The National Assessment Collaboration (NAC) Objective Structured Clinical Examination (OSCE) is administered independently of any other Medical Council of Canada (MCC) examination. The examination material on the NAC OSCE is presented and scored at the level of a graduating medical student from a Canadian medical school.
Objectivity on the NAC OSCE is achieved through the use of standardized guidelines for the administration, the training of physician examiners and standardized patients, and the use of predetermined scoring instruments. The OSCE component is evaluated by physician examiners based on the candidate’s performance at each station. The therapeutics written component is based on the candidate’s multiple-choice answers/single best answer.
To pass the examination, a candidate must achieve an overall score that is set at the standard of a graduating student from a Canadian medical school. In awarding the final standing on the examination, the NAC Examination Committee also considers any observations made by the physician examiner at each of the OSCE stations with regards to the candidate’s ability to demonstrate the ethical and professional behaviour appropriate for a physician entering postgraduate training.
Physician examiners observe candidate interactions with the standardized patients and provide ratings on up to nine competencies relevant to the presenting problem and clinical task. These competencies are history taking, physical examination, organization skills, communication skills, language fluency, diagnosis, data interpretation, investigations and management. The OSCE station score is the average of a physician examiner’s competency ratings. A candidate’s score on the OSCE component is the average of the station scores.
The therapeutics component consists of multiple-choice questions with predefined answer keys/single best answer.
The candidate’s examination score is a weighted combination of the OSCE and therapeutics components. As of 2013, the OSCE component will account for 90 per cent of the examination score while the therapeutics component will account for the remaining 10 per cent of the examination score.
NAC OSCE examination scores are reported on a scale with a distribution ranging from 0 to 100. The fixed passing score is based on the performance equivalent to a graduating candidate from a Canadian medical school. A candidate’s performance is judged in relation to the pass score for the examination and not judged on how well other individuals have performed on the examination.
In addition to the total score, which is reported in the Statement of Results, candidates are provided with supplemental feedback on their examination performance. This information consists of a graphical display of the candidate’s performance on the nine competencies and therapeutics. The report provides the candidate with a table listing the system (e.g. respiratory, gastrointestinal), discipline (e.g. Medicine, Psychiatry), and the major objective of the OSCE stations in rank order from the station on which they performed the highest to the station on which they performed to poorest.
Competency scores are based on few observations, and therefore do not have the same precision as the total examination score. Candidates who retake the examination should prepare for all competencies as they could improve some scores and inadvertently lower other scores.
View an example of a 2012 Statement of Results and a supplemental feedback report.