By:- firoz qureshi

Dept. psychiatric nursing

OSPE

OSCE

Assessment of clinical practice skills in health profession’s

education poses several challenges in terms of its

objectivity.

• Objective Structured Clinical Examination (OSCE) is one

form of objective evaluation method that is gaining more

importance and is being adopted by educators of various

disciplines

OSCE -OBJECTIVE

• All the candidates are presented with the same test

• Specific skill modalities are tested at each station

• History taking

• Explanation

• Clinical examination

• Procedures

OSCE - Structured

• The marking scheme for each station is structured

• Structured interaction between examiner and student

OSCE-Clinical examination

Advantage-OSCE• Wider sampling than traditional methods

• Every candidate does same examination

• Greater opportunity for objectivity

• OSCE Stations are re-useable

• Better psychometrics than traditional methods

Focus

• It involves use of cognitive skills like critical thinking and problem solving. OSCE also enhances good interaction between the teacher and the student .Although OSCE is practiced worldwide in nursing education, its practice in India and other developing countries is scarce.

• The nurse educators from India and other developing countries should be encouraged to utilize this form of evaluation.

Core Assessment area

OSCE is an approach to the assessment of

clinical competence in which the components

of the competence are assessed in a planned or

structured way, with attention being paid to the

objectivity of the examination (Harden, 1988).

OSPE

In a non clinical area e.g. Biochemistry/Anatomy

Physiology lab setting), a similar approach

may be adopted and in this context, it is

referred to as an OSPE (Objective Structured

Practical Examination)

PURPOSES OF OSCE

According to Boursicot, Ware, and Hazllet (2011), the purposes of OSCE are to

– Measure clinical skills

– Match assessment to intended constructs

– Promote structured interaction between student and examiner

– Make structured marking scheme possible

– Present all candidates with the same test

– Promote objectivity

COMPONENTS ASSESSED IN

OSCE

Various components of clinical competence are assessed using OSCE, – For example, the components of advance clinical nursing practice skills typically assessed by OSCE are…

1. Interpersonal and communication skills

2. History taking skills

3. Physical examination of specific body system

4. Mental health assessment

5. Clinical decision making including the information of differential diagnosis

CONT

6. Interpretation of clinical findings and investigations ,management of a clinical situation including treatment and referral

7. Patient education

8. Health promotion

9. Clinical problem solving skills

10.Acting safely and appropriately in an urgent clinical situation

11.Critical thinking in therapeutic management

Quality of Assessment

Reliability of a test

• measure reproducibility of scores across raters, questions, cases, occasions

• capability to differentiate consistently between good & poor students

Reliability

Validity of a test

• MeasureContent is deemed appropriate by relevant experts

• Test measures the characteristic (e.g. knowledge, skills) that it is intended to measure

• Performance of a particular task predicts future performance

Feasibility

• Is it a reasonable task to expect the candidates to perform? Is it authentic?

• Can the task be examined at an OSCE station? Match clinical situations as closely as possible

• Some tasks may require simulated patients• Some tasks may require manikins• Some tasks simply cannot be examined in this

format

congruence

• Is the station testing what you want it to test?

• Station construct: describe what station is testing

cont

• Ensure that all parts of station coordinate Candidate instructions

• Marking schedule

• Examiner instructions

• Simulated patient instructions

• Equipment

Train the examiner

THE COMPONENTS OF THE OSCE

The OSCE (Objective Structured Clinical

Examination) has reached a stage of

development that allows clear recognition of

key components that bring structure and

organization to its construction,

implementation and assessment of its

performance

Blueprinting

• Content of the assessment should align with the learning objectives of the course

• Blueprinting allows mapping of test items to specific learning outcomes

• ensures adequate sampling across subject area and skill domains

Bp-System based

BP-Discipline based

Possible station

• Communication – a telephone conversation• Counseling – a trained SP• Reading a CVP – special equipment• Intubation – anaesthetic manikin• Excision biopsy – a pig skin and equipment• Breast palpation – silicon simulations• Form completion – a collection of forms• CPR – Resus Annie• Suturing – RCS suture jig• Assembling equipment – IV infusion set• Traction – SP and equipment• Bandaging – masses of crepe bandage

History taking station

Procedure station

Physical examination station

Major components

The major components are

1.The (examination) coordinating committee

2. The examination coordinator

3. Lists of skills, behaviors and attitudes to be assessed

4. Criteria for scoring the assessment (marking scheme of checklist)

5. The examinees

6. The examiners

7. Examination site

THE COMPONENTS OF THE OSCE

Examination stations

8.1 Time and time allocation between stations

8.2 Anatomic models for repetitive examinations (Breast, Pelvic/Rectum)

8.3 Couplet Station

8.4 Examination Questions

8.5 Environment of Exam Station

8.6 Examination Station Circuit

The Examination Coordinating Committee

The Examination Coordinating Committee

• An examination coordinating committee is made up of members who are committed to the evaluative and educational process and whether appointed or volunteered must give this effort high priority in order for the OSCE to be developed and implemented.

