Workshop on ospe and osce

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Workshop on ospe and osce

  1. 1. Prof. Mrs Betty Thomas
  2. 2. INTRODUCTION • Assessment of clinical practice skills in health profession’s education poses several challenges in terms of its objectivity. • Objective Structured Clinical Examination (OSCE) is one form of objective evaluation method that is gaining more importance and is being adopted by educators of various disciplines.
  3. 3. Cont..d • It involves use of cognitive skills like critical thinking and problem solving. OSCE also enhances good interaction between the teacher and the student Although OSCE is practiced worldwide in nursing education, its practice in India and other developing countries is scarce. • The nurse educators from India and other developing countries should be encouraged to utilize this form of evaluation.
  4. 4. DEFINITION • OSCE is an approach to the assessment of clinical competence in which the components of the competence are assessed in a planned or structured way, with attention being paid to the objectivity of the examination (Harden, 1988).
  5. 5. • In a non clinical area e.g. Biochemistry/Anatomy Physiology lab setting), a similar approach may be adopted and in this context, it is referred to as an OSPE (Objective Structured Practical Examination).
  6. 6. PURPOSES OF OSCE According to Boursicot, Ware, and Hazllet (2011), the purposes of OSCE are to – Measure clinical skills – Match assessment to intended constructs – Promote structured interaction between student andexaminer – Make structured marking scheme possible – Present all candidates with the same test – Promote objectivity
  7. 7. COMPONENTS ASSESSED IN OSCE • Various components of clinical competence are assessed using OSCE, – For example, the components of advance clinical nursing practice skills typically assessed by OSCE are… 1. Interpersonal and communication skills 2. History taking skills 3. Physical examination of specific body system 4. Mental health assessment 5. Clinical decision making including the informationof differential diagnosis
  8. 8. Cont..d 6. Interpretation of clinical findings and investigations Management of a clinical situation including treatment and referral 7. Patient education 8. Health promotion 9. Clinical problem solving skills 10.Acting safely and appropriately in an urgent clinical situation 11.Critical thinking in therapeutic management
  9. 9. THE COMPONENTS OF THE OSCE • The OSCE (Objective Structured Clinical Examination) has reached a stage of development that allows clear recognition of key components that bring structure and organization to its construction, implementation and assessment of its performance.
  10. 10. The major components are: 1. The (examination) coordinating committee 2. The examination coordinator 3. Lists of skills, behaviors and attitudes to be assessed 4. Criteria for scoring the assessment (marking scheme of checklist) 5. The examinees 6. The examiners 7. Examination site
  11. 11. Cont…d 8. Examination stations – 8.1 Time and time allocation between stations – 8.2 Anatomic models for repetitive examinations (Breast,Pelvic/Rectum) – 8.3 Couplet Station – 8.4 Examination Questions – 8.5 Environment of Exam Station – 8.6 Examination Station Circuit
  12. 12. 1. The Examination Coordinating Committee • An examination coordinating committee is made up of members who are committed to the evaluative and educational process and whether appointed or volunteered must give this effort high priority in order for the OSCE to be developed and implemented. • It is the responsibility of the examination committee to determine the content of the examination, development and implementation.
  13. 13. 2. The Examination Coordinator • The functions of the examination coordinator (M.D. or Ph.D. educator) are the catalyst that facilitates the smooth working of the committee in developing, implementing and assessing the performance of the OSCE.
  14. 14. 3. Lists of Skills, Behaviors and Attitudes to be Assessed • The examination will measure objectively the competencies in specific areas of behavior, techniques, attitudes and decision-making strategies based on the objectives of the course or the requirement of the licensing body. • The OSCE should be able to reliably assess clinical competence in history taking, physical examination, laboratory, radiographic and other data interpretation, technical and procedural skills as well as counseling and attitudinal behaviors.
  15. 15. 4. Criteria for Scoring the Assessment (Marking Scheme or Checklist) • A marking scheme or checklist is prepared for each station. Preparation of the checklist requires predetermined objective criteria that are agreed upon by the examination committee, based on faculty input. • Marking scheme/checklist should be concise, unambiguous and written to contribute to the reliability of the station.
  16. 16. 5. The Examinees • The examinee is the student, resident, or fellow in training or at the end of training of a prescribed course designed to teach certain clinical competencies that the examinee can use in a clinical situation to make an assessment and develop a diagnostic formulation that culminates in a therapeutic plan.
  17. 17. 6. The Examiners • Most stations will require an examiner, although some stations do not. The examiner at the station where clinical skills (history-taking, physical examination, interviewing and communication) are assessed, may be either a physician or a standardized patient
  18. 18. 7. The Examination Site • The examination site is part of a special teaching facility in some institutions. When such facilities are not available, the examination may be conducted in an outpatient facility or other space where offices are available in close proximity to each other.
