OSCE.pptx

Objective structure clinical examination is an established and multistation test used for the assessment of practical skills of the student.

1. Introduction OSCE means Objective Structured Clinical Examination. It is a form of multi-station examination of clinical subject. It was first described by Harden et al. in 1975. V Objective structured clinical examination (OSCE) is a modern type of examination often used in health sciences ( e.g , medicine, dentistry, nursing, pharmacy and physiotherapy) to assess clinical skill performance and competence in skills such as communication, clinical examination, medical and nursing procedures/ prescription, exercise prescription and interpretation of results .

2. Cont… A framework for the development of clinical competence has been described (Miller 1990) which outlines four levels at which a learner can be assessed: knows, knows how, shows how and does (Fig. 5.2). The OSCE conforms to the third shows how the level of the Miller's pyramid (Fig. 5.1) which focuses on assessment of performance of specific skills in a controlled setting. This makes it particularly relevant for the early stages of undergraduate curricula, where assessment comprises compartmentalized exercises.

3. The development of clinical skills/competence/performance (adapted from Miller) 1990

4. Meaning of OSCE Objective: Because examiners use a checklist for evaluating trainers. Structured: - The marking scheme for each station is structured. - A clinical skills or procedure is typically broken down into component parts in a very structured way. - Structured interactions between an examiner and student. - Stations are short, numerous, highly focused. Clinical: Because the tasks are representative of those faced in real clinical situations. Examination : Because the skills are assessed in the form of examination

5. Definitions of OSCE Objective Structured Clinical Examination (OSCE) is a form of performance-based testing used to measure candidates' clinical competence. During an OSCE, candidates are observed and evaluated as they go through a series of stations in which they interview, examine and treat standardized patients who present with some type of medical problem. According to Harden 1988, The OSCE or objective structured clinical examination is 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. ‘An exam whereby ‘students demonstrate their competence under a variety of simulated conditions ’. - Waston,2002 “ Examinations in which the student is required to perform specific skills and behaviors in a simulated clinical or patient care environment”.

6. Structure of Objective Structured Clinical Examinations In an objective structured clinical assessment, a series of stations in an examination room is set up to examine the students. At each station, students may be asked to carry out a procedure, which may involve taking history, performing preset clinical tasks and diagnosing patients' problems. When performing the clinical tasks, students may often interact with 'patients', who may be healthy volunteers or mock patients. Students also have to answer questions based on their findings and their interpretation. Students are observed and scored at some stations by examiners with checklists.

7. Types of stations

8. Purposes of OSCE Used in both formative and summative assessment in health professional education Identify objective performance criteria for the skill being examined Structure the performance criteria in a checklist to facilitate the identification of desired clinical skills. A requirement for accreditation in many health professional programs.

9. The components of the OSCE The Examination Coordinating Committee The Examination Coordinator Lists of Skills, Behaviours and Attitudes to be Assessed Criteria for Scoring the Assessment The Examinees The Examiners The Examination Site Examination stations Patient (Real/ Simulated) Time keeper/ Time clock and time signal Contingency plan Assessment of the performance of the OSCE

10. OSCE DESIGN An OSCE usually comprises a circuit of short (usual is 5 to 10 minutes although some use up to 15 minute) stations, in which each candidate is examined on a one-to-one basis with one or two impartial examiner(s) and either real of simulated patients (actors). Each station has a different examiner, as opposed to the traditional method of clinical examinations where a candidate would be assigned to an examiner for the entire examination. Candidates rotate through the stations, completing all the stations on their circuit. In this way, all candidates take the same stations. It is considered to be an improvement over traditional examination methods because the stations can be standardized; enabling fairer peer comparison and complex procedures can be assessed without endangering patients’ health.

11. ORGANISATION OF OSCE

12. Cont… A) Advance Planning : Time ideally 6 months for major examination 8 weeks for formative. B ) The Day Before The Examination Final check for preparations & arrangement in ward Final documentation to be given to each examiner C) The Day Of Examination Coordinator 1 hour prior Final check for arrangement Staff member brief the student All examiners have arrived and are at their correct station D ) After The Examination Give feedback to students by showing checklists & questions scored by examiners.

