osceimplementationinnursingcolleges-200629053803.pptx

osce implementation in nursing schhol

1. Objective Structured Clinical/ Practical Examination ( OSCE/ OSPE ) Presented By : Ms Nazish Ali Msc Nursing 1 st Year

2. Introduction Providing fair and reasonable clinical evaluation is one of the most important and most challenging faculty roles. c l i n ical ( O S C E/O S P E ) competence w as de s igned to test the while simultaneously i m proving objectivity and reliability.

3. OSCE Objective : examiners use a checklist for evaluating the trainees Structured : trainee sees the same problem and performs the same tasks in the same time frame

4. Clinical: the tasks are representative of those faced in real clinical situations

5. What is OSCE/ OSPE OSCE \ OSPE Examination i s a method o f c li n ical / pr a ctical w here pred e term i ned d e cisions a re made on the competencies to be tested with the use of checklists incorporating important skills .

6. Th e ca n d i dates rotate throu g h a numb e r of stations at which they are asked to carry out a specific task .

7. Background of OSPE Considering the drawbacks of TPE , OSPE Started in 1972 Dundee, Scotland by R. Harden and F.Glesso First literature about OSCE in 1975, BMJ First introduced in Medicine.

8. Cont…. Used in undergraduate as well as postgraduate programs. Formative & summative Evaluation. Now used in many disciplines

9. Abbreviations O S C E : OS P E : OS V E : COS P E : Objective structured clinical examination Objective structured practical examination Objective structured video examination Computer assisted OSCE

10. The Objective Structured Long Examination Record (OSLER) OSLER was introduced by Gleeson in 1992 An attempt to remodel and improve the long case examination He suggested modifications to improve the long case examination

11. OSLER.. The long case is divided into 10 items or more on which each candidate is assessed The 10 items cover all aspects of working up a long case

12. OSLER CONT… The process of history taking, examination and management of the patients is observed In addition to observation during history taking, communication skills are also evaluated

13. Purposes of OSPE 1. To test each component of clinical competence uniformly and objectively for all students 2. To assess the extent of achievement of each student in every practical skill

14. PURPOSE CONT… 3. To improve the objectivity and reliability of clinical evaluation . To evaluate set of predetermined clinical competencies. To reduce patient and examiner variability.

15. Difference between OSCE/OSPE OSPE OSCE Domain Higher level of knowledge Psychomotor Testability Identifies structures on images, specimens, radio graphs and relate it with clinical scenario Apply structural knowledge to perform examination and procedures Time 2-4 min per station >4 min per station Space One big hall Isolated small class rooms close to each other

16. Difference between OSCE/OSPE OSPE OSCE Examiner Non specific 2-3 persons per hall Expert examiner for wach station Checklist Nor required Required Standardized patients Not required Required Observers Not required Required

17. S. No Register No. ASSESSMENT (8) PLANNING (5) IMPLEMENTATION (18) EVALUATION (4) VIVA INTERNAL EXAMINER EXTERNAL EXAMINER OSPE TOTAL Health history Physical assessment Nursing Diagnosis Plan of action Nursing care I m p le m en t a tion Scientific Principles Health Education Reassessment Documentation 4 4 3 2 12 3 3 2 2 5 40 40 20 100 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 SAMPLE EVALUATION PROFORMA FOR PRACTICAL EXAMINATION FUNDAMENTALS OF NURSING – B.Sc (N) I YEAR

18. SAMPLE EVALUATION PROFORMA FOR PRACTICAL EXAMINATION MIDWIFERY & OBSTETRICAL NURSING B. SC. (N) IV YEAR & PB.B.SC(N) I YEAR S. No. Register No. ASSESSMENT (4) PLANNING (3) IMPLEMENTATION (6) EVALUATION (2) VIVA INTERNAL EXAMINER EXTERNAL EXAMINER OSPE TOTAL History General Assessment Specific Assessment Nursing D ia gno sis Plan of Action Nursing Care Scientific P r incipl e s Co mm un i c a tion skills Health E du c a tion Recording & Reporting 1 1 2 1 2 3 1 1 1 2 5 20 20 10 50 1 2 3 4 5 6 7 8 9 10

19. Types of OSCE/PE stations Interactive Non interactive

20. Types – Cont… Presence of Examiners Manned Abs e nce of Examiners Unma n ned

21. Types – Cont… Procedure Respon s e

22. 20 Condu cti n g Delivery e.g. CPR, P R O C E DUR E STATION QUESTION/ R ESPO N SE STATION Drug C alc u lati o n I n ter p retati o n of lab report etc.

