An accessible OSCE is designed for the widest range of candidates first and adjusted for individuals second. The 2026 Clinical Teacher guide on accessible OSCEs gives a decision model that separates what a station tests from how it tests it, and analyzes each station component on its own. This page turns that model into a policy, a component table, and a request-to-record process.
Why design for access before adjusting for individuals?
Two approaches to disability in assessment exist, and they are complements, not rivals. Universal design is built into the exam so that most candidates need no adjustments: large-print instructions for everyone, adjustable-height couches in every room, a timing signal that is both heard and seen. Individual accommodation changes the exam for one candidate whose need the design did not cover. The accessible-OSCE guide is clear that both are needed. Universal design reduces the number of individual cases. It does not remove them.
Starting with design has a second benefit. Every individual adjustment is a difference between candidates. Fewer adjustments mean fewer differences to defend. A school that gives everyone fifteen minutes to read a long chart has no case to argue about reading speed.
The candidates section covers what candidates are told. This page covers what the school decides.
What is the skill, and what is the format?
The central question in every adjustment is the one the guide puts first: is this demand part of the skill being tested, or part of the way we test it? The guide calls it separating the construct from the format, and names three format demands that are often mistaken for skills: reading speed, typing, and navigating a screen.
A worked distinction:
- A station tests taking a history from a patient in eight minutes. The eight minutes are part of the skill if the program's outcome is a focused history under time pressure. They are format if the outcome is a complete history.
- A station tests interpreting a chart. Reading a small-print chart quickly is format. Reaching the right interpretation is the skill.
- A station tests documenting an encounter. Typing speed is format. The content of the note is the skill.
The committee decides, per station, which demands are construct. It writes the decision into the station template, so the adjustment decision does not have to be made from scratch for each candidate. When a demand is construct, it cannot be adjusted away. When it is formatted, it can.
How do adjustments differ across the parts of a station?
The guide's most useful move is to analyze the three parts of an encounter separately: the pre-encounter material, the encounter itself, and the post-encounter task. The demands differ, so the adjustments differ.
Component | What it usually tests | Format demands that can be adjusted | Demands that are often construct |
|---|---|---|---|
Pre-encounter (reading the chart or instructions) | Understanding the task and the patient's situation | Reading time; print size; screen contrast; a reader or screen reader; a printed copy of on-screen material | Recognizing what matters in the information |
Encounter (the station itself) | The clinical, technical, or communication skill | Room layout and access; an adjustable couch; a chair for the candidate; extra time for movement between rooms; a rest break; a scribe or a signer where the skill is not communication | The skill itself, including the time pressure when that is a stated outcome |
Post-encounter (documentation or questions) | Reasoning and recording | Typing or handwriting alternatives; extra time; a separate quiet room; assistive software | The content and accuracy of the record |
Two adjustments need care. Extra time is the most common request and the least examined. Applied to a whole circuit, it changes the rotation for every candidate, so it usually means a separate circuit, a separate session, or a candidate who sits the timed encounter as designed and gets extra time only in the pre- and post-encounter parts. A human reader or signer inside the encounter can change what the station tests. Decide that per station, in advance.
What process should the school follow?
The decision model in the guide runs in steps from the candidate's request to the record of what was done. Reduced to a process a school can run:
- Publish the policy with the handbook: what can be requested, what evidence is needed, the deadline. The timeline opens requests at three months and issues decisions at four weeks.
- Receive the request through student support, with evidence. The OSCE lead does not see the medical details; student support translates them into functional needs.
- Map the need to components. Which stations, which part of each, which demand.
- Check construct against format using the station template's decision.
- Decide the adjustment and the fallback if it cannot be delivered at a site. The OSCE lead approves; the governance page sets out the roles.
- Implement it in the plan: the room plan, the circuit, the packs, the examiner's brief. The examiner is told what changes and not why.
- Record it as applied on the day, with any deviation, in the exam office log.
- Review it with the candidate after results and update the policy.
The record is the piece that gets forgotten. An appeal on the ground that an approved adjustment was not applied is decided on that record.
What should the policy say?
Keep it to one page under the regulations. It states:
- Who can apply, by when, and with what evidence.
- That adjustments are decided per station component, and that construct demands are not adjusted.
- The standard adjustments the school can deliver at every site, and those that need notice.
- That examiners are told the adjustment, not the reason.
- How adjustments are recorded and how a candidate can raise a failure to apply one.
- That candidates with adjustments sit the same stations and are marked to the same standard.
The last point matters for fairness in both directions. An adjustment changes access to the task. It does not change the pass mark.
Where do accessible OSCEs go wrong?
- A blanket rule. "Twenty-five percent extra time on everything." It ignores the component analysis and changes the circuit for everyone.
- Adjustments decided by the examiner in the room. Kind, inconsistent, and unrecorded.
- The reason shared with examiners. There is no need to apply the adjustment, and it invites bias.
- No fallback at the second site. The adjustment exists on paper and not in the building.
- Universal design never attempted. Every candidate with low vision becomes an individual case that large-print instructions would have solved.
Frequently asked questions
What reasonable adjustments are common in an OSCE?
Extra reading time before the encounter, large-print or screen-reader material, an accessible room and couch, a rest break, a separate quiet room for documentation, and a typing or handwriting alternative for the written task. Adjustments within the encounter itself are determined per station, since the encounter is usually where the skill is tested.
Can a candidate get extra time in an OSCE?
Yes, where time is part of the format and not the skill. Extra time is easiest to give in the pre-encounter reading and the post-encounter writing. Inside a timed encounter, it depends on whether time pressure is a stated outcome of the station. Because it changes the rotation, it often means a separate circuit or session.
What is the difference between universal design and a reasonable adjustment?
Universal design changes the exam for everyone so that fewer candidates need anything individual: readable instructions, accessible rooms, signals that are heard and seen. A reasonable adjustment changes the exam for one candidate whose need the design did not cover. The accessible-OSCE guide treats them as complements.
Should examiners know why a candidate has an adjustment?
No. They need to know what changes in the station: the extra time, the seated position, the printed chart. The reason stays with student support. Sharing it is unnecessary for applying the adjustment and invites bias in the marking.
Who decides on OSCE adjustments?
Student support receives the request and the evidence, then turns them into functional needs. The OSCE lead approves the adjustment in accordance with the station's construct-and-format decision. The exam office and the floor manager implement it in the room plan and the packs, and the exam office records what was applied on the day.