13. Uses of OSCE

14. Advantages of OSCE It provides a uniform marking scheme for examiners and consistent examination scenarios for students. It provides an authentic way to assess nursing students, including pressure from patients Generates formative feedback for both the learners and the teaching program. Immediate feedback collected may improve students' competency at subsequent stations and even enhance the quality of the learning experience. Minimizes the effect of cueing: When students go to a station, they will need to diagnose patients' problems or carry out some clinical procedures. When they go to a subsequent station, they have to answer some questions relevant to their diagnosis or clinical tasks. However, students cannot go back to correct any mistakes or omissions on what they did in the previous station

15. Cont… More students can be examined at any one time. When a student is carrying out a procedure, another student who has already completed that stage is answering the question at another station. In the Objective Structured Clinical Examination, the setting is more controlled (only two variables exist: the patient and the examiner) and a more objective of the student's clinical competency can be made Provides more insights about students' clinical and interactive competencies It can objectively assess other important aspects of clinical expertise, such as physical examination skills, interpersonal skills, technical skills, problem- solving abilities, decision-making abilities, and patient treatment skills

16. Cont… More valid than the additional approach to clinical examinations The examiner can decide in advance what is to be treated and can then design the examiner to test competencies Emphasis can be moved away from testing factual knowledge to testing factual knowledge to testing a wide range of skills including advanced clinical skills. More reliable because variables of the examiner and the patient are removed to a large extent. The use of checklist by examiners and the use of multiple choice questions result in a more objective yon examination More practical because it can be used with a large number of student

17. Disadvantages of OSCE Students' knowledge and skills are tested in compartments and they are not tested on their ability to look at the patient as a whole Demanding for both examiners and patients Examiners are required to pay close attention to students repeating the same task on a number of occasions The time involved in setting up the examination is greater than for the traditional examination Maintaining uniform difficulty level is not always possible

18. Cont… It is expensive in terms of manpower, resources and time (such as number of examiners, patients, and even the space of examination room) It may discourage students from looking patient as a whole because the students' knowledge and skills are being put into compartments. The assessment examines a narrow range knowledge and skills and does not test for history- taking competency properly. Students only examine a number of different patients in isolation at each station instead of comprehensively examining single patient It requires an extensive amount of organizing

19. OSCE Methodology The OSCE examination consists of about 15-20 stations, each of which requires about 4-5 minutes of time. All stations should be capable of being completed at the same time. The students rotate through all stations and moves to the next station at the signal . Each candidate is examined on a one to one basis with one or two impartial examiners on each station. They are marked by the examiner on standardized mark sheet. Using 15 stations of 4 minutes each, 15 students can complete examination within 1 hour.

20. Steps in developing an OSCE Decide the types of skills to be examined Decide the types of assessment (such as a uniform checklist) Consider the number of skill assessment stations needed (it is recommended to have 10 to 15 stations, and six minutes for each station) because the length of the examination is determined by the number of assessment stations and the time each candidate will spend at each station.

21. What are common OSCE stations? 1. Clinical examination : Performing a clinical examination on a real or simulated patient. 2. Objective Structured Clinical Exam (OSCE) - Assessment Criteria An OSCE comprises a series of stations, usually between 5-10 minutes, in which all candidates rotates through the different stations. At each station, the candidates are assigned a written, oral practical task to be solved within a given timespan, no aid is allowed. Before the exam, the students will be given the number of minutes available at each station. Between each station, there will be a short break to allow time for transferal. The circuit also contains resting stations.

22. Cont… OSCE tests medical knowledge and clinical skills such as clinical judgment, clinical examination, ability to reason, and problem-solving. Communication skills including attitude/behavior towards the patient, and linguistic dissemination and perceptiveness are also tested as well as the candidates' competence in diagnosing and treatment of diseases . The questions can be integrated or related to clinical situations from any medical subjects which has been taught, but the questions should be aligned with learning outcomes.

23. Cont… At each station, an examiner assesses the candidate according to certain criteria. The assessment emphasizes the following elements of the candidate : Clinical judgment. Clinical examination. Ability to reason, as well as problem solving. Communication skills including behavior towards the patient. Linguistic dissemination and perceptiveness. Diagnosing and treatment of diseases.

