CHANGING TRENDS IN THE MEDICAL EXAMINATIONS

1. CHANGING TRENDS IN THE MEDICAL EXAMINATIONS
DR.T.V.RAO MD
Methods for student assessment in medical education has changed over the past 50 years. We have
moved from a standard of pen-and-paper tests of knowledge and facts toward a more complex
system of evaluation. Medical students today are tested on knowledge, attitudes, and skills across
multiple settings and methods, which are often triangulated to reach summative decisions. Current
educational and assessment strategies include problem-based learning, computer simulations, and
checklists, standardized patients, and team-based learning that we call as seminars. When we
started our life in Medicine; we were few students in a Unit for training, my teachers who were
always willing to spend the time in training us. Patients were poor in many Government hospitals,
helpful to cooperate, and willing to answer many questions put many times with our ignorance.
Medical council of India wishes that graduates should have the knowledge, skills, professional
behaviours and attitudes necessary to enter the unsupervised practice of medicine in India, as
Graduates must be able to diagnose and manage health problems and provide comprehensive,
compassionate care to their patients. Today we teach the students on comprehensive and
integrated care of the patients, as it is desired to be a competent physician as Prospective
candidates should be aware that, cognitive, physical examination, management skills,
communication skills, and professional behaviours are all evaluated in timed simulations of patient
encounters. Doctors should be able communicators both in good and as well in critical times and
student must be able to speak, to hear and to observe patients in order to effectively and efficiently
elicit information, describe mood, activity and posture and perceive non-verbal communication. A
student must be able to communicate effectively and sensitively with patients, families and any
member of the health care team. A student must also be able to summarize coherently a patient’s
condition and management plan verbally and in writing. To the students, we should teach to be
effectually to use motor functions. A student must demonstrate sufficient motor functions to safely
perform a physical examination on a patient, including palpation, auscultation and percussion. The
examination must be done independently and in a timely fashion. A student must be able to use
common diagnostic aids or instruments either directly or in an adaptive form (e.g.
sphygmomanometer, stethoscope, otoscope and ophthalmoscope). A student must be able to
execute motor movements reasonably required to provide general and emergency medical care to
patients. Compassion, integrity, concern for others, interpersonal skills, interest and motivation are
all personal qualities that physicians must demonstrate and are expected qualities of students.
efficient motor function to safely perform a physical examination on a patient, including palpation,
auscultation and percussion ability to use common diagnostic aids or instruments either directly or
in an adaptive form (e.g., sphygmomanometer, stethoscope and needles)ability to execute motor
movements that are reasonably required to provide general and emergency medical care to
patients. Many Medical assessment examinations in India and abroad are changing to the new
educational assessment for the new generation of students to eliminate the older examination
system fraught with poor assessment criteria, designated as Objective Structured Clinical
Examinations (OSCEs). An Objectively Structured Clinical Examination (OSCE) is a modern type of
examination often used in health sciences (e.g. Midwifery, orthopaedics, optometry, medicine,
chiropractic, physical therapy, radiography, nursing, pharmacy, dentistry, naturopathic medicine,
Para medicine, podiatry, veterinary medicine). It is designed to test clinical skill performance and
competence in skills such as communication, clinical examination, medical procedures / prescription,
exercise prescription, joint mobilisation / manipulation techniques, radiographic positioning,
radiographic image evaluation and interpretation of results. An OSCE usually comprises a circuit of
short (the usual is 5–10 minutes although some use up to 15 minute) stations, in which each

2. candidate is examined on a one-to-one basis with one or two impartial examiner(s) and either real
or simulated patients (actors or electronic dummies). Each station has a different examiner, as
opposed to the traditional method of clinical examinations where a candidate would be assigned to
an examiner for the entire examination. Candidates rotate through the stations, completing all the
stations on their circuit. In this way, all candidates take the same stations. It is considered to be an
improvement over traditional examination methods because the stations can be standardised
enabling fairer peer comparison and complex procedures can be assessed without endangering
patient’s health. Medical schools in many developed countries are increasingly relying on Objective
Structured Clinical Exams as a method to evaluate their medical students' clinical skills and
communications skills. As OSCE exams are now the method of the licensure examination in the USA,
Canada, UK, Australia, and New Zealand and many other countries, most schools are now
implementing these clinical skills assessment exams right from the first year for their medical
students.OSCEs for Medical Student tend to be system oriented as you move from placement to
another, like while they do their surgery clerkship, the topics will be around surgical topics, and so
on. However, medical students have to keep their minds open to all possible diagnoses and explore
the relevant ones as time permits. Differential diagnosis is still needed to be covered in all medical
student OSCEs. The best way for a medical student to prepare for an Objective Structured Clinical
Exams (OSCE Exam) is repetitive practicing following a well prepared systematic approach model.
Acquire a systematic organized approach that covers clinical skills, communication skills, and
differentials. Start as early as possible in your medical education and keep repeating and practicing
your approach over and over for months and all through your medical school years. Make it a habit
in order to master patient encounters. It will be one practicing for all your coming medical OSCE
exams. Does it make sense, The OSCE is an assessment format in which the candidates rotate
sequentially around a series of structured cases located in ‘stations’, at each of which specific tasks
have to be performed, usually involving a clinical skill, such as history taking, examination of a
patient or a practical skill. The marking scheme for each station is structured and determined in
advance. There is a different examiner and a time limit for each station. The basic structure of an
OSCE may be varied in timing for each station, use of checklist or rating scale for scoring, use of
clinician or standardised patient as examiner, use of real patients or manikins, but the fundamental
principle is that every candidate has to complete the same assignments in the same amount of time
and is marked according to a structured marking schedule. Many Medical Institutions and some
deemed universities are planning for a change. The DNB courses have successfully implemented
many aspects of OSCE. My little experience with OSCE in a Medical College, it is far more confusing
than the traditional system, for the undergraduates, I think who are implanting the system should be
sound in doing the procedures or else it is confusing to the Teacher as well as taught. However
Successful OSCEs are often the result of significant planning, coordination of multiple resources,
commitment to large-scale testing, and judicious use of assessment data. More research is needed
about the best uses of the OSCE method and how to maximize reliability and validity. Advocates of
the OSCE method should continue to produce and disseminate evidence of the far-reaching impact
that is seen by students and educators.
Dr.T.V.Rao MD. Professor of Microbiology, Creator and Designer of e-learning resources in
Microbiology and Medicine - a Freelance writer. Travancore Medical College, Kollam. Kerala
the article published in the souvenir Golden Jubilee celebrations of J. N Medical College Belgaum
Karnataka