Appendix 4

Sample OSCE marking sheets

The following four OSCE mark sheets demonstrate how process and content can
be distinctly separated within assessment instruments. The dierentiation of
content and process skills enables examiners to appreciate more clearly the
skills that they are marking and allows marks for content and process to be
weighted dierently for each individual station (see Chapter 11).
Note that each marking sheet has been derived by selecting appropriate items
from the CalgaryCambridge Process Guides for each communication process
challenge being assessed. Process items are then combined with case-specic
content items for each scenario.

Process grid

1 Greets patient and obtains patient's name

2 Introduces self, role and nature of interview; obtains consent
3 Demonstrates interest and respect, attends to patient's physical comfort
4 Uses appropriate opening question (e.g. `What problems brought you to hospital today?')
5 Listens attentively, allowing patient to complete statements without interruption and leaving
space for patient to think before answering or go on after pausing
6 Checks and screens for further problems (e.g. `So that's headaches and tiredness what other problems
have you noticed?')
7 Encourages patient to tell the story of the problem(s) from when rst started to the present in own
words
8 Uses open and closed questions, appropriately moving from open to closed
9 Facilitates patient's responses verbally and non-verbally (e.g. use of encouragement, silence,
repetition, paraphrasing, interpretation)
10 Picks up verbal and nonverbal cues (body language, speech, facial expression, aect); checks out
and acknowledges as appropriate
11 Claries statements which are vague or need amplication (e.g. `Could you explain what you mean
by light headed?')
12 Periodically summarises to verify own understanding of what the patient has said; invites patient
to correct interpretation or provide further information.
13 Uses clear, easily understood language; avoids jargon
14 Actively determines patient's perspective (ideas, concerns, expectations, feelings, eects on life)
15 Appropriately and sensitively responds to and further explores patient's perspective
16 Demonstrates appropriate non-verbal behaviour (e.g. eye contact, posture and position,
movement, facial expression, use of voice)
17 Acknowledges patient's views and feelings; is not judgemental
18 Uses empathy to communicate appreciation of the patient's feelings or predicament
19 Provides support: expresses concern, understanding and willingness to help

Good

Adequate

Yes (2)

Yes but (1)

Not done/
inadequate
No (0)

Content grid
Symptoms
1 Tired, few months
2 Septic spots
3 Rash
4 Thirst
5 Polyuria
6 Weight loss
Other symptoms
7 Joint aches
8 Blurred vision
Relevant functional enquiry
9 No loss of appetite
Ideas and thoughts
10 Diabetes
11 Hep C
Concerns
12 Amputations or blindness
Expectations
13 Tests
Feelings
14 To be taken seriously
Past medical history
15 Migraine
16 Hepatitis
17 Asthma
18 Vitiligo
Drugs
19 Atenolol
20 Two inhalers
21 Steroids intermittently

20 Progresses from one section to another using signposting; includes rationale for next section
21 Structures interview in logical sequence, attends to timing; keeps interview on task
Notes to student on performance:
Overall impression: nb: this will not determine whether students pass or fail
Excellent pass:
Good pass:
Clear pass:
Borderline:
Clear fail:
[ ]
[ ]
[ ]
[ ]
[ ]

Yes (1)

No (0)

330 Teaching and learning communication skills in medicine

School of Clinical Medicine, University of Cambridge

OSCE Station Gathering Information: Maturity-Onset Diabetes

School of Clinical Medicine, University of Cambridge

OSCE Station: Dealing With a Distressed Patient or Relative
Process grid

Good
Yes (2)

1 Greets patient and obtains patient's name

2 Introduces self, role
3 Demonstrates interest and respect, attends to patient's physical comfort

Adequate
Yes but (1)

Not done/
inadequate
No (0)

Content grid

Yes (1)

No (0)

1 Worried about kids

2 Father was sent home from
hospital and had fatal MI
3 Wish husband was at home
4 Husband's vasectomy

4 Listens attentively, allowing patient to complete statements without interruption and leaving
space for patient to think before answering or go on after pausing
5 Facilitates patient's responses verbally and non-verbally (e.g. use of encouragement, silence,
repetition, paraphrasing, interpretation)

7 Actively and sensitively explores patient's feelings

(2 if explores eectively once stated)
8 Actively and sensitively explores patient's concerns
(2 if explores eectively once stated)