24. Cont… Communication skills: history taking, information giving, breaking bad news Data interpretation: interpreting investigation results (e.g. X-rays, blood tests, CSF results) Simulation / ABCDE assessment: assessing and managing an acutely unwell patient Clinical procedures: performing a clinical skill (e.g. venepuncture or blood cultures)

25. Cont… Allocate resources for the examination (such as space for examination rooms, marking sheets and plastic models) Prepare the staff resources needed (including examiners, timekeepers and patient/volunteers) Determine/arrange the day/period of exams. Conduct a review/evaluation of the arrangement of the exam after it is over To design concise marking schemes that focus on actions that distinguish To design concise marking schemes that focus on actions that distinguish between good and poor performance To provide marking scheme instructions on what students would do at each station for the examiner To provide instructions which outline exactly the task required at each station for students.

26. Steps in taking OSCE as examination for students

27. 1. Registration The first step is registration. In this you will go through the following process: Show your roll number or identity card General instructions are provided regarding examination. Invigilator will inspect articles and prohibit those which are not allowed in examination. e.g. use of mobile. Receive your exam envelop which contains your ID, stickers, pencil, notebook or clipboard.

28. 2 . Orientation The next step after registration is orientations Exam format, procedures and policies will be reviewed Introduce to your team and team leader. Instructed about your starting station and how to proceed. Students can ask their queries regarding OSCE

29. 3. Escorting to exam position After briefing and exam. orienting students OSCE, students will be escorted to stations. Students will be instructed about time at each station and about time buzzer. Students will start exam as soon as long bell or buzzer announce the start of the exam .

30. 4. Station Instruction time This is one or two minutes to read the instruction about the station, the situation, patient and required task. Students read carefully and enter the room at the next bell.

31. 5. The encounter Start your encounter with the standardize patient. There is a 5-20 minutes encounter. Perform the required task. Stop at the next bell.

32. 6. Post encounter period Some OSCE will have no post encounter period. Some will have 1-2 min of the encounter period assigned to an oral question asked by the examiner inside the examination room. No more communication is allowed with the patient, and then written questions to be answered on a paper or computer outside the exam room for 5-10 min. At the next bell, first station ends as well as next station starts. Student proceeds to the next station quickly .

33. 7. Repeat step 4 to 6 Step 4-6 will be repeated until student have been in all the stations. Some OSCE will offer 1 or 2 short rest period

34. 8. Exam ended Exam is over. Student will be escorted back to dismissal area for signing out. He will be asked to handle back all what he has received on signing in; he may be asked to stay for some time for exam security reason

35. Tips for Organizing OSCE Assessment: Produce a grid summarizing. What is to be tested during OSCE. Down the left hand side list the competencies such as history taking, physical exam, patient education, etc. Duration of stations: Once the duration has been fixed make sure that the task expected of the student can be accomplished with time. No. of stations: Within the time constraints include in the examination as many stations as possible as there is good evidence that the reliability of the examination. Use of examiners: Make sure that examiners are fully briefed prior to the examination, both for an examination in general and particular with regard to the station to which they are assigned. Provide them with a list of resources that will be available at these stations. Range of approaches: When planning an OSCE for the first time, talk with number of individuals from different settings who have previously made use of this technique. If possible, visit and watch examinations.

36. Cont… New stations: New station should be tested with one or more student before use in the examination. Organizations of the examinations. There should be co-coordinator appointed in advance of the examination that has the responsibility for taking overall charge of the advance planning of the exam and its implementation on that day. Resource requirements: It is helpful to produce a checklist of the resources required for each station in exam. Plan examination and directions: After the exam is set up and the directions in place for students that they can find their way easily from one station to the next. Use of tape on the floor for direction can also be used. Change signal: Before examination, check that the audible signal can be heard clearly at all locations on the examination. Records: Keep an OSCE file into which all resources required, such as station numbers, direction arrows, master sheet of instruction to students, checklists, rating scales and so on .

37. Problems in Conducting OSCE Non-availability of many faculty members. Lack of enthusiasm of the teachers to try out new methods Students' apprehension for having to learn even the smallest detail of the subject Lack of physical facilities and cooperation in the clinical settings Controversies over the evaluation criteria .

38. Strategies to Overcome Training the faculty members in using OSPE. Preparation of the students from the beginning of the course for this type of examination. Proper communication with the administrators of the clinical areas regarding OSCE. Ensuring the reliability and validity of the evaluation criteria. Adequate planning and organization of the whole exercise.

39. Thank you….