An objective undergraduate clinical examination in child health. Arch Dis Child

SUMMARY A new type of test used to examine medical students ' clinical skills in paediatrics is described. Each student has to circulate round a number of timed stations. At each one he performs a specified clinical procedure-such as history taking, physical examination, urine analysis, and radiological interpretation-and is marked according to his performance. This type of test is objective and can be extended to cover different aspects of clinical methods; it readily informs the student about his progress, and enables the teacher to look critically at his own technique. 'In the long run, the type of evaluation device used determines... the type of learning activity in which students will engage...'.1 Put more directly, students learn best the subjects they expect to be examined on. Yet much of what clinical teachers want students to learn is not reliably tested. For example, their abilities to take a history and elicit physical signs are often only cursorily assessed, while such procedures as urine microscopy and the analysis of biochemical data tend not to appear in clinical examinations. In addition, many students dislike the standard formal clinical examination which places them in a most unnatural situation with a patient and provokes considerable anxiety. The view is increasingly being advanced that this type of examination, in which the examiner conducts the student round a number of patients and at the end gives him a single mark or grading for his total performance, is too subjective and tests only a limited part of the student's repertoire. A common criticism of junior doctors today is that they lack empathy and rapport, pay insufficient attention to accurate history taking, and are incompetent at carrying out simple side-room tests. These are all aspects of clinical ability which are inadequately assessed in the traditional examina-tion. It was for these reasons that the objective structured clinical examination (OSCE) was introduced in 19752 and was adapted by us for use in child health. During their final year at Dundee, medical students in groups of 16 to 20 spend about 8 weeks studying child health, both in the wards at Ninewell