9 Demonstrates appropriate non-verbal behaviour (e.g. eye contact, posture and position,
movement, facial expression, use of voice)
10 Acknowledges patient's views and feelings; is not judgemental
11 Uses empathy to communicate appreciation of the patient's feelings or predicament (2 if verbal
and non-verbal empathy)
12 Avoids platitudes or false reassurance
13 Provides support: expresses concern, understanding and willingness to help
Notes to student on performance:
Overall impression: nb: this will not determine whether students pass or fail
Excellent pass:
Good pass:
Clear pass:
Borderline:
Clear fail:
[ ]
[ ]
[ ]
[ ]
[ ]

Appendix 4 Sample OSCE marking sheets 331

6 Picks up verbal and non-verbal cues (body language, speech, facial expression, aect); checks out
and acknowledges as appropriate

Process grid

Good
Yes (2)

BUILDING A RELATIONSHIP
1 Demonstrates interest and respect for patient as a person
2 Demonstrates appropriate non-verbal behaviour (e.g. eye contact, posture and position,
movement, facial expression, use of voice)

Adequate
Yes but (1)

Not done/
inadequate
No (0)

Content grid
1 Appropriate gravity of
explanations
2 Discusses driving
3 Discusses smoking

3 Uses empathy to communicate appreciation of the patient's feelings or predicament (2 if verbal

and non-verbal empathy)
PROVIDING THE CORRECT AMOUNT/TYPE OF INFORMATION FOR THE INDIVIDUAL PATIENT
4 Chunks and checks, using the patient's response to guide next steps
5 Assesses the patient's starting point (2 if carefully tailors explanation)
6 Discovers what other information would help the patient; seeks and addresses the patient's
information needs
AIDING ACCURATE RECALL AND UNDERSTANDING
7 Organises explanation (2 if uses signposting/summarising)
8 Checks patient's understanding (2 if asks patient to restate information given)
9 Uses clear language, avoids jargon and confusing language
ACHIEVING A SHARED UNDERSTANDING INCORPORATING THE PATIENT'S PERSPECTIVE
10 Relates explanations to patient's illness framework
11 Encourages patient to contribute reactions, feelings and own ideas (2 if responds well)
12 Picks up and responds to patient's non-verbal and covert verbal cues
PLANNING SHARED DECISION MAKING
13 Explores management options with patient (2 if signposts position of equipoise or own preferences )
14 Involves patient in decision making (2 if establishes level of involvement patient wishes)
15 Appropriately negotiates mutually acceptable action plan
Notes to student on performance:
Overall impression: nb: this will not determine whether students pass or fail
Excellent pass:
Good pass:
Clear pass:
Borderline:
Clear fail:
[ ]
[ ]
[ ]
[ ]
[ ]

Yes (1)

No (0)

332 Teaching and learning communication skills in medicine

School of Clinical Medicine, University of Cambridge

OSCE Station: Explanation and Planning re Chest Pain Investigations

School of Clinical Medicine, University of Cambridge

OSCE Station: Breaking Bad News
Process grid

1 Greets patient and obtains patient's name

2 Introduces self, role
3 Explains nature of interview (reason for coming to talk to patient)

4 Assesses the patient's starting point: what patient knows/understands already/is feeling
5 Gives clear signposting that serious important information is to follow
6 Chunks and checks, using patient's response to guide next steps

Good

Adequate

Yes (2)

Yes but (1)

Not done/
inadequate
No (0)

Content grid

Yes (1)

No (0)

1 Appropriate gravity of
explanations: avoids
inappropriate reassurance
2 States clearly the level of
amputation
3 In response to patient question
about smoking, makes
empathic non-judgemental
comment
4 Discovers patient is a coach
driver

7 Discovers what other information would help patient, attempts to address patient's information
needs (2 if attempts to address student does not need to know answer)

8 Gives explanation in an organised manner (2 if uses signposting/summarising)

9 Uses clear language, avoids jargon and confusing language

11 Allows patient time to react (use of silence, allows for shut-down)

12 Encourages patient to contribute reactions, concerns and feelings (2 if explores these eectively once
stated)
13 Acknowledges patient's concerns and feelings; values, accepts legitimacy

14 Uses empathy to communicate appreciation of the patient's feelings or predicament

(2 if verbal and non-verbal empathy)
15 Demonstrates appropriate non-verbal behaviour (e.g. eye contact, posture and position,
movement, facial expression, use of voice including pace and tone)

16 Provides support (e.g. expresses concern, understanding, willingness to help)

17 Makes appropriate arrangements for follow-up contact
Notes to student on performance:
Overall impression: nb: this will not determine whether students pass or fail
Excellent pass:
Good pass:
Clear pass:
Borderline:
Clear fail:
[ ]
[ ]
[ ]
[ ]
[ ]

Appendix 4 Sample OSCE marking sheets 333

10 Picks up and responds to patient's non-verbal cues