  19. 19. 8. Examinations Station • The total number of stations will vary based on a function of the number of skills, behaviors and attitudinal items to be tested. 8.1 Time Allocation and Time between Stations – The competency being assessed in particular station will define how much time should be allotted per station. The length of time will range from 5-20 minutes. – The time allocated per station should be as uniform as possible thus facilitating the smooth movement of examinees from station to station.
  20. 20. Cont…d e.g., a 10 minute station, 9 minutes is allocated for the task and one minute transit time to the next station. The examiner can complete the checklist prior to the entry of the next examinee.
  21. 21. 8.2 Anatomic Models for Repetitive Examinations (Breast, Pelvic/Rectum • The skill, behavior or attitude to be tested in a station determines whether the station requires a real patient, simulated patient Chronic patients (stable) may serve well in this situation with proper training. • Simulated patients who are well-trained offer reliability and consistency in the quality of their presentations.
  22. 22. 8.3 Couplet Station • Some competencies may best be assessed by coupled or linked stations. For example, a couplet station may consist of a history-physical examination combined with a problem-solving station.
  23. 23. 8.4 Examination Questions • Examination questions are designed to assess the ability to interpret information and critical thinking. The questions deal with diagnostic investigations, differential diagnostic and management plans.
  24. 24. 8.5 Environment of Exam Station • The Examination Station environment should be conducive to the competency to be tested, including adjustable lighting for fundoscopic examinations and appropriate examination tables for focused physical skills assessment. • Stations where auscultatory skills are being assessed should be either well insulated or in appropriately quiet areas of the examination site. Clearly marked directions leading from one station to the next should be displayed.
  25. 25. 8.6 Examination Stations Circuit Stations • The Examination stations should be clearly marked in a logical sequence that allows easy, unimpeded transit from one station to the next.
  26. 26. EXAMPLE S.No Station Task/Question 1. I Check and record Blood Pressure 2. II List five factors which helps in maintaining Blood Pressure 3. III Take oral temperature and record it 4. IV Rest station 5. V Using the formula, convert 39 °C into Farenheit 6. VI Test the urine for sugar and albumin 7. VII List five causes of albuminuria
  27. 27. 9. Patient (Real) or Simulated • A standardized patient is an individual with a health problem that is in a chronic but stable condition. Standardized or simulated patient may be used when properly trained for history and physical assessments. • Simulated patients may come from the ranks of volunteers, or acting guilds.
  28. 28. Cont..d • Detailed instruction package is provided for both the standardized and simulated patient. The instructions describe how the patient responds to historical questions and physical exam, as well as how the patient should dress
  29. 29. 10. Timekeeper, Time Clock and Time Signal • Appropriate personnel for the position of official timekeeper and exam facilitators need to be identified and properly instructed. A well functioning time clock and time signal are critical. • One support person per three stations is recommended.
  30. 30. 11. Contingency Plans • A contingency plan includes reserve standardized patients who are trained to assume a number of roles, and a patient trainer who circulates to deal with any patient problems that arise. • A number of reserve stations should be available. A contingency plan must be developed for students who must leave the exam when the situation arises.
  31. 31. 12.Assessment of the Performance of the OSCE • The OSCE should be tested for appropriate measurement characteristics such as validity, reliability, feasibility and credibility. • A valid OSCE station measures what it was designed to measure. A reliable station measures it consistently. • Grading can be based on a criterion-referenced system, norm-referenced system, or a combination of both. The Examination committee needs to decide in advance which system best meets its fundamental purposes for the exam.
  32. 32. ADVANTAGES The advantages of OSCE outweigh other traditional methods of clinical evaluation. The main advantages of OSCE listed by Wikidot (2011) are as follows: – The whole examination is objective – It ensures integration of teaching and evaluation – Variety inbuilt in OSCE maintains student's interest – It helps in the development of critical thinking and problem solving skills – There is increased faculty and student interaction – It is adaptable to local needs – A large number of students can be tested within a short time – Subjective bias is minimized
  33. 33. LIMITATIONS • As components of clinical competence are broken down for examination at different stations, it leads to the following limitations such as: • Compartmentalization • Inability to assess simple and specific skills • Discomfort to patient • Artificial setup • Fatigue of examiners
  34. 34. Viva Voice/Oral Examination • Knowledge is tested in theory examination and skills are evaluated in clinical/practical examination and oral examination is meant to evaluate the following qualities: depth of knowledge, ability to discuss and defend one's decisions,' attitudes, alertness, ability to perform under stress and professional competence.
