Second Edition
Editors Amar Agarwal MS FRCS FRCOphth
Dr Agarwal's Group of Eye Hospitals and Eye Research Centre 19 Cathedral Road, Chennai-600 086, Tamil Nadu, India
Dimple Prakash MS
Dr Agarwal's Group of Eye Hospitals and Eye Research Centre 19 Cathedral Road, Chennai-600 086, Tamil Nadu, India
Athiya Agarwal MD FRSH DO
Dr Agarwal's Group of Eye Hospitals and Eye Research Centre 19 Cathedral Road, Chennai-600 086, Tamil Nadu, India
Foreword Kevin M Miller
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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OSCE in Ophthalmology
© 2009, Amar Agarwal, Dimple Prakash, Athiya Agarwal
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2005
Second Edition: 2009
9788184486124
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset & Packagings Ltd., New Delhi
This book is dedicated to Thomas Kohnen
5Foreword to the Second Edition
For decades, the assessment of cognitive knowledge and the evaluation of a medical doctor's ability to make appropriate medical decisions have been the responsibility of licensing agencies around the world. Once certified, it was usually expected that a practitioner would maintain competency through a self-directed course of continuing education. Traditionally, this was accomplished by requirement that license holders acquire a certain number of continuing medical education credits over a multi-year cycle by taking courses offered by accredited medical schools and professional societies. Increasingly, however, the public demands that physicians not only demonstrate initial competency to practice medicine, but show objective and measureable evidence of life-long learning. In many countries, physicians are being issued time-limited certificates and required to recertify on a regular basis. Recertification entails documenting a certain number of continuing education credits and passing a written examination.
To maintain objectivity and ease of grading, most written qualifying examinations have a multiple-choice question and answer format. The questions can be validated in field-testing and their difficulty can be assessed by the correct response percentage. When used in review format, multiple-choice questions are an excellent way of reinforcing known information and exposing areas of cognitive deficit that require additional study. A problem of the multiple-choice format is that the correct answer is among the distracters, and it is possible to choose the correct answer simply by guessing. If there are n possible answers to a given question, there is a 1/n chance that the correct answer can be selected randomly. The odds improve if one or more distracters can be eliminated.
Open-ended questions, on the other hand, require test takers to recall information that has been committed to memory. If such questions are written well, they not only require a recollection of facts, but application of the facts in a problem-solving mode. There are many difficulties in writing questions that have a limited number of possible answers. In fact, the more knowledgeable the test taker, the more often he or she will perform poorly on such an examination because their 6knowledge makes them aware of the nuances and vagaries of a variety of possible etiologies and courses for any given clinical presentation.
Drs Amar Agarwal, Dimple Prakash and Athiya Agarwal have assembled a collection of patients and clinical scenarios from which they draw relevant evaluation and management questions. This text should be useful for those studying to certify in ophthalmology and those already in practice who are looking for a quick question and answer text to refresh and update their knowledge. The editors are to be congratulated for their effort in producing this text, and for their many other contributions to the field of ophthalmology.
To those who will use this text as a self-study manual, I encourage you to provide feedback to the editors so that they can continue to refine their questions and answers for future editions.
Kevin M Miller md
Kolokotrones Professor of Clinical Ophthalmology
Jules Stein Eye Institute
David Geffen School of Medicine at UCLA
Los Angeles, California, USA
7Foreword to the First Edition
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.
This book is the first attempt to prepare a sample module to introduce OSCE to the students of Ophthalmology. It contains good illustrations along the discrete questions framed to reach with their clear reply. The book has a good learning material as well as clear and critical analysis of the content there in.
I am sure that this book will justify its publication and help to promote OSCE as a friendly induction of a good evaluation technique.
DK Mehta
Director, Guru Nanak Eye Centre
Director, Professor of Ophthalmology
Maulana Azad Medical College
New Delhi, India
8Preface to the Second Edition
When we wrote the first edition of the OSCE book, it was the first book published on OSCE. The book helped many students who wanted to sit for their postgraduate exams. Since then we have the annual Kalpavriksha meet in the first week of October every year which is an annual conference for postgraduate training. The word Kalpavriksha means a tree of knowledge. To help students benefit more we decided to bring out the second edition of the OSCE book.
In this edition, we wanted to cover up topics like plastics, microbiology and other interesting topics which are normally covered in the actual OSCE exams. The idea here is basically for you dear readers to understand how the OSCE pattern is and how to succeed in the exam.
We would like to thank all the doctors of Dr Agarwal's Group of Eye Hospitals who helped us prepare this book.
We would also like to thank Shri Jitendar P Vij (Chairman and Managing Director) and the whole team of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for bringing out such a book.
Amar Agarwal
Dimple Prakash
Athiya Agarwal
9Preface to the First Edition
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.
On the other hand, students are not trained for this kind of examination and there is an acute need for more literature on the type of questions asked and appropriate responses. This book seeks to equip the students with a suitable knowledge of the system and to enhance their performance in the examination.
The first of its kind, this book will prove invaluable to all the postgraduate students whether Primary DNB, DO or MS. It will also make interesting reading for examiners.
It is a pleasure to present you this indispensable guide to the OSCE.
Amar Agarwal
DP Prakash
Sunita Agarwal
Athiya Agarwal