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Author's reply

Bhatnagar, Kavita R

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Indian Journal of Ophthalmology: Jul–Aug 2012 - Volume 60 - Issue 4 - p 334
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Dear Editor,

We thank the author for the encouraging comments on our article.[1] We agree that Objective structured clinical examination (“The OSCE is an approach to the assessment of clinical competence in which the components of competence are assessed in a planned or structured way with attention being paid to the objectivity of the examination” Harden, 1988) was developed to overcome the drawbacks of conventional clinical exams (CCE) using the long and short case formats. But, there are limitations with OSCE as well that we have already mentioned in our article.

We highly appreciate the way authors in this communication have highlighted the modifications to overcome drawbacks of CCE, namely Objective Structured Long Examination Record (OSLER), Leicester assessment package (LAP) and mini-CEX (Clinical Evaluation Exercise). We understand that long case is considered important to test the holistic approach of a student for a given case, and is still the method of examination in almost all Indian medical colleges. Because of tradition and its practical application, long case exam will possibly always be an integral component of clinical examinations. An observation of whole long case exam where an examiner is required to be present while the candidate works up the case may be ideal. However, this would be very expensive in terms of examiners’ time and, therefore, is not practical.[2] Bearing this in mind, Gleeson has developed the OSLER as a more valid, reliable and objective tool for the assessment of clinical competence.[3]

Other modifications suggested, like Leicester assessment package and mini-CEX, are also gaining popularity worldwide because students are observed during several encounters during their training period by different faculty members in various settings (ambulatory, emergency department and inpatients) and, therefore, the patients present a broader range of challenges.[4]

We do not agree with the statement that OSCE is a summative examination like CCE. OSCE provides opportunity for formative as well as summative feedback, making it an excellent teaching tool as well.[56]

The most important virtue of any assessment is that it should be valid; OSCE is able to achieve it to a great extent as it assesses the wider domain, objectivity and other quoted advantages. An important feature of any examination process is the ability to reliably differentiate between the performance levels of candidates, which OSCE is able to achieve. Reliability is an important aspect of an assessment's validity evidence.

In the current long and short case formats, we assess the student only on one case. It is well documented in the literature by Norcini et al., that performance on one case can not be used to make a judgment on candidate's performance (Death of long case by John Norcini).

Thus, the importance of OSCE.

You will agree with us that no single assessment tool meets all the requirements. Therefore, in our article,[1] we have suggested to combine OSCE (formative as well as summative assessment) with modified CCE (summative assessment).

We agree with the authors about other methods.

1. Bhatnagar KR, Saoji VA, Banerjee AA. Objective structured clinical examination for undergraduates: Is it a feasible approach to standardized assessment in India? Indian J Ophthalmol. 2011;59:211–4
2. Sood R. Long case examination-Can it be improved? J Indian Acad Clin Med. 2011;2:251–5
3. Gleeson F. Assessment of clinical competence using the objective structured long examination record (OSLER) Med Teach. 1997;19:7–14
4. Norcini JJ, Blank LL, Duffy FD, Fortna GS. The Mini-CEX: A method for assessing clinical skills Ann Intern Med. 2003;138:476–81
5. Varkey P, Natt N. The objective structured clinical examination as an educational tool in patient safety Jt Comm J Qual Patient Saf. 2007;33:48–53
6. Kaufmann DM, Mann KV, Muijtjens AM, vander Vleuten CP. A comparison of standard setting procedures for an OSCE for undergraduate medical education Acad Med. 2000;75:267–71
© 2012 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow