A socio-historical study of the birth and adoption of the Objective Structured Clinical Examination (OSCE)
Bibliographic record
Abstract
The Objective Structured Clinical Examination (OSCE) was invented in 1975 for the assessment of medical students at the University of Dundee. This examination was radically different from anything that had been utilized before. During OSCEs, students were observed interacting with a series of patients in fixed-interval "stations" and scored by observers on standardized measures. Some of the patients were actors called "simulated patients". Assessment with OSCEs and simulated patients represented a new direction in examination of competence that emphasized 'standardization' and 'objectivity'. The research reveals three discourses related to OSCEs: performance, psychometrics and production. Each discourse is associated with characteristic statements, modes of expression and models of legitimation; each has brought into existence specific roles for individuals to occupy; and each augments the power of different types of institutions. Analysis of these discourses reveals the extent to which they have become dominant, or conversely are resisted, at different times and in different locations. These differences in legitimacy are, in turn, related to larger socio-historical contingencies such the emergence of neo-liberal capitalism; the unequal distribution of power and opportunity on the basis of gender and ethno-racial origin; and the general adoption of governmental technologies of surveillance for social control. Subsequently, OSCEs were adopted by medical schools around the world and for national medical licensure in Canada and the United States. OSCEs were also adopted for midwives, nurses, pharmacists, physiotherapists, police and massage therapists in North America and the UK and in Asia, South America and Africa OSCE projects were launched in order to 'meet international standards'. Why did this simple examination spread so quickly into every aspect of education and assessment? In the research presented here, a Foucauldian genealogy is undertaken to address this question. The objective is to identify different discourses that are linked to the legitimation and uptake of OSCE technology. The "archive" from which these discourses are sought includes over 600 published articles, interviews with 25 key informants in Canada, the UK and the USA and visits to institutions that have been central in promoting the use of OSCEs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.015 | 0.032 |
| Scholarly communication | 0.007 | 0.011 |
| Open science | 0.001 | 0.006 |
| Research integrity | 0.002 | 0.007 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".