What is an OSCE?

OSCE is an abbreviation for Objectively Structured Clinical Examination.  We and others have used this examination format to assess the clinical reasoning skills of health professions students (including medical and dental students).  The examination consists of a number of written “stations,” each of which presents a clinical scenario that you would be likely to encounter in a general dental practice.   As you read through the stations, you will encounter a range of “virtual” patients with conditions and/or treatment needs like those described in Section A below.  You will be expected to provide differential and/or definitive diagnoses at some of the stations and to recognize and treat/manage dental and medical emergencies at other stations.  At some of the stations you will be expected to make determinations regarding oral health treatment needs and to develop comprehensive treatment plans.

 

Why do I have to take this examination?

The University of Michigan School of Dentistry must certify that every student graduating from the DDS program is competent to practice general dentistry.  The document entitled “Competencies for the New Dental Graduate” describes the seventeen (17) competencies expected of graduates of the DDS program. The ADA Council on Dental Accreditation (CODA) requires that all accredited dental schools conduct competency assessments of students prior to graduation.  Attainment of some of the required competencies is assessed in the clinics using “test cases.”  The OSCE assesses attainment of most of the remaining competencies which are mainly in the domains of clinical reasoning skills (interpretation of clinical data, development of differential diagnoses and treatment plans, recognition and management of medical emergencies, etc.) and interpersonal communication skills.

 

How is this examination graded?

Each station has been developed by and will be graded by a group of faculty members.  Each station will be graded using “critical error” criteria.  A critical error is one that would result in (1) ineffective/inappropriate treatment/management of the patient, (2) harm to the patient; or (3) violation of state/federal laws governing dental practice. A passing grade is determined by obtaining less than a predetermined percentage of critical errors and the absence of errors that would actually harm the patient. This predetermined percentage of critical errors is reviewed annually by the Curriculum Committee and was previously set at 15%.

  

What is the format of the OSCE?

This year’s OSCE will consist of about ten written stations, some of which have multiple parts.  Each station presents a patient scenario and may contain photographs of a patient, radiographs, the results of clinical examinations, and study models.  You will be asked to respond to specific questions for each written station regarding oral health care issues for the patient.  You may be asked questions relevant to the treatment/management of these patients.  One station is a communication skills station at which you will interview a standardized patient instructor with a specific oral health problem.  Another of the stations deals with practice management issues.

• For D4 students the examination will be conducted from 8:30 AM-1:00 PM on Thursday, February 18, 2010.
   
• For D3 students the examination will be conducted from 8:30 AM-1:00 PM on Friday, February 19 ,2010.
  

•  You will be permitted to take a pocket drug reference manual with you to the examination. NO ELECTRONIC DEVICES WILL BE PERMITTED.

 

What tasks will I be required to perform?

• Identify health and disease

• Identify conditions in need of treatment.

•  Identify patients with treatment needs that require the patient to be referred to others to obtain treatment; particularly when the treatment needed exceeds your level of competency

•  Demonstrate effective communication skills.

•  Analyze the findings from physical, behavioral and clinical assessments. (For example, interpretation of medical history or periodontal charting)

•  Determine differential, provisional or definitive diagnosis.

• Develop treatment plans that are sequenced to address the patient’s chief concern, control oral disease, restore oral form, function and esthetics, maintain health and prevent disease.

• Modify treatment as required by changing circumstances.

• Develop treatment/management plans for craniofacial diseases and disorders.

• Treat/manage dental and medical emergencies.

• Practice appropriate infection control and environmental safety.

• Apply business and practice management skills to clinical practice.

 

How can I minimize my chances of committing a critical error?

Review your answers to make sure that the patient care you render would not result in ineffective treatment, harm to the patient, or violation of state or federal laws governing dental practice.

It will be useful for you to understand our use of the following terminology on this examination:

Treatment/Management of Patients:  When you are asked what treatment you would provide, write down how you would treat the patient, describe what care you would provide.  Management can include referral of the patient to another health care provider.  If you refer a patient, write down to whom you would refer the patient and why (what do you want the referring provider to do?)

Differential diagnosis: List of reasonable diagnoses related to the clinical symptoms. At least 2 diagnoses must be on a differential list. For example, a differential diagnosis for chest pain is myocardial infarction, angina pectoris, indigestion, anxiety attack, muscle pull, etc…..

A definitive diagnosis is the diagnosis of the condition that is determined after all of the assessment data are collected and analyzed.

Prescription writing:  If you are asked to write a prescription, write it out as you would on a prescription form.  Use your drug guide as needed for dosing indications.

Describing a lesion:  When asked to describe a lesion, provide as much of the following types of information as you can:

• Location – the more specific the better (example:  the tongue is a large area and has 4 sides, dorsal, ventral, right lateral or left lateral, give a specific location - Right lateral, adjacent to #30 and 31 or dorsal surface, 1 cm posterior to the tip)

• Size(measurement, give three dimensions if possible, and estimate the actual size [mm or cm] don’t just use a word like small)
• Color(pink, red, white, blue)

• Texture(soft, hard, firm, fluctuant - fluid filled, etc.)

• Surface description: smooth, ulcerated, papillary, pedunculated - stalk like attachment to underlying tissue, or sessile - broad base 

• Asymptomatic/symptomatic
  

• How detected: was it an incidental finding (patient was not aware it was there) or did the patient tell you about it?

• Radiographically detected – Is it radiolucent, radiopaque, or mixed RO/RL? Describe borders, estimate size (mm or cm), describe appearance.

 

Section A - Patient Scenarios you are likely to encounter on this examination:

 1. Systemically healthy patient with dental needs requiring routine diagnosis and treatment planning

 2. Geriatric patient taking multiple medications

 3. Child or adolescent with malocclusion

 4. Patient with dental/oral pain requiring management

 5. Patient with a dental urgency/emergency

 6. Patient with a medical urgency/emergency

 7. Patient with systemic disease(s) that would affect provision of oral health care

 8. Patient with dental concern that leads to an ethical dilemma

 9. Patient seeking a second opinion (you will be required to demonstrate effective communication skills)

 10. Patient with oral health care needs that exceed your ability to treat

 11. Patient with oral soft/hard tissue lesions

 12. Patient with complicated restorative and/or periodontal needs

 13. Patient with signs suggesting abuse

 14. Patient with esthetic concerns

 15. Patient with lifestyle and/or behavior affecting oral health

 16. Patient for whom a diagnostic test should be ordered

 

Be aware that we expect minimally that you will be able to identify dental caries on radiographs.  This is important in diagnosis and treatment planning procedures.  Failure to detect dental caries on a radiograph, and/or failure to differentiate caries from technical problems encountered in radiographs (i.e. cervical burnout), is a critical error.