23. Couplet & Double Station Some competencies may best be assessed by coupled or linked stations The use of linked stations extends the time available to complete a task of previous station

24. The key components of OSCE are There is a time limit for each station (5-10 min ) An examiner/observer present with a checklist at each station to carry out assessment

25. All students are assessed according to the same standards ( OSCE checklists ) Student may communicate with standardized patient via role play

26. Patients in OSCE Standardiz e d patients Simulated Patients

27. Standardized Patients (SP) A standardized patient is an individual who is trained to portray scripted patient These instruction must be detailed as standardized patient playing the same role

28. CONT.. Standardized patients may be volunteers or paid Clinically stable patient can also be used as standardized patient Ideally a physician will observe the standardized patients before the examination

29. Simulated patients Persons playing the role of patients (i.e."simulated" patients) can be used instead of actual patients But to make it more reliable use as many actual patients as possible 30

30. Instructors, lay-persons or students can be prepared for the role of standardized patient. Training of SP must stress the following : Inform them the purpose of the training and their role Directions should use patient-based language Specify patient’s perception of the problem Provide only relevant information Responses to all checklist items should be included

31. Guidelines for Conducting Examination Describe patient behavior and affect Describe symptoms to be simulated Provide training on signs to be simulated

32. Simulated Patient ( Hi s tory ta k in g )

33. Simulated Patient(examination )

34. Video station

35. Methodology of OSCE/OSPE STATIONS : The students during the examination moves around a number of stations spending a specific amount of time in each stations .

36. CONT.. On a signal, he/she moves on to the next station . The time allowed is the same for all the stations and the stations must be designed accordingly. 3-10 minutes are given in each stations.

37. OSPE STATIONS

38. Where to conduct OSPE Clinical set up- OPD and other areas Multi Purpose Hall Examination Hall Library Laboratary eg : Foundation lab Large Class rooms etc

39. Exam Venue

40. Changing Stations

41. What is assessed by OSCE? Various clinical skills History taking Physical e x amination Technical proced u re Communication Inte r pe r sonal skills Knowledge and understanding Nursing Diagnosis Data interpretation Problem solving Attitudes Nursing inte r ventio n s

42. Advance Planning The following are planned in advance : Blue print The patients have to be selected and briefed . The examiners and staff concerned to be briefed

43. CONT… The venue for conducting the examination . Checklist Instructions to candidates, Evaluators and Simulated patients

44. Organization Duration of station- 3-10 minutes Number of stations – depends on Number of students and tasks to be performed, and content covered. Number of examiners – depends on need and availability. Use of bells - change signal

45. Organization-cont.. Resource requirements Assigning priority – To include Must know categories Arrangement for the examiners and other supporting staff and simulated patients Direction arrows

46. Check list Steps in sequence Break into small steps Outcome INDEPENDENT of previous steps Marks based on importance Validation Open to suggestions and Feedback

47. Marking Scheme Marks allotted to each item on a checklist Marks are allotted for each stations independently depending on the importance of the each task.

48. Instructio n s Students Patients / Simulated Patients Examiners

49. Instructions for students Display Roll No prominently. Number of stations = N Proceed in one direction Time allotted = ‘t’ min (each station) Start & end of time (ring of bell) Clear instructions given at each station No interaction with examiners No negative marking

50. Patients About Their roles Unifor m ity in a n swering Not to give any extra inf o rmation

51. Examiners Examiners must be trained in OSCE Clear Instructions on Time/ duration, marking Avoid interacting with students unless instructed Objective evaluation using Check lists

52. OSCE station requirement: Task/scenario to be completed Instructions for student available at the station(pasted) Instructions for the standardized patient Assessment tool (checklist )

53. Guidelines for Conducting Examination Resources needed for student to be able to perform –may simulate Uniform station time limit Mannequins and articles to set up the station as guided by the examination superintendent/ examination coordinator

54. Before OSCE Discuss the number of OSCE stations, time limit for each station and OSCE round with the student. Ask if the student has any questions about the OSCE This is orientation – NOT coaching

55. During OSCE Observe and assess the student’s p erf o rma n ce Stand where you can see without intruding and let the student perform the skill Do not interfere (steps performed wrongly which may be dangerous for the clients MUST be discussed with student following the OSCE) Feedback MUST be delayed until completion of all stations in OSCE

56. After OSCE: Review the performance of the student (student shares what she did well and what could be improved) Provide positive feedback and offer suggestions for improvement Determine if the student is competent or needs additional practice

57. Formative (Internal) assessments Use the results (only when formative assessments done through OSCE) to improve students’ performance by giving an opportunity to ask questions about steps they did not understand or they performed incorrectly and instructing/coaching students to practice the steps that they performed incorrectly. If many students had trouble with the same stations, it means that either the teaching methods or materials did not adequately cover that learning objective

