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 Table of Contents 
Year : 2001  |  Volume : 8  |  Issue : 3  |  Page : 79-82  

Views of undergraduate students on objective structured clinical examination in neurology: A preliminary report

King Fahd Hospital of the University, Al-Khobar, Saudi Arabia

Date of Web Publication30-Jul-2012

Correspondence Address:
Hassan M Ismail
P.O. Box 40152, Al-Khobar 31952
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

PMID: 23008655

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Objective: Obtain the undergraduate medical students' evaluation of an objective structured clinical examination (OSCE) formed by two stations in neurology.
Methods: The fifth-year medical students taking the neurology course at King Faisal University during the first rotation of academic year 1420-1421H (2000-2001G) made the evaluation. The time for each station was seven minutes. After finishing the exami­­nation, each student completed a six-item questionnaire on coverage, question clarity, time, patients, educational usefulness and organization of the examination with yes, no or don't know responses.
Results: A total of 48 students (30 males and 18 females) took the examination. The average time to complete the examination for a group of 16 students was 2 hours. The responses were positive for clarity of questions and organization of the examination 41(85%), and allotted time 36(75%). Thirty-two students (67%) found the structured exami­nation a useful educational experience. About half the students expressed their concern about the coverage of taught material and the number of patients seen in the examination as representative of those seen during the course, and 11 students (23%) requested more time.
Conclusions: The students' response to the use of the structured clinical examination as an objective tool for evaluation of clinical skills in neurology was favorable and com­parable to reports from other parts of the world. Improvement is required in the number of patients, coverage and allotted time to optimize outcome by improving content vali­dity and reducing stress on participating patients.

Keywords: Neurology, undergraduate, medical education, OSCE, Saudi Arabia.

How to cite this article:
Ismail HM. Views of undergraduate students on objective structured clinical examination in neurology: A preliminary report. J Fam Community Med 2001;8:79-82

How to cite this URL:
Ismail HM. Views of undergraduate students on objective structured clinical examination in neurology: A preliminary report. J Fam Community Med [serial online] 2001 [cited 2021 Dec 4];8:79-82. Available from:

   Introduction Top

The Department of Neurology in King Faisal University is the first academic department of neurology in the Kingdom of Saudi Arabia. The department offers a three-week clinical rota­tion in neurology (course MDNL506) to fifth-year medical students. Since the depart­ment was established the rotating students have been evaluated at the end of the course by a conventional long-case clinical examina­tion. The Objective Structured Clini­cal Exami­na­tion (OSCE) is presently the pre­domi­nant method for formative and sum­mative evaluation of clinical skills and competencies in undergraduate medical edu­ca­tion. [1],[2],[3],[4] OSCE has been recently used for evaluation of undergraduate and postgraduate students in various sub-specialty departments including radiology, [5] dentistry, [6],[7] rheu­mato­logy, [8] urology, [9] critical care medicine [10] and surgery. [11] Experience with the use of OSCE in neurology has been limited. [12],[13] The neurology course objectives focus primarily on teaching clinical skills; thus, at the end of the course students are expected to be able to perform a neuro­logical examination com­petent­ly, and interpret the clinical signs in terms of neuro­-anatomical localization of neu­ro­logical disease. In order to improve ob­jec­tivity in evaluating our students it was decided to give OSCE a trial for fifth year students rotating during the first semester of academic year 1420-1421H (2000-2001G). This paper presents a preliminary report of the students' views on the trial of OSCE.

   Methods Top

The students were divided into two male groups and one female group who rotated in neurology for three-week blocks. The examination was composed of two stations, each with a patient having neurological signs similar to those covered during the course. The time given for each station was seven minutes. Each student answered a question­naire of six items immediately after finishing the examination. The first ques­tion was on the coverage of the examination for the clinical material that was taught during the course. The second question was on the clarity of the examination questions. The third was on the adequacy of the allocated tine for each station. The fourth was on whether the patients seen in the examination were representative of those seen during the course. The fifth was on whether the examination could be viewed as a useful educational clinical experience, and the last question was on whether the organization of the examination was satisfactory. The students had to answer yes, no or don't know.

