Objective Structured Practical/Clinical Examination

Objective Structured Practical/Clinical Examination, OSPE/ OSPE

1. OBJECTIVE STRUCTURED CLINICAL/PRACTICAL EXAMINATION(OSCE/OSPE) Amit newton MSc Psychiatric Nsg

2. Introduction : Assessment of clinical competence is an essential requirement of health professional education. Since its development in the 1970’s the objective structured clinical examination(OSCE) has gained acceptance as a benchmark for clinical skills assessment(Banfay,2004). It has been widely adopted tool to assess the student’s competence in a range of subjects.

3. Conti.. It is a formal assessment of student’s clinical procedure skills. An OSCE requires each student to perform or demonstrate specific skills and behaviors in a simulated work environment with standardized patient.

4. Candidates are assessed using exactly the same stations or cues with the same marking scheme. Candidates get marks/points for each step that they perform/answer correctly. This makes the assessment of clinical skills more objective rather than subjective .

5. Stations/cues have specific tasks. Where simulated patients are used, detailed scripts are provided to all candidates, including emotional data. Instructions are carefully written/spoken to ensure that candidates are given specific tasks to complete or questions to answer. The OSCE is carefully designed to include all elements of the curriculum .

6. An OSCE is designed to apply clinical and theoretical knowledge . Where theoretical knowledge is required, questions are standardized.

7. There can be clinical or practical tasks:

8. definition According to Harden,1988; O bjective S tructured C linical Examination(OSCE) is an approach to the assessment of clinical competence in which the components of competence are assessed in a well planned or structured way with attention being paid to objectivity.

9. Ospe : Objective structured practical examination is a new pattern of practical examination in which each component is tested uniformly and objectivity for all the students who are taking up a practical examination at a given place.

10. Features: The examiner cover a broad range of clinical skills. A pre-set structured mark scheme is used; hence reduced examiner input and discretion. Emphasis on what candidates can do rather than what they know. Written answer sheets are observe and assessed by using checklist. The scoring is objective.

11. Full simulated of a “real” situation OSCEs are based on practice not necessarily how the complete job is done A discrete aspect of a learning outcome e.g . Taking a blood pressure e.G A full ALS resuscitation

12. Importance: Enhance student’s interest . Encourage each student to demonstrate specific behaviors in simulated work environment. Now being adopted in disciplines. Enhance clinical or practical skills performance

13. Practical skills are assessed in nursing using osce / ospe .

14. Conti..

15. Components of osca : Khattab & Ravelings (2001) report using a two components objective structured clinical assessment (OSCA) for student nurses. One for tasks(skills assessment) One for questions ( knowledge assessment)

16. Tips for organizing an osce / ospe Assessment. Duration of station. Number of stations. Use of examiners. Range of approaches. New stations. Organization of examination. Resource requirement.

17. Conti.. Plan of examination and directions. Change signal. Records.

18. Requirement for conducting osce / ospe : Standardized Patient(SP):- Standardized patients are individuals trained to portray a patient with a particular disease or condition; thus affording hands on testing of students. Use of standardized patients increase reliability across different stations.

19. Conti.. Station and required Procedure articles:- Number of stations are determined by number of students and number of activities for which examiners want to evaluate students. Arrange necessary articles in advance and prepare different stations

20. Making schemes:- Checklists have been standard in many established OSCE/OSPE programs and have intuitive value as an assessment tool. But; checklist may have limits when testing skilled students. Global rating scales scored by experts show higher inter-station reliability; better construct validity .

21. Checklist Examiner to fill in box to each item that student successfully completes Marks Drapes patient appropriately 2 Inspects abdomen 1 Auscultation abdomen 1 Percussion abdomen 1 Asks patient for the location of pain 1 Start to palpate abdomen from the area which is not pain 2 Lightly palpates each quadrant 2 Deeply palpates each quadrant 2 Checks for peritoneal irritation 2 Stem

22. Trained observer:- Roles of trained observers in conduction of OSCE/OSPE are: Observes the performance of the trainee at a particular task. Score according to the marking scheme. Contribute to the good conduct of the examination.

23. Steps of conducting OSCE/OSPE Registration :- The first step is registration. The students must show their identification card; and keep in mind about the exam rules. Orientation:- Students should be oriented initially with the format of OSCE, procedures and policies. Keep the students informed with the number of groups they would be divided into and team leader assigned to them.

24. Escorting the students to exam position:- Students are divided into groups e.g ; if total number of students are 25 and there are 5 stations; then each group will consist of five each students. Exam starts with buzzer or long bell. Station instruction time:- Once to two minutes will be given; students should read the instruction about the station situation, patient, and required tasks.

25. The Encounter:- Students should execute the skills for the period of 5-20 minutes. The period should be fixed with accurate time for all procedures. Perform the required tasks. Stop at the next bell/buzzer. Repeat steps 4 to 5:- Following the bell; the students will go the next stations and step 4 and 5 are repeated till; the students complete all the stations.

26. Post encounter period:- This is question-answer period. Escorting to dismissal area:- Examination has come to end. Students will be escorted to the dismissal area; where the identity card will be taken back. Keeping them away in this area for some-time; is for security reasons that is in case another group of students have to be evaluated on the same day.

