---
title: "What an OSCE costs: cost drivers, published ranges and a worksheet"
description: "OSCE cost drivers, published per-candidate figures from four decades of studies, where the hidden costs sit, and a worksheet to build a budget."
canonical: https://studydrome.com/docs/osce/planning/budget-and-cost-model/
updated: 2026-09-27
---

# What an OSCE costs: cost drivers, published ranges and a worksheet

OSCE cost drivers, published per-candidate figures from four decades of studies, where the hidden costs sit, and a worksheet to build a budget.

An OSCE costs between a few dollars and a few hundred dollars per candidate, depending on who is paid and who volunteers. Published figures run from about US$35 per student-station in 1993 to £293 per student at one Scottish school in 2015. Examiner time is the highest cost everywhere. This page lists the drivers, the published ranges, and a worksheet to build a budget.

## What drives the cost of an OSCE?

A 2025 scoping review of OSCE cost studies groups the spending into five categories: simulated patients, examiner compensation, infrastructure, logistics and digital resources. That is a useful frame. Within it, three drivers move the total more than the rest.

**People hours.** Every station needs one or two examiners for the whole session, plus a simulated patient where the station calls for one. The design-and-deployment guide plans on one to two examiners per station. Multiply by the number of stations, circuits, and sessions, and the hours add up fast. The 2025 review reports one six-station OSCE that consumed more than 300 staff hours, about eight hours per student.

**Paid versus volunteer time.** This is the largest swing. A 1997 paper on running an OSCE "on a shoestring" reduced costs to about US$70 per student through volunteer faculty and sparing use of simulated patients. The 1993 Toronto analysis put the cost at about US$35 per student-station before counting donated time. Whether faculty examining counts as free depends on who is asking.

**Simulated patient pay and training.** A survey of US and Canadian schools found that 54% of programs hire 51 to 100 simulated patients a year, with an average of 4.8 permanent staff in the program. Pay in that survey was about US$15-16 per hour for training and portrayal. The AMEE guide recommends preparation time of up to 15 hours per simulated patient. Training hours are paid hours.

Behind those three sit the fixed costs: rooms, equipment, consumables, catering, printing or devices, and the exam office's time across the year.

## What do published studies say an OSCE costs?

Four decades of studies give a range rather than a number. Read each figure with its year, its currency and what it counted.

| Study | Setting | Figure | What it counted |
| --- | --- | --- | --- |
| Reznick et al., 1993 | Canadian licensing-style OSCE | About US$35 per student-station | Before donated faculty time |
| Cusimano et al., 1994 | Canadian medical school | CAD 200 to 300 per candidate; up to about CAD 900 | The higher figure adds hidden administrative costs |
| "Shoestring" OSCE, 1997 | Low-budget program | About US$70 per student | Volunteer faculty, few paid simulated patients |
| Brown et al., 2015 | University of Aberdeen final-year OSCE | £293 per student | Component costing; examiner time the main cost |
| Scoping review, 2025 | Studies across settings | Under US$7 per student to over US$150,000 per cycle | Whole range of the literature |

Two lessons come out of the table. First, the per-candidate cost of a high-stakes OSCE in a well-resourced school has remained in the low hundreds in local currency for thirty years. Second, the range is wide because the studies count different things. A figure that excludes faculty time can be a tenth of one that includes it. Ask which one you are looking at before you compare.

## Where are the hidden costs?

The 1994 Toronto study is the one to remember. Its headline cost was CAD 200-300 per candidate. When the authors added the administrative costs that no budget line showed, the figure rose toward CAD 900. Three costs hide most often:

- **Exam office time across the year.** Scheduling, candidate lists, room bookings, printing, reconciliation of marks. It is salaried, so no invoice appears. It is still cost.
- **Station development.** Writing, review and piloting take faculty hours months before the exam. Most budgets start on exam day.
- **Chasing incomplete data.** A Swiss study of 377 examiners found that 14.2% of paper checklists had missed ratings, and none of the electronic ones did. Every missed rating is a phone call, a reconstruction, or a mark that cannot be used. The staff hours to fix them are nowhere to be found.

A budget that includes these three is honest. A budget that excludes them is the one that gets approved and then overrun.

## How can a school reduce costs without reducing quality?

The evidence points to five levers. Each has a limit.

1. **Use faculty examiners as part of their teaching load.** Most schools do. The limit is fairness: examining is work, and unpaid work gets declined at short notice.
2. **Use trained senior students or staff as simulated patients for low-stakes stations.** The limit is stakes. A summative station needs a trained, calibrated portrayal.
3. **Run more candidates through the same set-up.** Two sessions on one day share the venue, briefing, and equipment. The limit is examiner fatigue and the security of the stations between sessions.
4. **Build a station bank.** Development cost is paid once and reused. The limit is that banked stations still need review and, if changed, a pilot.
5. **Start formative.** The Tunisian implementation study recommends formative OSCEs first, because the barriers it found were educator capability and student familiarity, not money alone. A formative exam costs less and builds the people who make the summative one cheaper.

What does not work is cutting the station count or the training. Fewer stations lower reliability, as the [validity and reliability page](/docs/osce/foundations/validity-and-reliability/) explains. Untrained examiners raise variance. Both costs come back as appeals.