  35. 35. Cot..d • Oral examination should primarily aim at testing, problem-solving, alertness, ability to develop and answer and come decisions quickly.
  36. 36. Advantages • It allows a direct contact between the examiner and the examinee, it provides an opportunity for studying personal characteristics and permits flexibility in questioning. • There is less scope for cheating or unfair practice by the examinee. • It can be a good learning experience as there is scope for an immediate feedback.
  37. 37. Objective Structured Practical Examination (OSPE) • Objective structured practical examination (OSPE) is a new pattern of practical examination, in which each component of clinical competence is tested uniformly and objectively for all the students who are taking up a practical examination at a given place.
  38. 38. Steps of OSPE • In order to organize an OSPE successfully, one has to spell out the objectives of practical experiences in a given discipline related to a particular subject. 1. Demonstrate Practical Skills. For example, for demonstration of practical skills, monitoring and recording oral temperature, blood pressure, converting 39.4 degree centigrade to Fahrenheit and testing urine for sugar, etc. can be given.
  39. 39. 2. Make Accurate-Observations Differentiate between the normal and abnormal ECG, identify the type of arrhythmias from the ECG. 3.Analyze and Interpret Data Hemogram report, liver function report, urine or blood sugar report and other laboratory reports.
  40. 40. 4. Identify the Patient's Problems • The student has to identify the patient's problem in order to organize her work. • Problems such as Dyspnea, • Rieor following blood transfusion and • CSF rhinorrhea following head injury. 5. Plan Alternative Nursing Interventions • In case of airway obstruction, the student is expected to keep the patient in side lying position. • Do Oro pharyngeal suction. • Start O2 inhalation if required.
  41. 41. Types of Stations • Procedure station: It requires a student to perform a task, e.g. monitoring of oral temperature. When a student performs the task, simultaneously she is observed and marked against the checklist being prepared in advance, by a silent but vigilant examiner.
  42. 42. • The question station/the response station: The student answers the question being asked on the answer sheet provided and leaves it in the place specified.
  43. 43. Scoring Students in OSPE • For each specific skill, a checklist is prepared by breaking the skill being tested into essential steps and score is assigned to each step which is proportional to the importance of the step related a particular procedure.
  44. 44. Procedure of Conducting OSPE • Examiners A, B, C stand in a place from where they can have a good view of what a candidate is doing at a particular station. They have a checklist on which they tick as they observe. The score of each student is entered separately and confidentially.
  45. 45. • The students are given clear instructions regarding how they will rotate around the stations and the time limit in each station and what they are supposed to do in each station (demonstrate a skill, make observation, make calculation from the data provided or answer the question asked).
  46. 46. Limitations of OSPE • OSPE is used only in simulated situations due to non- availability of patients for the same procedure. • The simulated situation may not reflect the real life situation. • Students cannot be assessed for different skills, such as IPR, communication skills and dexterity in handling equipments. • Empathy towards the patients cannot be evaluated. • The skill of the student in providing holistic nursing care cannot be assessed.
  47. 47. Cont…d • It may be time consuming to construct an OSPE. • It cannot be used by a single person, it needs more resources in terms of manpower, time and money. • There is no interaction between the examiner and the student. • There is a risk of fatigue.
  48. 48. APPENDICES
  49. 49. LIKERT SCALE CONT..D
  50. 50. CHECKLIST
  51. 51. CONCLUSION • The OSCE has several distinct advantages. In view of these, the nurse educators can adopt it as an objective method for clinical evaluation. This will help the students to improve their clinical competence. The emphasis is on assessing what students can do rather than what they know. Therefore, OSCE gives direction for attaining the ultimate aim of the teaching- learning process.
  52. 52. REFERENCES • Agarwal A., Batra, B., Sood, A. K., Ramakrishnan, R., Bhargava, S. K., Chidambaranathan, N., & Indrajit, I. K. (2010). Objective structured clinical examination in radiology. Indian Journal of Radiology and Imaging, 20 (2), 83-88. • Boursicot, K., Ware, J., & Hazlett, C. (2011). Objective structured clinical examination and objective structured practical examination. Retrieved from http://www.oes.cuhk.edu.hk/Archives/01d%20 Presentations/OSCE%20OSPE%20B%20W%20H.pdf • Harden, R. M. (1988). What is an OSCE? Medical Teacher, 70(1), 19- 22.
  53. 53. Cont..d • Sturpe, D.A. (2010). Objective Structured Clinical Examinations in Doctor of Pharmacy Programs in the United States. American Journal of Pharmaceutical Education, 74 (8), 148. • Wikidot (2011). Objective structured clinical examination in otolaryngology. Retrieved from http.V/oscenotesent. wikidot .com/

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