OBJECTIVE STRUCTURED CLINICAL EXAMINATION.pptx

Nursing OSCE- OSPE

1. OBJECTIVE STRUCTURED CLINICAL EXAMINATION/ OBJECTIVE STRUCTURED PRACTICAL EXAMINATION 1

2. OSCE and OSPE OSCE was first described in 1975 by Harden and others in the University of Dundee. OSPE is an extension of OSCE First used by Dr Nayar in 1986 in AIIMS to assess the skills of students in Physiology 2

3. Miller’s pyramid 3

4. OSCE/OSPE-Assessment of clinical competence 4

5. Uses For providing feedback selection test adjunct of a long case Quality assurance 5

6. Definition An approach to the assessment of clinical competence in which the components are assessed in a well planned or structured way with attention being paid to the objectivity of the examination. - Harden,1988 6

7. Features Objective- A check list is used to evaluate the students Structured - All students are given the same problem and perform the same tasks in the same time frame Clinical- The tasks given are the representative of those faced in the real clinical situation- skills and attitudes 7

8. FEATURES OF OSCE Stations are short Highly focused Structured mark scheme Reduced examiner discretion Emphasizes on clinical competence than knowledge Test the application of knowledge than recalling 8

9. Components Standardization Multiple stations Structured checklist 9

10. WHAT IS ASSESSED IN AN OSCE? Interpersonal and communication skills History taking skills Physical examination of specific body system Mental health assessment Basic and advanced nursing care procedures. Clinical decision making Clinical problem solving skills Interpretation of clinical findings and Investigations. Management of clinical situations Patient education Health promotion 10

11. Variables in designing Number of stations Length of time in the stations Number of circuits Types of stations Organisation of the stations in the circuit Provision of feedback to the student 11

12. Types of stations 12 Practice based Question based

13. Practice-based stations Procedure station/ Performance station Performs a task Student gets a score, sometimes negatively scored for making mistakes Eg : taking vital signs, taking the history of a patient 13

14. Question station/Interpretation station Answers a question being asked on the answer sheet provided which is left in the place specified Eg: Interpretation of lab results, identifying surgical instruments, specimens 14

15. Linked stations Linked stations are sequential stations at the first of which the candidate carries out a task or prepares for the second station, where he or she builds on the findings of the first station or answers questions related to it. Types-I, II, III, IV

16. Couplet station A variation of the single-station OSCE is the couplet station. A couplet station consists of clinical encounters followed by post-encounter exercises. 16

17. Linked stations Type I Two stations can be linked and are possible with process First station- physical examination is tested and in the second station answers related questions and prepares a report on what was found in the first station 17

18. Contd.. Type II First station student is asked to undertake part of a procedure and complete it in the second station RT insertion followed by RT feeding 18

19. Contd.. Type III First station, student receives information regarding the patient and has to prioritise the problems Vital signs- fever Second station, student has to perform the tasks based on the first station Cold sponge or compress 19

20. Contd.. Type IV First station- the student undertakes an activity or observes any activity- recorded interview of a psychiatric patient Second station- discusses regarding the activity with the examiner 20

21. Personnel involved Student Patient Examiner Assessor Facilitator Time keeper 21

22. Properties used Real patient Simulated patients Simulators Video recordings Patient medical records and investigations Text description of a patient 22

23. If a real patient is used Obtain consent Select a patient who can spend time in the stations Give clear instruction to the patient regarding his role Arrange for refreshments Orient the patient to the environment Standardise the history of the patient Arrange for transportation of the patient 23

24. Simulated patient The patient is carefully trained (history, physical findings, expressions and psychological and emotional responses of the actual patient in a realistic manner) Students, faculty can act Expected to replicate the portrayal consistently for each candidate Paediatric patients- carers also require training 24

25. Others Video recordings – for assessing decision-making abilities of the students with regard to patient care Patient’s records and reports of investigations can be used to interpret the results Eg: ECG tracings 25

26. PRELIMINARY REQUISITES/EQUIPMENTS For Examiner Writing pad with evaluation proforma Scoring sheet Pen Pencil Eraser Sharpener For Examinee Writing pad Paper Pen Pencil Eraser Sharpener Drop Box for documented Response 26

27. Timing 5 to 15 minutes per station Equal timing for the completion of the tasks should be ensured by the examiners 5-15 stations 27

28. Organisation- OSCE Advance planning- content, fixing weightage to various components, deciding on number of staff, selection of patients and their briefing, preparation of various documents including instructions to -students, examiners, patients 28

29. ‘blueprinting’ for OSCE

30. INSTRUCTIONS TO THE EXAMINEE Nandhini, 14 years old school girl residing at had left elbow joint fracture and having severe pain. Examine the fractured site and immobilize the fractured site with the available resources and educate about RICE. Hand over the Response Sheet to the Examiner 30

31. EXAMINEE RESPONSE SHEET Registration Number:______ Date:_____ Documentation: Signature of the Examinee Signature of the Examiner 31

32. Instructions to the simulated patient Your role: Kumari Nandhini You are playing the role of 14 years old girl residing at X Village who has fell down from the bicycle when rushing to the school in hurry. The left elbow bone started to swell without any bleeding. You are unable to move your left upper limb and having severe pain. 32

