OSCE implementation in Nursing colleges
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This document provides an overview of Objective Structured Clinical Examination (OSCE) and Objective Structured Practical Examination (OSPE). It discusses the background, purposes, methodology, advantages and disadvantages of OSCE/OSPE. Key points include that OSCE/OSPE aims to objectively and reliably evaluate clinical skills through structured stations using checklists. Stations typically last 3-10 minutes and assess skills like history taking, physical exams, procedures. OSCE/OSPE provides a standardized way to assess students and has been found to improve evaluation objectivity and student satisfaction compared to traditional exams. Challenges include the significant planning and resources required to implement OSCE/OSPE effectively.
OSCE implementation in Nursing colleges
- 1. Objective Structured Clinical/ Practical Examination ( OSCE/ OSPE) Presented By: Dr Latha Venkatesan Principal Apollo College of Nursing Chennai- 600 095 Email: drlatha_Venkatesan@apollohospitals.com
- 2. Introduction • Providing fair and reasonable clinical evaluation is one of the most important and most challenging faculty roles. • Objective structured clinical/ practical examination (OSCE/OSPE) was designed to test the clinical competence while simultaneously improving 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 Clinical: the tasks are representative of those faced in real clinical situations
- 4. What is OSCE/ OSPE OSCE OSPE is a method of clinical/practical Examination where predetermined decisions are made on the competencies to be tested with the use of checklists incorporating important skills. The candidates rotate through a number of stations at which they are asked to carry out a specific task.
- 5. 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.
- 6. Cont…. Used in undergraduate as well as postgraduate programs. Formative & summative Evaluation. Now used in many disciplines
- 7. Abbreviations OSCE: Objective structured clinical examination OSPE: Objective structured practical examination OSVE: Objective structured video examination COSPE: Computer assisted OSCE
- 8. 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
- 9. 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 • 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
- 10. Use of OSPE in India • Commonly used in Medicine in Undergraduate and postgraduate students. • Introduced in Tamil Nadu Dr MGR Medical University recently. • Used in Manipal College Of Nursing, CMC Vellore , Apollo College of Nursing • In Tamil Nadu – used as a part of Formative Evaluation.
- 11. 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 3. To improve the objectivity and reliability of clinical evaluation. 4. To evaluate set of predetermined clinical competencies. 5. To reduce patient and examiner variability.
- 12. 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 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
- 13. Traditional practical examination & OSPE • Evaluation Proformas of existing pattern are modified with addition of OSCE marks • 10 % of marks are for OSCE (i.e.20/100, 10/50) • UG and PG exams included
- 14. S.No Register No. ASSESSMENT (8) PLANNING (5) IMPLEMENTATION (18) EVALUATION (4) VIVA INTERNALEXAMINER EXTERNALEXAMINER OSPE TOTAL Healthhistory Physicalassessment NursingDiagnosis Planofaction Nursingcare Implementation ScientificPrinciples HealthEducation 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
- 15. 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 INTERNALEXAMINER EXTERNALEXAMINER OSPE TOTAL History GeneralAssessment SpecificAssessment Nursing Diagnosis PlanofAction NursingCare Scientific Principles Communication skills Health Education 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
- 17. Types of OSCE/PE stations Interactive Non interactive
- 18. Types – Cont… • Presence of ExaminersManned • Absence of ExaminersUnmanned
- 20. 20 PROCEDURE STATION e.g. CPR, Conducting Delivery QUESTION/ RESPONSE STATION Drug Calculation Interpretation of lab report etc.
- 21. 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
- 22. 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 • All students are assessed according to the same standards ( OSCE checklists) • Student may communicate with standardized patient via role play
- 24. 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 • 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
- 25. 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
- 26. 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 Guidelines for Conducting Examination • Describe patient behavior and affect • Describe symptoms to be simulated • Provide training on signs to be simulated
- 27. Simulated Patient (History taking)
- 29. Video station
- 30. 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. • 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.