58. Scoring sheet for interactive stations S.No Procedure steps Reg No Reg No Reg No Reg No Reg No

59. Overall scoring format for OSCE Name\ Reg No of the stude n t Station I Station II Station III Station IV Station V T ota l - 25 1 4 5 4 5 3 21 2 3 4 3 4 4 18 3 4 5 3 5 3 21 4 4 3 2 4 3 16 5 5 4 5 5 3 22 Total 20 22 17 22 16

60. Name of OSCE Station STATIONS Total marks Percentage Student Registration Number 1 2 3 4 5 Max Marks Name of the Station Evaluator Signature of the Station Evaluator OSCE Overall Scoring Compilation Sheet

61. Model Stations in Nursing

62. Fundamentals of Nursing Rare procedures Eg. Death care CPR Bowel wash Bladder irrigation

63. OSCE in Medical Surgical Nursing Tracheostomy care/colostomy care Blood transfusion Setting up for surgeries Interpretation of ECG/ABG

64. OSCE in Maternity Nursing Instruments names and purposes Management of PPH Management of eclampsia IUCD insertion Episiotomy suturing

65. WHAT IS ? SIM MOM

66. OSCE in Child Health Nursing Immunization procedure Use of Restraints in children Neonatal resuscitation Feeding neonate with cleft lip/palate.

67. OSCE in Community Health Nursing ORS Preparartion Dietary advices to Ante Natal mother Checking temperature of the child Wound dressing

68. OSCE in psychiatric Nursing Counseling alcoholic clients Managing patient with Extra Pyramidal side effects Assessing memory status of the patient Orienting the patient after ECT

69. Advantages of the OSPE Valid examination Objectivity and reliability are increased

70. The examiners can control the complexities of the examination Used as summative as well formative Can be used with larger number of students

71. Advantages of the OSPE (cont) Reproducible The variability of the examiner and the patient are to a large extent removed

72. Variety maintains students’ interest Students’ satisfaction is increased. Fun activity within the department or college, which promotes team work

73. Disadvantages of the OSPE Kn o w led g e an d s kil ls are tested in c o mp a rtme n ts, and wholistic patient care is not possible. The OSCE may be demanding for both examiners and patients .

74. More time in setting it up Shortage of examiners Might be quite distressing for some students It requires very careful and meticulous organization

75. Feedback from Students (positive) A ssess our performance in action D etects our weaknesses A ssess our abilities in solving clinical problems A ssess our clinical skills, skills in communication and approaching patients

76. Feedback from Students (positive) S tudent is made to organize his/her thoughts Increases self confidence Fair to all students Clinically oriented T T rains the students because OSCE is also an international examination

77. Feedback from Students (negative) Might be exhausting for the real patient It’s humiliating to patients Needs extra preparation time Burden on the student Some stations require more time than the others

78. How to overcome difficulties Training course for teachers Preparation of the students from the beginning of the course Proper communication with administrators

79. How to overcome difficulties Ensuring reliability and validity of the evaluation Adequate planning and organisaton Preparartion of OSPE Can be conducted along with Teaching

80. Research Findings Study was conducted in Apollo College of Nursing, Chennai to assess the nursing students’ attitude and satisfaction towards practical examination. Findings of the study revealed that, majority of the students had negative attitude towards practical examination( 64%), followed by uncertain attitude ( 37%). They also expressed ( 67%) that OSPE could be included in the practical examination.

81. Conclusion When used correctly, the OSCE can be highly successful as an instrument to assess competence Ronald Harden

82. Bibliography Ananthakrishnan N, Sethuraman K R, Kumar S ( 2000 ). Medical Education: Principles and Practice, Second edition, Alumni Association of National Teacher Training centre, JIPMER. Armstrong G E, Spencer T S, Lenburg C B. Using quality and safety education for Nurses to enhance competency outcome performance assessment ; A synergistic Approach tht promotes patient safety and quality outcome. Jl of Nursing Education 2009. 48 ( 12), 686-693. Bhat, Sham M, Anana & Susan. Objective Structured Clinical examination (OSCE \ OSPE). Nursing Journal of India. 2006.

83. Bibliography- Cont.. Billings d M, Halstead J A. ( 2006 ). Teaching in Nursing. A guide for Faculty. Second edition. Elsevier Saunders. Dacre, 1., Fox, R., Rothman, A. (1999). Development of a new OSCE \ OSPE marking schedule based on a combination of item scores and global judgments, Medical Education, 33, 230. Elnicki, D.M., Shockcor, W.T, Morris, D.K. and Halbritter, K.A. (1993). Creating an objective structured clinical examination for the intemal medicine clerkship: Pitfalls and benefits, American Journal of the Medical Sciences, 306(2), 94-97.

84. Thank You