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© 2005, Amar Agarwal, DP Prakash, Sunita Agarwal, Athiya Agarwal

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The evaluation techniques have been put to a critical scrutiny for a long time. Clinical assessments apart from being a long and tiring process leave transparency and bias factor a point of discussion. Short and multiple choice question formats have reduced the bias and increased transparency to a great extent in testing the cognitive skills. Objectively structured clinical examination (OSCE) has been visualised as clinical evaluation techniques to eliminate the ambiguity and bias in the clinical examination.

Including OSCE (Objectively Structured Clinical Examination) into the DNB examination is an applaudable decision as it enhances the quality of the examinations and evaluates the performance of the students in a very practical and unbiased manner.

OSCE stands for objectively structured clinical examination. The National Board of Examinations (NBE) has introduced this new pattern for the DNB (Diplomate National Board) final clinical examination since 2003. The main purpose of this new pattern is to examine all the candidates with the same set of questions even for the clinical exams thereby eliminating any bias that may occur with different set of questions at different centers. The examination starts at the same time at all the centers all over India and the students answer the same set of 25 to 30 questions. Each question is kept in a station or cabin and the student enters the cabin at the ring of a buzzer. The student gets 5 minutes to read the question and write the answers for the same. At the end of 5 minutes the buzzer rings and the student is supposed to hand over the answer for that question to the examiner. Then he moves to the next station where another set of questions await him which he answers in 5 minutes. The examination hall is divided into 30 stations and each student occupies 1 station at the start of the examination. At the end of 5 minutes the student moves on to the next station which was occupied by another student who also moves on. Thus, all the students get the same set of questions and the same time of 5 minutes for answering each question. By this process objectivity is established in the examination. The student has to be alert and stick to the time limit as he cannot make up for lost time.

In this section the student is asked to perform a clinical examination technique like slit lamp examination or retinoscopy in front of an observer examiner. The observer examiner will mark the student in 5 minutes according to the key given to him. For example: if the question is perform retinoscopy on the patient dilated with cyclopentolate the marks are distributed in the following manner:

Anterior segment photographs may be displayed and questions will be asked. It is better to first read the question then look at the photograph and then once again read the question before answering. This is because the questions may sometimes carry a clue which might be helpful for answering. Try to keep the answer to the point and be clear. The student has only 5 minutes to answer and move to the next station.

Look at many fundus photographs and fluorescein angiograms of especially diabetic retinopathy cases. Be sure about classification of retinopathy based on ETDRS and similarly for ROP.15

The student will most likely be shown photographs of squint patients in all 9 diagnostic positions. Read the photograph carefully and systematically from the primary position then proceeding to the versions and finally the elevation and depression. Formulate the diagnosis based on the photograph and any clue that may have been given in the question in the form of history.

The student may be shown a video of surgical procedures like phaconit, phacotrab, penetrating keratoplasty with IOL, viscocanalostomy or lasik laser. It is advisable to first read the questions and then see the video to look for answers. This section will have the latest surgical procedures and the student is advised to be abreast with recent trends.

Electroretinogram, VEP, EOG, orbscan, aberrometry, field test reports, Amsler charts and any other diagnostic report may be shown and questions asked on it. The student has to familiarize himself with the results, their limitations, etc.

CT scans, MRI scans, ultrasonography pictures, X-rays or any other procedure like dacryocystography may be shown and questions based on that. The student should be familiar with the method employed to take the scan for example: whether it's a T1 or T2 weighted image in MRI scanning.

Procedure of Gram's staining and KOH mount are important. Look at the question first before looking at the slide as the question might carry a clue as to which structure is mounted.

The student may be asked about the National Blindness Control Programme or about any nationwide programme like, vit-A supplementation or eye banking.

In the OSCE pattern the student will be tested in all branches of ophthalmology without bias and objectively. The student should prepare for the OSCE exams 16in a systematic manner to come out successful. The total marks allotted for the OSCE exams is 150 and it is theoretically-possible to score full marks. As of now there is no negative marking in the OSCE examinations and hence the student is advised to attempt all questions. A student by and large will have to pass the OSCE test to pass the total clinical examination.