Objective Structured Clinical Examinations (OSCEs) are a cornerstone of assessing healthcare students, trainees and professionals’ clinical competencies. Despite widespread use, implementing an OSCE successfully can be challenging.
Institutions often encounter pitfalls that undermine the assessment’s reliability, validity, and overall effectiveness. This blog explores some of the most common pitfalls in OSCE implementation and provides strategies to overcome them.
1. Inadequate Planning and Preparation
Pitfall: Poor planning can lead to logistical issues such as unclear timelines, insufficient resources, and overlapping responsibilities.
Challenge: Ensuring all stakeholders are aligned and aware of their roles while coordinating multiple moving parts under tight deadlines.
Solution: Develop a detailed project plan that includes timelines, resource allocation, and clearly defined roles for administrators, assessors, invigilators and staff.
2. Poor Station Design and Alignment with Learning Objectives
Pitfall: Stations that lack clear objectives or fail to represent real-world scenarios can result in ineffective assessments.
Challenge: Misaligned stations fail to evaluate the intended competencies, undermining the exam’s validity.
Solution: Use a blueprint to map stations to specific competencies and learning objectives. Collaborate with subject matter experts to design realistic and relevant scenarios that test critical skills.
3. Insufficient Training for Assessors leading to Inconsistent Scoring
Pitfall: Variability in assessor scoring leads to inconsistent results and reduced reliability of the exam.
Challenge: Subjective biases or lack of calibration among assessors create discrepancies in scoring.
Solution: Conduct assessor training and calibration sessions to standardise scoring and use clear, objective marking rubrics. Monitor assessor performance in real-time and provide ongoing support to them during the assessment process.
4. Missing or Illegible Information
Pitfall: Relying on paper scoresheets can lead to incomplete or illegible records, creating confusion during scoring and slowing down the collation process.
Challenge: Missing scores or unreadable assessor comments reduce the reliability of the results and may necessitate rescoring or re-assessment.
Solution: Digital scoring systems eliminate issues with legibility and incomplete entries through real-time data capture. This ensures that all required fields are completed and legible while automating the collation of scores meaning you have a full dataset instantly available for each exam once the final OSCE stations are completed.
5. Time-Consuming Collation of Scores and Feedback
Pitfall: Manual collation of scores and assessor comments is labour-intensive and prone to error, delaying result finalisation.
Challenge: Institutions often spend weeks gathering and verifying data, delaying the delivery of results and feedback to candidates.
Solution: Automated systems streamline data collation, enabling instant aggregation of scores and feedback. This reduces administrative workload and accelerates the reporting process, ensuring results are delivered in a timely manner.
6. Inefficient Standard Setting for High-Stakes Decisions
Pitfall: Standard setting is critical for determining pass or fail thresholds, yet many institutions struggle with establishing consistent and defensible benchmarks.
Challenge: Using subjective or inconsistent methods undermines the validity of the exam and opens institutions to challenges from candidates.
Solution: Implement evidence-based standard-setting methods such as the Angoff or Borderline Regression to finalise your OSCE pass and fail outcomes.
7. Inconsistent Marking Schemes
Pitfall: Ambiguous or overly complicated marking schemes can lead to variability in scoring, reducing reliability.
Challenge: Ensuring all assessors interpret and apply the marking scheme consistently while avoiding subjective biases.
Solution: Develop clear, objective marking rubrics for each station. Use checklists, rating scales, or a combination of both to ensure consistency across assessors. Conduct regular audits of scoring during each OSCE to identify and address discrepancies.
8. Overlooking the Role of Technology in High-Stakes Assessments
Pitfall: Relying on manual processes for data capture, scoring, and feedback delays results and increases the likelihood of errors.
Challenge: High-stakes exams demand precision and efficiency, which are difficult to achieve with paper-based systems.
Solution: Leverage digital assessment platforms to automate workflows, reduce human error, and speed up finalising outcomes which are defensible and have an audit trail in the event of appeals or legal challenges.
9. Overlooking Inclusivity and Accessibility
Pitfall: Exams that fail to accommodate diverse candidate needs risk disadvantage certain groups and individuals.
Challenge: Identifying and addressing the varied accessibility needs of a diverse candidate pool while maintaining fairness and consistency in assessments.
Solution: Ensure OSCE stations comply with accessibility standards and consider the needs of all candidates, such as those with disabilities or non-native language speakers. Provide options like extended time or alternative formats where appropriate.
10. Failure to Provide Personalised Feedback
Pitfall: Not sharing personalised feedback with candidates is a missed opportunity to enhance learning and improve future performance.
Challenge: Candidates are left unaware of their specific strengths and areas for improvement, reducing the educational value of the OSCE.
Solution: Digital platforms make it easy to provide tailored feedback to candidates, including detailed comments and performance metrics. This helps candidates contextualise their learning and fosters continuous improvement.
By addressing these pitfalls through proactive planning and leveraging the right tools and resources, assessment teams can ensure a smoother, more efficient OSCE process when evaluating candidates’ clinical competencies. Proper preparation not only improves the reliability and validity of assessments but also enhances the experience for both candidates and assessors, setting the stage for long-term success.