   Results Top

A total of 48 students took the OSCE, 30 males and 18 female students. The average time taken to com­plete the OSCE for a group of 16 students was two hours. [Figure 1] shows a bar chart of students' responses for the questionnaire items, including cover­age of material taught, clarity of questions, adequacy of time per station, given patients as representative of those seen during the course, usefulness of the examination as an educational clinical experience, and organi­za­tion of the examination. Forty-one students (85%) were satisfied with the clari­ty of the questions and organization of the examination. Thirty-six students (75%) were satisfied with the allotted time, but 11 (23%) suggested increasing the time to 10 minutes per station. Thirty-two students (67%) found the examination a useful edu­ca­tional clinical experience. Around half of the students found the coverage of the clinical material taught and the number of patients inadequate.

   Discussion Top

Evaluation of students in undergraduate medi­cal education is a measurement of student learning and is directed towards assessment of knowledge, and of clinical and communica­tion skills. Data analysis and data interpre­tation are the two most popular methods for assessing knowledge, whereas OSCE and case presentation are the most used methods for assessing clinical skills. [1] OSCE was introduced first as a new test for clinical com­petence. [14],[15],[16],[17],[18],[19] It has been widely accepted as a means of objectively assessing the acquisition of clinical skills and clinical competence with greater reliability and validity [1],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] and is now considered worldwide as the standard form of examination for the clinical assessment of both under- and post-graduate students. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13] The students in previous reports felt that OSCE is a fairer system than the other forms of examination and preferred it as a method of clinical assessment. [22],[23]

Although the overall response to using OSCE as an objective tool for evaluating neurology students was favorable, the salient shortcomings included the coverage of the examination for the clinical material taught, the number of patients, and to a lesser extent the allotted time per station. Improvement in coverage and increase in the number of patients requires an increase in the number of stations to improve content validity, but will also increase the total time of the exami­nation. Thus, the addition of a third patient and an increase of time to eight minutes per station will increase the examination time to three hours, which is still shorter than the time taken to examine the same number of students using the conventional interactive bedside assessment method. That method requires, on average, four hours for the same number of students. Furthermore, the stress to the participating patients has to be taken into consideration.

Although using a different set of patients may resolve this issue, it will certainly affect that important factor in favor of OSCE regarding objectivity, uniformity and fairness of the student evaluation process. Similar prob­lems were previously noted on using OSCE in neurology. [12],[13]

The present preliminary results of using OSCE in neurology were favorable and are comparable to reports from other parts of the world. Improvement, however, in the number of patients, material coverage and allotted time per patient is required to optimize the outcome by improving content validity and reducing stress to participating patients.

