OSCE (pronounced ah-ski) is the acronym for Objective Structured Clinical Exam. This past April, nearly 100 JMC third-year students came to the Clinical Skills Center (502 Sheridan Building) for the pilot of Jefferson's first OSCE. The pilot was the Center's first large scale test of the facility, its trained standardized patients, the analog and digital recording equipment, and computer tracking and database systems.

AISR has worked closely with the Center's staff from the initial planning of the facility, and its unique technology support issues, through this first pilot session. AISR will continue to support the Center's information technology and curricular needs, as it becomes an integral part of the education and skill training of Jefferson students.

Beginning with the class of 2005 the NBME (National Board of Medical Examiners) will make an OSCE part of the Step 2 exam process. Currently (as of May 2003) the USMLE (United States Medical Licensing Exam) Step 2B exam will consist of 10 OSCE stations. The test format will include a 15-minute encounter with a standardized patient followed by a 10-minute post-encounter evaluation.

The case studies used during the Jefferson OSCE were contributed by third-year clerkship directors and edited by the Center's staff -- Drs. Katherine Worzala, Dale Berg, and Sal Mangione. The case "door" notes, which provide a general introduction to the encounter for the student, the SP checklist, and the post encounter questions, were entered into the Clinical Skills Testing & Evaluation software package by the Centers' administrator, Carol Trent and AISR staff.

Standardized patients are carefully trained in the conditions they are asked to portray (not all medical conditions lend themselves easily to this format, where possible, patients with actual physical findings are used.) Training includes what the appropriate history taking components should include, as well as what physical exam, diagnostic decision, and patient education/counseling should take place.

Standardized patients then use a computerized checklist to identify what aspects of the encounter were performed and whether they were performed correctly or not.

Following the encounter, students are asked to provide a SOAP note (Subjective data, Objective data, Assessment, Plan of action) and respond to other questions about the patient.

Helping to keep everything running efficiently, a commercial database was purchased from Enterprise Messaging Services, Inc. This software organizes information on the standardized patients, the facility's rooms, the case studies themselves, and student registration, tracking and response files.

During a testing session, the student follows a planned route and the software assists in the tracking and recording of responses, by both the SP and the student, for later scoring by the Center's staff.

The OSCE sessions are recorded onto both videotape and video-CD disks for continued training and follow-up review. Though most of the encounter rooms have only one camera, one room has two, allowing multiple camera angles and zoom, pan, and tilt functions.

Center staff and JMC faculty can observe the encounters from the recording suite and the CSTE software has a module for faculty to also complete a checklist that can be used in quality assurance training with the standardized patients.