33. INSTRUCTIONS TO THE EXAMINER Objectives : This station is designed to test the examinee’s ability to -Calculate the BMI for the adult patient Instructions: Observe if the examinees is performing the steps in the correct sequence and interpret the values correctly. Score: Score the task based on the following. - Score “2” for fully competent - Score “1”for partially competent - Score “0” for Incompetent or not performed - Calculate the total score

34. OSCE- Teacher Define objectives Make correct and accurate observations Analyse and interpret data Demonstrate the spirit of inquiry Explain logically unexpected observations 34

35. Stations Criteria   Max. marks Marks       Register Numbers                           Ex I Ex II Ex I Ex II Ex I Ex II Ex I Ex II Ex I Ex II Ex I Ex II Ex I Ex II 1. Cognitive skill/ Writing skill: Nursing care plan 10                         2. Procedural skill   20                         3. Communicative skill   5                         4. Interpretive skill 5                           5. Viva 10                             Total 50                             Grand total 100               KERALA UNIVERSITY OF HEALTH SCIENCES SECOND YEAR BSc. NURSING SURGICAL NURSING - PRACTICAL EXAMINATION Objective Structured Clinical Examination (OSCE) TOTAL SCORE SHEET Examiner I: Examiner II:

36. SL No. Criteria Marks Register Numbers                 1. Analyze the scenario and identify the problem 1           2. Prioritize / formulate nursing diagnosis 2           3. Formulate specific objectives 1           4. Develop appropriate nursing interventions with scientific rationale 4           5. Plan for evaluation of care 1           6. Comprehensiveness and completeness of the plan 1             Total 10           36 Kerala University of Health Sciences SECOND YEAR BSc. NURSING SURGICAL NURSING - PRACTICAL EXAMINATION Objective Structured Clinical Examination (OSCE) EVALUATION CRITERIA: COGNITIVE SKILL STATION Date: Time: 30 mts Name and signature of the examiner

37. Criteria for passing Assessors complete an item checklist, and then an overall global grade Usually five global ratings (e.g. fail, borderline, pass, credit, distinction) (The global grades in our OSCEs are recorded numerically as 0 - clear fail, 1- borderline, 2 - clear pass, 3 - very good pass and 4 - excellent pass). Minimum score and full score in KEY areas/ extra weightage to key steps Chance to reappear

38. Contd.. A day before Final check in the area Documents to respective examiners Lay out should be planned and all stations should be marked Periodic break for patients can be planned Student instructions, plan of station sites, answer sheets, notes- keep it ready 38

39. Contd.. Final check- one hour before Students should be briefed in a side room Examiners should take the positions time keeper Comfort facilities As decided bell should be rung every 5 minutes separate entry and exit 40

40. OSCE – 41 Register Orientation Escorting the students Station instruction time The encounter Repeat steps 4 and 5 Escorting to dismissal area

41. Contd.. After the examination Answer sheets and checklists are evaluated and scored Feedback is given to the students Evaluation 42

42. OSCE- skills example Prepare a cardiac bed Record BP of a patient Prepare 1% hypochlorite solution Prepare adrenaline injection in a ratio of 1:10,000 Perform a surgical dressing Perform a colostomy care 43

43. Definition of OSPE It is a pattern of practical examination For pre-clinical and non-clinical subjects 44

44. OSCE AND OSPE 45

45. OSCE Vs OSPE 46 OSCE OSPE Tests psychomotor skills Tests higher level of knowledge and psychomotor skills Clinical settings Labs Real patients required Standardised patients can be used Examiners required in each station Not mandatory

46. Contd.. Inform the examinees about the objectives of the examination Train the examiners regarding their roles Prepare the site and arrange the stations Ensure adequate space for stations and movement and waiting area Number, type, and time allotted should be decided Prepare direction arrows and station numbers Prepare the list of candidates Appoint a timekeeper or for automatic time signal Decide on giving feedback to the students Organise resources and conduct as planned 47

47. Instructions to students Stationery items which should be brought Electronic devices that should not be brought Writing the identification details- registration number How to proceed to each station Number of stations and direction of rotations Starting and ending time of each station Dos and don'ts in each station 48

48. Eg of instructions to students Student will rotate around stations- numbered 1-10 spending 5 minutes at each station. At each station the student will demonstrate a skill or make observations A bell will be rung at the beginning and end of 5 minutes When the bell rings, student will move to the next station 49

49. Role of examiner Checking the resources at each station- patient and simulated patient Greeting the examinee and checking the registration number Observation and scoring Providing comments and feedbacks Time keeping Keeping a record of the problems faced Deciding the outcome of each student Evaluation of examination process 50

50. Measuring quality of OSCE Assessment of assessment No single metric is sufficient in itself to meaningfully judge the quality of the assessment process C-Alpha Coefficient of determination R2 and many more….

51. Disadvantages- OSCE Can not assess some skills Stimulated situation may not reflect the real life situation Holistic nursing care can not be assessed Time consuming Non-challenging stations 53

52. Merits Objective, reliable, valid and discriminatory Covers a wide spectrum of learning domains A wide range of skills can be checked uniformly in all students The examiners decide on content and complexity and have better control over the content Helps to test the analytical ability of the students Large number of students can be examined in short time Teaching learning errors can be corrected effectively Suitable during pandemics 54