- 31. OSPE STATIONS
- 32. Where to conduct OSPE Any area wherever there is space and resources • Clinical set up- OPD and other areas • Multi Purpose Hall • Examination Hall • Library • Laboratary eg : Foundation lab • Large Class rooms etc
- 34. Exam Venue
- 37. What is assessed by OSCE? Various clinical skills History taking Physical examination Technical procedure Communication Interpersonal skills Knowledge and understanding Nursing Diagnosis Data interpretation Problem solving Attitudes Nursing interventions
- 38. 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 • The venue for conducting the examination. • Checklist • Instructions to candidates, Evaluators and Simulated patients
- 39. Organization-cont.. • 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
- 40. Organization-cont.. • Resource requirements • Assigning priority – To include Must know categories • Arrangement for the examiners and other supporting staff and simulated patients • Direction arrows
- 41. Check list Steps in sequence Break into small steps Outcome INDEPENDENT of previous steps Marks based on importance Validation Open to suggestions and Feedback
- 42. 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.
- 44. Instructions for students 1. Display Roll No prominently. 2. Number of stations = N 3. Proceed in one direction 4. Time allotted = ‘t’ min (each station) 5. Start & end of time (ring of bell) 6. Clear instructions given at each station 7. No interaction with examiners 8. No negative marking
- 45. Patients About Their roles Uniformity in answering Not to give any extra information
- 46. Examiners • Examiners must be trained in OSCE • Clear Instructions on Time/ duration, marking • Avoid interacting with students unless instructed • Objective evaluation using Check lists
- 47. OSCE station requirement: Task/scenario to be completed Instructions for student available at the station(pasted) Instructions for the standardized patient Assessment tool (checklist) 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
- 48. 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
- 49. During OSCE Observe and assess the student’s performance 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
- 50. 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
- 51. 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
- 52. Scoring sheet for interactive stations S.No Procedure steps Reg No Reg No Reg No Reg No Reg No
- 53. Overall scoring format for OSCE Name Reg No of the student Station I Station II Station III Station IV Station V Total- 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
- 54. 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
- 56. Fundamentals of Nursing • Rare procedures Eg. Death care • CPR • Bowel wash • Bladder irrigation
- 57. OSCE in Medical Surgical Nursing • Tracheostomy care/colostomy care • Blood transfusion • Setting up for surgeries • Interpretation of ECG/ABG
- 58. OSCE in Maternity Nursing • Instruments names and purposes • Management of PPH • Management of eclampsia • IUCD insertion • Episiotomy suturing
- 59. OSCE in Child Health Nursing • Immunization procedure • Use of Restraints in children • Neonatal resuscitation • Feeding neonate with cleft lip/palate.
- 60. OSCE in Community Health Nursing • ORS Preparartion • Dietary advices to Ante Natal mother • Checking temperature of the child • Wound dressing
- 61. 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
- 62. Advantages of the OSPE • Valid examination • Objectivity and reliability are increased • The examiners can control the complexities of the examination • Used as summative as well formative • Can be used with larger number of students
- 63. Advantages of the OSPE (cont) • Reproducible • The variability of the examiner and the patient are to a large extent removed • Variety maintains students’ interest • Students’ satisfaction is increased. • Fun activity within the department or college, which promotes team work
- 64. Disadvantages of the OSPE • Knowledge and skills are tested in compartments, and wholistic patient care is not possible. • The OSCE may be demanding for both examiners and patients • More time in setting it up • Shortage of examiners • Might be quite distressing for some students • It requires very careful and meticulous organization.
- 65. Feedback from Students (positive) • assess our performance in action • detects our weaknesses • assess our abilities in solving clinical problems • assess our clinical skills, skills in communication and approaching patients
- 66. Feedback from Students (positive) • student is made to organize his/her thoughts • Increases self confidence • Fair to all students • Clinically oriented • trains the students because OSCE is also an international examination
- 67. 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
- 68. How to overcome difficulties • Training course for teachers • Preparation of the students from the beginning of the course • Proper communication with administrators • Ensuring reliability and validity of the evaluation • Adequate planning and organisaton • Preparartion of OSPE Bank • Can be conducted along with TPE
- 69. 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.
- 70. Studies reporting the strengths of the OSPE approach • Provides students with both formative and summative feedback of their clinical skills. • Provides means to work and think under stress which helps sharpen critical thinking, and assessment skills • Mutual input encourages team-building Issenberg S & McGaghie W 2002
- 71. Studies reporting the strengths of the OSPE-cont… • Measures what a student can do rather than what he or she knows (Humphris, G M & Kaney 2001 ) • Employs standardized objective outcome measures with no ethnic bias • Provides safe, supervised environment for practicing a diversity of skills before entering the clinical setting ( Elnicki D M, Shockcor W T, & Halbrtitter K. A 1993)
- 72. Studies reporting the strengths of the OSPE-cont… • Both faculty members and students perceive OSCE OSPE as a valid measure of their cognitive ability and a vehicle of reliability • Provides performance-based testing with excellent test-retest reliability• [[ (Martin I G, Stark P & Jolly B 2000)
- 73. Studies reporting the strengths of the OSPE-cont… • The checklist approach reduces measurement error because of its apparent objectivity • The checklists are excellent feedback tools for students and identify learner needs • Provides a medium to access indicators of performance and helps decrease subjectivity. • Work can be decreased in terms of preparation time with subsequent administrations of the identical OSCE OSPE . (Offering the prospect of decreased cost) (Dacre, J, Fox R, Rothman A, 1999)
- 74. Studies reporting the strengths of the OSCE-cont… • More reliable and valid than traditional testing methods. • Highly adaptable to a variety of clinical competencies (e.g., cognitive, psychomotor, self- efficacy) • Easily employed in assessing in a variety of clinical competencies (Elnicki D M, Shockcor W T, & Halbrtitter K. A 1993)
- 75. Studies reporting the limitations of the OSPE approach • It is expensive in terms of institutional resources such as development costs and salaries of faculty, administrators and support staff. • Critical indicators require validation and piloting. • Poorly trained personnel result in inconsistencies in the evaluation process • Checklists remove professional judgment • Thoroughness, rather than competence, may be rewarded, thereby failing to recognize alternative problem- solving approaches. ((Dacre, J, Fox R, Rothman A, 1999)
- 76. Studies reporting the limitations of the OSPE – cont.. • May not be appropriate to meet the learning objectives on teaching philosophies of the institution • Objectivity may be compromised due to examiner boredom or fatigue. • Criteria-based learning may not be appropriate to the students once they meet the criteria for the initial stage • May not be integrated into the curriculum to advance practice of knowledge (e.g., problem-solving)
- 77. Studies reporting the limitations of the OSPE –cont.. • Does not provide a means for students to engage in self-evaluation • Specific performance criteria discourage students from looking at patients holistically • May produce “simulation syndrome” that limits the student’s ability to adapt to a diversity of different clinical situations and settings (Humphris, G M & Kaney 2001 )
- 78. Studies reporting the limitations of the OSPE –cont.. • Inadequate as a sole method and unable to accurately replicate all clinical and community environments or patient situations • Students’ scores may be increased due to Likert’s scale effect, especially with increased fatigue and boredom of assessors (Elnicki D M, Shockcor W T, & Halbrtitter K. A 1993)
- 79. Studies reporting the limitations of the OSCE approach- Cont.. • Poorly trained personnel (e.g., seasonal and inexperienced instructors) result in inconsistencies in the evaluation process (Dacre, J, Fox R, Rothman A, 1999) • Objectivity of evaluation process may be compromised due to examiner boredom or fatigue. (Humphris, G M & Kaney 2001 )
- 80. Key Points- OSPE • Reliable, valid, and objective • Staff development • Dynamic process • Simulation • OSPE Bank • Videos & simulators • Enjoyable • Feedback
- 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.
- 85. Thank You