Practical issues in developing a program for the objective assessment of clinical skills

Although the assessment of medical students' clinical skills through the use of an Objective Structured Clinical Examination (OSCE) is becoming more widespread among American medical schools, there is still a significant number of medical schools that do not utilize this type of examination. The reasons for this are many, including considerations about expense, commitment of faculty time and the logistics of setting up and administering an OSCE program. Although studies have been published on various aspects of the OSCE, there have been very few overviews on how to develop this type of examination from initial needs assessment to implementation. This paper describes the process of developing an OSCE at a American medical school of intermediate size. The development process is divided into seven activity areas: initial preparation, case writing, developing a standardized patient program, procedures for conducting the exam, faculty participation, measurement and evaluation, and financial support. Results of innovations that were tried during the pilot phase of development are discussed.