Table 3. A detailed Objective Structured Clinical Exam (OSCE) to evaluate the quality of performance of the learner in recognizing and responding to a post-operative myocardial infarction (MI) on a behaviourally anchored rating scale (BARS).

A pass/fail score for an OSCE can be found at the bottom.

Components of the Objective Structured Clinical Exam	Poor	Fair	Good	Excellent
Communication skills and professionalism	Interrupts the patient frequently and appears frantic. The learner demonstrates difficulty in putting the patient at ease.	Communicates their assessment and decision making with the patient and nurse confederate. Appears uncomfortable in the situation but has reasonable control given their level of training.	Appropriate communication with the patient and nurse confederate. Communicates their assessment and decision making and appears to be in control of the situation at a level that would be appropriate given their training.	Appears confident, calm and in control of the situation. Places the patient at ease while effectively gathering information from both the patient and nurse. Communication with the staff and patient is at a level that would be above expectations for their level training.
Focused history	Demonstrates knowledge below their level of training. Fails to perform a focused history to obtain further information about the clinical picture. Does not screen for further risk factors and reacts based on the limited information provided in the prompt.	Demonstrates knowledge below their level of training. Performs a focused history but is limited to only a few screening questions (<3). Misses the majority of risk factors that would lead to cardiac causes (smoking, obesity, diabetes, hyperlipidemia, hypertension, cocaine use, previous coronary artery disease, family history of heart disease).	Demonstrates knowledge appropriate to their level of training. Pertinent questions to the clinical scenario are asked leading to a prioritized differential diagnosis including both cardiac and respiratory causes. The majority of risk factors were screened for except 2-3 (obesity, smoking, coagulopathies, bleeding disorders, malignancy, recent trauma, recent long distance travel, cough, unilateral leg swelling, diabetes, hyperlipidemia, hypertension, cocaine use, previous CA, family history of heart disease).	Demonstrates knowledge beyond their level of training and applies it appropriately to this situation. Asks pertinent questions to formulate a prioritized differential diagnosis ultimately ruling out respiratory causes and narrowing in on cardiac causes. Nearly all relevant risk factors were accounted for except 1 in a timely fashion (obesity, smoking, coagulopathies, bleeding disorders, malignancy, recent trauma, recent long distance travel, cough, unilateral leg swelling, diabetes, hyperlipidemia, hypertension, cocaine use, previous CA, family history of heart disease).
Focused physical exam	Does not perform a physical exam.	Performs a limited physical exam only listening to breath sounds. The learner describes the breath sounds out loud to the assessor.	Performs an appropriate physical exam including respiratory and precordial examinations. The learner describes the patient's breath sounds, adventitia, work of breathing, heart sounds, murmurs and precordial rubs. Vital signs are asked to be repeated.	Performs a physical exam that is complete and timely. Begins with the learner commenting on the patient's appearance (diaphoretic, increased WOB, signs of cyanosis). The learner describes a midline trachea, breath sounds, adventitia, heart sounds, murmurs, precordial rubs and JVP. The learner also assesses for calf tenderness, unilateral leg swelling and asks for vital signs to be repeated.
Initiating response to a perioperative MI	Does not identify the situation as a cardiac cause and must be prompted by the nurse confederate to get an ECG. Fails to recognize the anterior ST-elevation MI.	Identifies respiratory distress and calls for supplemental oxygen and investigations/management for respiratory pathology (i.e. chest X-ray, CT angiogram and/or chest tube). Must be prompted by the nurse confederate to consider cardiac causes and order an ECG. Recognizes the anterior ST-elevation MI and calls the attending physician.	Identifies a cardiac cause for the patient's presentation and promptly orders an ECG. Recognizes an anterior ST-elevation MI and immediately calls the attending physician for further management.	Identifies a cardiac cause for the patient's presentation and promptly orders and ECG and recognizes an anterior ST-elevation MI. The learner orders management steps that would be appropriate given their position (i.e. supplemental oxygen, crash cart, prepares nurses for MI). Calls the attending physician to provide handover and initiate reperfusion therapy.
Patient handover to the attending physician	Learner fails to provide handover to the attending physician. The nurse confederate must prompt the learner to call the attending physician for further assistance.	Learner provides insufficient information to the attending physician for handover leaving many gaps in knowledge. The handover that was provided would require the attending physician to repeat a focused history and physical exam to obtain the appropriate information.	Learner provides most of the pertinent information for a successful handover to the attending physician. The information is presented in a slightly disordered pattern but in a clear and comprehensible manner.	Learner provides all of the pertinent information for a successful handover to the attending physician. The information is provided in a clear and concise manner that flows effortlessly and logically.
Overall, on this task, should this learner: Pass Fail