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Part I OSCE examinations

Deputy Chief Examiner with responsibility for Part I, Royal College of Psychiatrists

Brian Lunn

Senior Lecturer in Psychiatry and Chair, OSCE Panel

We would like to respond to Yak et al regarding their reservations about the objective structured clinical examination (OSCE) in Part I of the Membership Examination (Psychiatric Bulletin, July 2004, 28, 265–266).

The College OSCE has not been borrowed from any other college’s examination. We have, however, learned from others’ experiences, both at undergraduate and postgraduate level. OSCEs have been used for clinical assessment for 30 years and there is a considerable body of evidence to support their validity. In psychiatry, most of the evidence in postgraduates has come from abroad, particularly from the Wilson Centre for Research in Education, University of Toronto, Canada (Hodges et al, 1998). The case for modernising the college examinations was ably put by the current and previous Chief Examiners (Tyrer & Oyebode, 2004).

The constructs of the individual OSCE stations are not ‘difficult and complex investigations’ leading to ‘snap diagnosis’. They are designed around focused tasks within common clinical work, in which candidates should be able to demonstrate a basic competency within the allotted time after a year of SHO training. All OSCE stations are extensively piloted and edited to make sure that they work, before being launched at a Part I examination, and remain subject to review and refinement.

There is no intention to encourage ‘quick perfunctory examination of patients’, but to ensure that candidates possess the relevant clinical skills that the constructs elicit; this necessitates accurate, focused clinical thinking and effective interviewing of patients. We are also now able to focus on essential skills not previously tested, such as communication with patients, carers and a variety of professional groups, physical examination and not least psychopathological examination in a ‘standardised’ clinical scenario.

The College retains an examination that involves the whole person appraisal recommended by Yak et al. This rightly belongs in Part II of the examination. After at least another 2 years’ training, candidates are expected to produce a sophisticated diagnosis and formulation based on a comprehensive assessment as well as discuss patient management.

Sorry, but Part I OSCEs are here to stay!

Perhaps an important point to be made is that rotating around 12 OSCE stations removes the elements of good or bad luck and patient variability, which make long case examinations so capricious, leaving aside the opportunity to shine in at least some areas rather than putting all one’s eggs in one basket.

References

HODGES, B., REGEHR, G., HANSON, M., et al (1998) Validation of an objective structured clinical examination in psychiatry. Academic Medicine, 73, 910 -912.[Medline]

TYRER, S., OYEBODE, F. (2004) Why does the MRCPsych examination need to change? British Journal of Psychiatry, 184, 197 -199.[Free Full Text]

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Mortimer, A. M. Articles by Lunn, B. Search for Related Content PubMed Articles by Mortimer, A. M. Articles by Lunn, B.