   References Top

1.Fowell SL, Maudsley G, Maguire P, Leinster SJH, Bligh J. Student assessment in undergraduate medical education in the United Kingdom, 1998. Med Educ 2000;34(Suppl.1):1-49.  Back to cited text no. 1
2.Bradley P, Humphris G. Assessing the ability of medical students to apply evidence in practice: the potential of OSCE. Med Educ 1999;33(11):815-7.  Back to cited text no. 2
3.Duerson MC, Romrell LJ, Stevens CR. Impacting faculty teaching and student performance: nine years' experience with the Objective Structured Clinical Examination. Teach Learn Med 2000; 12(4): 176-82.  Back to cited text no. 3
4.Carraccio C, Englander R. The objective structured clinical examination: a step in the direction of competency-based evaluation. Arch Pediatr Adolesc Med 2000;154(7):736-41.  Back to cited text no. 4
5.Morag E, Lieberman G, Volkan K, Shaffer K, Novelline R, Lang EV. Clinical competence assess­ment in radiology: introduction of an objective structured clinical examination in the medical school curriculum. Acad Radiol 2001;8(1):74-8.  Back to cited text no. 5
6.Brown G, Manogue M, Martin M. The validity and reliability of OSCE in dentistry. Eur J Dent Educ 1999;3(3):117-25.  Back to cited text no. 6
7.Manogue M, Brown G. Developing and imple­menting an OSCE in dentistry. Eur J Dent Educ 1998;2(2):51-7.  Back to cited text no. 7
8.Smith MD, Henry-Edwards S, Shanahan EM, Ahern MJ. Evaluation of patient partners in the teaching of the musculoskeletal examination. J Rheumatol 2000;27(6):1533-7.  Back to cited text no. 8
9.Sibert L, Grand'Maison P, Doucet J, Weber J, Grise P. Initial experience of an objective structured clinical examination in evaluating urology residents. Eur Urol 2000;37(5):621-7.  Back to cited text no. 9
10.Rogers PL, Jacob H, Thomas EA, Harwell M, Willenkin RL, Pinsky MR. Medical students can learn the basic application, analytic, evaluative and psychomotor skills of critical care medicine. Crit Care Med 2000;28(2):550-4.  Back to cited text no. 10
11.Merrick HW, Nowacek G, Boyer J, Robertson J. Comparison of the objective structured clinical exami­nation with the performance of the third-year medi­cal students in surgery. Am J Surg 2000;79(4): 286-8.  Back to cited text no. 11
12.Anderson DC, Harris IB, Allen S, Satran L, Bland CJ, Davis-Feickert JA, Poland GA, Miller WJ. Comparing students' feedback about clinical instruc­tion with their performance. Acad Med 1991;66(1): 29-34.  Back to cited text no. 12
13.Gledhill RF, Capatos D. Factors affecting the reliability of an objective structured clinical exami­na­tion (OSCE) test in neurology. S Afr Med J 1985; 67(12):463-7.  Back to cited text no. 13
14.Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Med Educ 1979;13(1):41-54.  Back to cited text no. 14
15.Cuschieri A, Gleeson FA, Harden RM, Wood RA. A new approach to final examination in surgery. Use of objective structured clinical examination. Ann R Coll Surg Eng 1979;61(5):400-5.  Back to cited text no. 15
16.Watson AR, Houston IB, Close GC. Evaluation of an objective structured clinical examination. Arch Dis Child 1982;57(5):390-2.  Back to cited text no. 16
17.Kirby RL, Curry L. Introduction of an objective structured clinical examination (OSCE) to an undergraduate clinical skills programme. Med Educ 1982; 16(6):362-4.  Back to cited text no. 17
18.Newble DI. Eight years experience with structured clinical examination. Med Teacher 1988;22:200-4.  Back to cited text no. 18
19.Newble DI, Swanson DB. Psychometric charac­teristics of the objective structured clinical examina­tion. Med Educ 1988;22:325-34.  Back to cited text no. 19
20.Rothman AI, Cohen R. Understanding the objective structured clinical examination (OSCE): issues and options. Ann R Col Phys Surg Can 1995;28:283-7.  Back to cited text no. 20
21.Newble DI, Dauphinee D, Dawson-Saunders B, Macdonald M, Mulloholland H, Page G, et al. Guidelines for the development of effective pro­cedures for the measurement of clinical com­petence. In: The certification and recertification of doctors: issues on the assessment of clinical com­petence. Ed. Newble DI, Jolly BJ, Wakeford RE. Cambridge University Press, Cambridge 1993; pp 69-91.  Back to cited text no. 21
22.Smith LJ, Price DA, Houston IB. Objective structured clinical examination compared with other forms of student assessment. Arch Dis Child 1984; 59(12):1173-6.  Back to cited text no. 22
23.Lazarus J, Kent AP. Student attitudes towards the objective structured clinical examination (OSCE) and conventional methods of assessment. S Afr Med J 1983;64(11):390-4.  Back to cited text no. 23


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