, professord
  1. a Department of Medicine (RIE), University of Edinburgh, Royal Infirmary, Edinburgh EH3 9YW
  2. b Centre for Medical Education, University of Edinburgh, Edinburgh EH8 9DR
  3. c Centre for Medical Education, Ninewells Hospital and Medical School, Dundee DD1 9SY
  4. d Clinical Pharmacology Unit, Department of Medicine (RIE), University of Edinburgh, Royal Infirmary, Edinburgh EH3 9YW
  1. Correspondence to: Dr Selby.
  • Accepted 3 February 1995

Objective structured clinical exams are increasingly used as a way of assessing a range of clinical skills at both undergraduate and postgraduate level. To those planning to introduce such assessments, this article provides basic guidance on their development and structure and the personnel required. For those already using the assessments, our article may provide new ideas or be the impetus for an exchange of ideas. For those who are facing such formal assessment as candidates, we hope this article shows the efforts that are made to achieve the necessary structure and objectivity in this type of examination.

The objective structured clinical exam has come to prominence as a means of assessing undergraduate and postgraduate candidates.1 Its basic structure is a circuit of assessment stations, where a range of practical clinical skills are assessed by an examiner using a previously determined, objective marking scheme.2 This mechanism of assessment is at the “showing how” level of Miller's pyramid of knowledge.3 Compared with clinical “short cases”—where examination candidates see various patients at different times and are assessed by examiners who may not work to identical marking schemes and standards—the objective structured clinical exam offers the advantages of uniform marking schemes for examiners and consistent examination scenarios for students. It has proved an appropriate means of assessment for the clinical skills now being emphasised in the medical undergraduate curriculum.4 5

This article is designed to give some guidance, derived from our recent personal experience, to those planning to introduce such a type of assessment (box). We also hope that this article may provide further ideas to those already using such assessments, and we welcome any comments or questions based on experience in other centres.

Steps in developing an objective structured clinical exam

  • Determine skills to be examined

  • How many skill assessment stations needed?

  • Skill assessments

  • Marking schemes

  • Space …

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