## The OSCE cost worksheet

Copy the table and fill the quantity and rate columns. Multiply across for each row, then add the rows. Keep two versions: one that prices faculty and staff time, one that does not. Show the committee both.

| Cost driver | Unit | Quantity | Rate | Total |
| --- | --- | --- | --- | --- |
| Examiners on the day | Examiner-hours | stations × examiners per station × session hours × sessions | Hourly cost, or 0 if in load |  |
| Examiner training and calibration | Examiner-hours | examiners × training hours | Hourly cost |  |
| Simulated patient portrayal | SP-hours | SP stations × session hours × sessions | Hourly pay |  |
| Simulated patient training and rehearsal | SP-hours | SPs × training hours | Hourly pay |  |
| Station writing and review | Faculty-hours | new stations × hours per station | Hourly cost |  |
| Pilot | Faculty and SP hours | stations piloted × hours | Hourly cost |  |
| Venue | Room-days | rooms × days including rehearsal | Daily rate, or 0 if owned |  |
| Equipment and consumables | Items | per station list, plus spares | Unit price |  |
| Marking: paper or devices | Sheets or devices | candidates × stations, or device count | Print cost, or device and license cost |  |
| Catering and travel | Persons | examiners + SPs + staff | Per-person rate |  |
| Exam office time | Staff-hours | scheduling, lists, reconciliation, results | Hourly cost |  |
| Analysis and reporting | Analyst-hours | standard setting, metrics, report | Hourly cost |  |
| Appeals and resits | Hours and rooms | expected cases × hours | Hourly cost |  |
| Contingency | Percent of total | 10% |  |  |

Divide the total by the number of candidates for the per-candidate cost. Compare it with the published range. If it is far below, check which rows you set to zero.

## Frequently asked questions

### How much does an OSCE cost per student?

Published figures range from under US$7 to a few hundred dollars per student, depending on what is counted. A well-resourced summative OSCE has cost in the low hundreds in local currency for thirty years: CAD 200 to 300 in 1994, £293 in 2015. Whether to count faculty time is the biggest reason the figures differ.

### What is the highest cost in an OSCE?

Examiner time. The Aberdeen component costing identified it as the main cost, and the 2025 scoping review lists evaluator compensation and simulated patients as the two largest categories. Every station needs one or two examiners for every session, and they need training before the day.

### How much are simulated patients paid?

A survey of US and Canadian schools found pay of about US$15-16 per hour for both training and portrayal. Rates vary by country and by the demands of the role. Training hours are paid hours, and the AMEE guide puts preparation at up to 15 hours per simulated patient.

### Is an electronic marking system cheaper than paper?

The published evidence is about data quality rather than price. A Swiss study of 377 examiners found that 14.2% of paper checklists had missed ratings, and none of the electronic ones did. The staff hours spent chasing missed ratings are a real cost that rarely appears in a budget. Price the device or license against those hours.

### Can a school run an OSCE on a very small budget?

Yes. A 1997 paper describes an OSCE at about US$70 per student using volunteer faculty and few paid simulated patients, and the 2025 review includes studies under US$7 per student. The trade is people's unpaid time. Start with a formative OSCE, build the station bank and the examiner pool, then raise the stakes.

## Sources

**Sources**

1. [Cost analysis of the objective structured clinical examination: a scoping review](https://pubmed.ncbi.nlm.nih.gov/41586756/) (Simulation in Healthcare, 2025)
2. [Cusimano MD, Cohen R, Tucker W, et al. A comparative analysis of the costs of administration of an OSCE](https://pubmed.ncbi.nlm.nih.gov/8018269/) (Academic Medicine, 1994)
3. [Reznick RK, et al. Cost analysis of objective structured clinical examinations](https://pubmed.ncbi.nlm.nih.gov/7669163/) (Academic Medicine, 1993)
4. [Running an objective structured clinical examination on a shoestring budget](https://pubmed.ncbi.nlm.nih.gov/9207170/) (PubMed, 1997)
5. [Brown C, Ross S, et al. Money makes the (medical assessment) world go round: the cost of components of a summative final year OSCE](https://doi.org/10.3109/0142159x.2015.1033389) (Medical Teacher, 2015)
6. [Standardized patient practices: initial report on the survey of US and Canadian medical schools](https://pmc.ncbi.nlm.nih.gov/articles/PMC2779617/) (PubMed Central, 2009)
7. [Wagner FL, Feller S, Schmitz FM, et al. Usability and preference of electronic vs paper and pencil OSCE checklists](https://pmc.ncbi.nlm.nih.gov/articles/PMC9174065/) (GMS Journal for Medical Education, 2022)
8. [Ben Amor A, et al. Evaluation of the implementation of the OSCE in health sciences education from a low-income context in Tunisia](https://pmc.ncbi.nlm.nih.gov/articles/PMC11089342/) (Health Science Reports, 2024)
9. [Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part II: organisation and administration](https://doi.org/10.3109/0142159X.2013.818635) (Medical Teacher, 2013)

> [!TIP]
> **In practice**
> The marking row of the worksheet is where paper and software get compared. To see what an electronic OSCE looks like from the examiner's device to the results report, read how StudyDrome runs an OSCE at /exam-manager/osce/.