Money makes the (medical assessment) world go round: How costly is an OSCE?

Introduction: The OSCE is an important component of assessment and yet is undoubtedly expensive (Patricio, et al. 2013). This study aims to evaluate the costs for one OSCE examination at one medical school however the message of the unrecognised cost of clinical exams is important for all. Methods: In 2013 the Aberdeen University held a two-day OSCE for 185 final year students. The costs of different stages of development and administration of this high-stakes OSCE were determined. Results: This OSCE cost our institution £65,328. Question development & testing costs approximated £6,280, £419 per question. Production costs were mostly examiner and patient training time, £8,154. The majority of costs occurred administering the examination including consumables, catering and staff time £52,504. The largest expense was examiner time £26,938. Post-examination costs included administrative tasks, exam board meeting and checking failed papers, £3,191. The most expensive station was depression history taking utilising actors, costing £5,105, an additional £2981 to the standard question cost. The cheapest station was prescribing, a total station cost of £2,760, an addition of only £636 to the standard cost. The total cost per student was approximately £293. Discussion: Cost in medical education assessment is a complex area; there are differences across institutions that lead to huge variations in cost, the use of volunteer patients in our institution incurs no cost, however other institutions pay up to £230 per patient. The main cost associated with the conduct of the OSCE is examiner time. Conclusion: The OSCE is expensive to run. With students and regulators demanding formative as well as summative OSCES costs are significant. Further work will need to identify whether the OSCE is value for money and tie to measures of utility- is it generalizable, valid, acceptable and economically feasible? (Walsh, et al. 2013).