Absolutely Micheal, as part of OSCE examination, (Objective Structured Clinical Examination), we prepare objective structured checklists. these checklists could be used with different examiners and could also be used to follow students performance over time. these OSCE stations could be designed in such a way that they can examine students at various levels of clinical competency. At the level of history taking, component examination or complete examination, reaching differential diagnosis or making a final diagnosis by providing them with relevant investigation results. These checklists are prepared by various examination bodies and at university levels, depending on what were thought to the students, the objectives and outcomes. But I am not really sure how these could be extended to CME? I believe some aspects of it could also be made available as part of CMEs, although not really very easy.

Thank you, @Seyed, for your information. What do you think is the main problem extending OSCE checklists to CME?

Thank you Micheal for your Question, well, yes I believe it is not very easy due to multiple reasons, number one goes to the fact that large number of doctors go to CMEs to complete the requirements of their, let's say, renewal of licensure or to collect credit for their professional development, they hardly would like to spend a lot of time actually learning new stuff and implementing them in their practice, so if we provide some sort of an exam, lets say an OSCE, at the end of each CME now far less number of doctors would ever become interested in attending those CMEs, you know, if it becomes a nationwide policy that no CME credits are given unless a sort of an OSCE exam is conducted at the end, then every one would, sort of, "get forced" to take up such CMEs. the other issue, I believe, is the extent and depth of CMEs in general, some CMEs have very superficial knowledge content, some are so in depth that goes above most of the audience's head, so the content and objectives of CMEs in general are not uniform. To design any kind of exam, we need to know the content area, as well as the examinees very well, it is really difficult to judge the background knowledge of each of the participating physicians' also, it is like you conduct a grade 6 exam for a grade one student, it is correct that all those who become specialized do have some common background knowledge, but definitely this knowledge is not at the same level for all of them.

It could become possible in the future, if there is an organization that, number one, regulates all CME contents and objectives, tracks doctor's performance through continued examinations and knows their level of competence and then makes it mandatory that all CMEs should end in an OSCE exam. This means a doctor should remain a student throughout his/her career life, as it is happening today and I think it has always been like that. what do you think?

Thanks, @Seyed, for your clear and informative answer. I tend to look at this problem from a more technical side, so your input will be very useful.

Relating the objective assessment process, I wonder how it is actually performed. Do they have checklists and count the 'ticks', maybe weighted somewhat for difficulty and importance of a step/question? Do you have any experience with that?

Thanks Michael, yes, we are conducting OSCE exams in our university, and not only I conduct these exams but also prepare the drafts of checklists that later get approved in a team of experts in different subjects. well, the thing is OSCE design and checklist preparation is a quite complex procedure that needs formal training.

yes, as you rightly said, in manned OSCE stations, each component of the skill has a weightage that is given to it, based on the total score of that station, the importance of that skill component and also the level of students' knowledge. for example for a second year medical student going to a station that is about abdominal exam, more weightage is given to communication skills, taking permission, introducing self, and less to the actual technique of examination. the same station for third year will focus on the technique and for final year, the ability to pick the abnormalities and interpret the findings. Some steps in an station needs to be done in a sequential order, that should also be considered in the checklist.

There is a concept of global rating, that some examiners don't believe in it much, but I believe is an important component of examination. for instance if a candidate hurts a patient , no matter how well has performed all the skills, should not pass that station and would automatically gets failed.

So designing an OSCE station and preparing the relevant checklists, I feel is like art. You know what your students must know, then you make a riddle and then watch for their response.

Hope I have answered your question.

Thank you, Seyed, for the valuable input. I was also hoping for others sharing their ideas and experience.

I totally agree in Seyd and can tell you, that you will find lots of books how to pass a OSCE Examen containg all relevant data which you need to construct a parcour. Take into account, that DOPS and Mini-CEX might be suitable as well though they are focused on some other aspects. For CME without credits they might be very useful and powerfull tools.