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Darke
County Senior Scribes
O S C E
By Delbert Blickenstaff, M.D.
The late Dr. Robert T. Blickenstaff helped develop the Objectively
Structured Clinical Examination (OSCE) at Indiana University School of
Medicine. Robert, my twin brother, was a research chemist with a PhD
from Purdue U. His contribution to the OSCE program was in training his
actor friends to be standardized patients. The medical doctors who were
in charge of the testing program for medical students developed the
scenarios and Robert would train the actors.
For example, the student reads on the medical chart that the patient is
a 65 year old retired physician who comes into the clinic because of
chest pain. The student then must take a medical history to find out
how long the “patient” has been having the pain, what activities bring
it on, what relieves it, where the pain is, how bad it is, etc. Then
the student must develop a plan to diagnose and treat the complaint,
and explain it to the patient in terms that he can understand. All this
is seen by a physician observer via closed circuit TV and afterward the
observer gives the student his evaluation. The students rotate through
a series of 10 to 15 exam rooms, each with a different standardized
patient, and also 4 computer stations with problem-solving sessions.
I became involved in this testing program at Robert’s invitation, and
functioned both as a standardized patient and as a physician observer.
Robert and I even wrote up a testing scenario about a female patient
who was given the wrong injection and the student had to explain the
error to the patient and tell her what the effect of the wrong
medication might be. I don’t know if our story was ever used.
One of the most difficult problems that students had to face concerned
a young couple who were told that their baby boy’s circumcision was
botched. The student had to admit to the mistake and arrange for a
pediatric surgeon to repair the damage. Some students tried to blame
the mistake on someone else, and some ended up in tears.
On a lighter note Robert was asked to make use of his theatrical skills
and put a black eye on a female actor with make-up. The patient
presented with some other complaint and the real test was the student’s
reaction to evidence of physical abuse. Some picked up on it right away
and questioned the patient. Others thought it was a real black eye and
avoided mentioning it because they didn’t want to embarrass the actor.
Robert was pleased that he fooled some of the students.
The use of standardized patients as a means of testing medical students
is a part of most students’ experience. I.U. was instrumental in
developing this technique. Wright State Medical School uses volunteer
patients who submit to medical history taking by students, but I think
they have not used standardized patients. I had some experience
observing and evaluating the history taking at WSU and I remember
advising them that when talking about heart surgery they had to be
specific. Having an arterial bypass operation has a different
significance as having aortic valve replacement.
Overall I was favorably impressed with the knowledge and sophistication
of both the IU and the WSU students. And I thoroughly enjoyed my
experience as a patient and as an observer.
Delbert Blickenstaff, M.D.
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