In this exam, the candidates undergo a series of structured stations. The candidates may be required to carry out different tasks at various stations; such as, at one station the candidate may be required to break bad news to the patient; and at the second station, they may be required to take a history; at the third one to interpret the provided laboratory investigations in the light of a patient’s problem, and so on. At each station, the candidate is required to perform a defined set of tasks as described. The examiner may also ask the candidate a few questions. The candidate needs to perform the required tasks and provide the answers to the questions asked by the examiner. The examiner marks the candidate at the end of each station using a pre-defined mark sheet.
Also, this type of examination pattern reduces the possibility for the candidate to go back and check their omissions that can be done in case of a written examination. As a result, the structured clinical examination helps in easily controlling the variables and complexity of the examination, clearly defining its aims and carrying out an accurate assessment of the student’s knowledge.
There are two types of OSCE stations:
1) Simulated patient or colleague tasks
2) Structured discussion tasks
In simulated patient or colleague tasks: In this the candidate interacts with the role players (actor). The examiner would be present in such stations in order to assess the candidate. However, they would neither interact with the role-player nor the candidate. The candidate must also not interact with the examiner on these stations. The simulated patient tasks are similar to the cases encountered by ST5 in the NHS wards and clinics.
For role players: In the simulated patient or colleague task, the candidates interact with the role players who have been trained and instructed about the role they are supposed to play. They are provided with all the significant details concerning the case and are also given some scripted questions to prompt the candidate in case it is required. They have been instructed to display emotions appropriate to the scenario; for example, they may get angry, anxious, or upset depending on the situation. However, they would not demonstrate extreme of emotions such as shouting or swearing. Also, they will not leave the station during the 10 minutes of the examination time. They have been trained and would provide clues to the candidates in case they are going in the wrong direction. So, it is utmost crucial for the candidate to carefully observe the role-player’s facial expressions during the task.
The role-players are given the authority to give up to 2 marks to the candidate depending on their confidence with the doctor and whether they would be prepared to see that doctor (candidate) again in future. Prior to the examination, there is a detailed training session for the role players to help ensure that they have fully understood the role they are supposed to play as defined in their instructions.
Role of an examiner: In this the examiner would be present in the examination booth. However, they will not interact with the candidate or the role-player. They will be observing and seeing the candidate with a neutral facial expression while taking a note of it. They would be giving marks to the candidate during the each task. The candidate is not supposed to interact with them or explain them anything.
Examiners: Candidates can be evaluated by two types of examiners, first is the clinical examiners and the lay examiners. In at least four of the simulated patient tasks in any single examination there may be both a clinical examiner and a lay examiner.
Clinical examiner: All these clinical examiners are well trained for conducing MRCOG Part 3 exam. Prior to each examination, there is a comprehensive meeting where the examiners are given instructions about a particular task. There is a detailed review of the examination scenario, examination instructions, and the marking scheme. This detailed training session ensures that assessment of each candidate is carried out against the same criteria and level of skills, thereby ensuring fairness in marking each candidate. This training also helps in ensuring that the examiner well understands the level of knowledge, skills and competencies, which a ST5 trainee must possess, and the appropriate professional attitudes and behaviours which they must exhibit in order to pass the MRCOG examination.
Lay examiner: Persons chosen to act as lay examiners are generally recruited from the general public. They do not have any clinical training or background in order to ensure that they accurately represent the majority of patients that obstetricians and gynaecologists encounter on a daily basis. All lay examiners, however, undergo an initial recruitment and selection process and training programme to help understand their role within the Part 3 MRCOG examination.
The role of the lay examiner is to award the communication of the candidate while they interact with the role players and their families. They also undergo a training session for the desired tasks. The lay examiners award marks in real time during the task and in the 2 minutes at the end of each task after the candidate has left the examination booth.
We will be discussing about the 2nd type i.e. Structured discussion tasks in the next blog post.
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