27. Exam Venue

28. Changing Stations

29. Simulated Patient(examination)

30. 32 STATION : TWO TYPES EXAMINER OBSERVES STUDENT ANSWERS ON THE ANSWER SHEET PROCEDURE STATION e.g. Taking history of a patient Examine eye of a patient QUESTION STATION MCQs related to finding Interpretation of lab report etc .

31. 33 PROCEDURE STATION : e.g. 1 History taking / Examining a patient - Examiner is present - Uses a check list to record the performance of the students as they pass through stations e.g. 2 Chest X-Ray inspection - No examiner - Student asked about his findings & interpretation at the next question station. - May be given additional information and asked about patient management (MCQs / TRUE – FALSE type Question used)

32. Physical Examination Station

33. History Taking Stations

34. A Procedure Station

35. 37 Examiner’s Checklist Student’s Name :……………………………………………… Instructions to students Carry out a neurological examination of the lower limbs excluding sensation and coordination Inspection of legs Test for tone Test for clonus Test power – Ankle Test power – Knee Test power – Hip Test reflexes – Knee Test reflexes – Ankle Test reflexes – Plantar Total Mark for general proficiency Taking into account, for example Scale Procedure carried out 8-10 Distinction Sequence of procedures 7 Very good pass Student has tendon hammer 6 Pass 5 Bare Pass 4 Fail 0-3 Bad Fail Total Carried out Satisfactorily Attempted but not Satisfactorily Not Attempted Please tick the appropriate boxes (3) Mark for attitude to patient Taking into account, for example Scale Use of patient’s name 8-10 Distinction Explanation to patient 7 Very good pass Discomfort to patient 6 Pass 5 Bare Pass 4 Fail 0-3 Bad Fail Total

36. 38 QUESTION STATION - PHYSICAL EXAMINATION Question : “ Which of the following statement is / are true about the patient you have just examined? 1. A) Inspection reveals muscle wasting in left leg. B) The tone in the left leg is decreased. C) Adduction at the left hip is decreased in power D) Flexion power at left knee is decreased E) Muscle power at the left ankle is decreased 2. A) The knee jerk on left side is increased B) The ankle jerk on left side is increased C) Clonuses is present at the left ankle. D) The left plantar reflex is flexor E) The signs in the left leg are those of an upper motor neuron lesion

37. 39 OTHER COMPONENTS OF COMPETENCE ASSESSED BY OSCE : Inspection – e.g.. Inspect the hands / face of this patient. Interpretation of Patient’s charts / Lab. Investigations : Record of temperature B.P. Chart ECG, Chest X-Ray. Biochemical / Hematological report Respiratory function report……. Patient education Interpersonal skills Instruments Specimens Practical procedures – on models e.g. CPR, L.P…. Fundus examination -

38. 40 EXAMINE ABDOMEN ANS.-Q. ON ST.1 QUE.ON ECG ECG ANS.-Q ON CT CT SCAN QUE.ON ST. 7 HISTORY QUE. ON ST. 5 HISTORY ANS.-Q ON ST.3 EXAMINE CHEST SPOT SLIDE (SPOT) QUE.ON ST.17 NEURO EXAM. QUE.ON ST.15 CVS EXAM. LAB DATA INSTRU. & QUE. 1 14 15 16 17 18 19 20 9 8 7 6 5 4 3 2 10 11 12 13 EXAMPLE OF OSCE

39. 42 OBJECTIVE STRUCTURED PRACTICAL EXAMINATION (OSPE)

40. 43 OBJECTIVE STRUCTURED PRACTICAL EXAMINATION (OSPE) Adaptation of OSCE to be applied for evaluation of skills in preclinical and paraclinical subjects. Basic format remains same i.e. procedure stations and question stations. Can be used as supplement to different method of evaluation

41. The OSPE is a method of objectively testing the practical knowledge and skills acquired during the preclinical years of a medical curriculum. This method was standardized by the All India Institute of Medical Sciences. It is a modification of Objective Structured Clinical Examination (OSCE) used for clinical evaluation.

42. Objective Structured Practical Examination (OSPE) is an assessment tool in which the competence of a student is evaluated: For general experiments; In terms of: Identification of equipment/accessories of experiment, procedure of experiment, handling of instruments, making observations/results, interpretation of results, conclusion.

43. Legal and ethical issues of clinical and evaluation and grading.

44. ADVANTAGES Ensures integration of teaching and evaluation. Examiners can decide in advance what is to be tested. Examiner can have better control on the content and complexities. Emphasis can be move from testing factual knowledge to testing a wide range of skills; including advance clinical skills. A large number of students can be tested and there is increased faculty-student interaction. Use of checklists and MCQ’s by examiner result in more objective examination.

45. Bibliography; Sharma Suresh K. Communication and Education Technology. Elsevier publishers; 2012; p: 397-403. Mukesh Chandra. Textbook of Nursing education. 1 st edn . Jaypee Publishers; 2013; p: 274-278. web.squ.edu.om/med/ chpe /CHPE2011/CHPE2011/11.%20 osce / ospe .