• It is the responsibility of the examinationcommittee to determine the content of the examination, development and implementation

The Examination Coordinator

• The functions of the examination coordinator

(M.D. or Ph.D. educator) are the catalyst that

facilitates the smooth working of the

committee in developing, implementing and

assessing the performance of the OSCE

Lists of Skills, Behaviors and

Attitudes to be Assessed

• The examination will measure objectively the competencies in specific areas of behavior, techniques, attitudes and decision-making strategies based on the objectives of the course or the requirement of the licensing body.

• The OSCE should be able to reliably assess clinical competence in history taking, physical examination, laboratory, radiographic and other data interpretation, technical and procedural skills as well as counseling and attitudinal behaviors

Criteria for Scoring the Assessment

(Marking Scheme or Checklist)

• A marking scheme or checklist is prepared for

each station. Preparation of the checklist

requires predetermined objective criteria that

are agreed upon by the examination

committee, based on faculty input.

• Marking scheme/checklist should be concise,

unambiguous and written to contribute to the

reliability of the station.

Rating

Likert scale

The Examinees

• The examinee is the student, resident, or fellow

in training or at the end of training of a

prescribed course designed to teach certain

clinical competencies that the examinee can

use in a clinical situation to make an

assessment and develop a diagnostic

formulation that culminates in a therapeutic

plan.

The Examiners

• Most stations will require an examiner,

although some stations do not. The examiner at

the station where clinical skills (history-taking,

physical examination, interviewing and

communication) are assessed, may be either a

physician or a standardized patient

The Examination Site

• The examination site is part of a special

teaching facility in some institutions. When

such facilities are not available, the

examination may be conducted in an outpatient

facility or other space where offices are

available in close proximity to each other.

Examinations Station

• The total number of stations will vary based on a function of the number of skills, behaviors and attitudinal items to be tested.

8.1 .Time Allocation and Time between Stations

– The competency being assessed in particular station will define how much time should be allotted per station. The length of time will range from 5-20 minutes.

– The time allocated per station should be as uniform as possible thus facilitating the smooth movement of examinees from station to station

OSCE DESIGN

e.g., a 10 minute station, 9 minutes is allocated

for the task and one minute transit time to the

next station.

The examiner can complete the checklist prior to

the entry of the next examinee.

8.2 Anatomic Models for Repetitive Examinations (Breast, Pelvic/Rectum)

• The skill, behavior or attitude to be tested in a station determines whether the station requires a real patient, simulated patient Chronic patients (stable) may serve well in this situation with proper training.

• Simulated patients who are well-trained offer reliability and consistency in the quality of their presentations.

8.3.Couplet Station

• Some competencies may best be assessed by

coupled or linked stations. For example, a

couplet station may consist of a history-

physical examination combined with a

problem-solving station.

8.4.Examination Questions

• Examination questions are designed to assess

the ability to interpret information and critical

thinking. The questions deal with diagnostic

investigations, differential diagnostic and

management plans.

8.5.Examination Station environment

The Examination Station environment should be conducive to the competency to be tested, including adjustable lighting for fundoscopicexaminations and appropriate examination tables for focused physical skills assessment.

• Stations where auscultatory skills are being assessed should be either well insulated or in appropriately quiet areas of the examination site. Clearly marked directions leading from one station to the next should be displayed.

8.6.Examination Stations Circuit Stations

• The Examination stations should be clearly marked in a logical sequence that allows easy, unimpeded transit from one station to the next.

EXAMPLE S . No Station

Task/Question

1. I Check and record Blood Pressure

2. II List five factors which helps in maintaining Blood Pressure

3. III Take oral temperature and record it

4. IV Rest station

5. V Using the formula, convert 39 °C into Farenheit

6. VI Test the urine for sugar and albumin

7. VII List five causes of albuminuria

As number of stations affects reliability, often overall OSCE’s

reliability is quite low

because often can’t practically run more than 20

stations

9.Patient (Real) or Simulated

• A standardized patient is an individual with a

health problem that is in a chronic but stable

condition. Standardized or simulated patient

may be used when properly trained for history

and physical assessments.

• Simulated patients may come from the ranks of

volunteers, or acting guilds.

cont

• Detailed instruction package is provided for

both the standardized and simulated patient.

The instructions describe how the patient

responds to history questions and physical

exam, as well as how the patient should dress.

10.Timekeeper, Time Clock and Time

Signal

• Appropriate personnel for the position of

official timekeeper and exam facilitators need

to be identified and properly instructed. A well

functioning time clock and time signal are

critical.

• One support person per three stations is

recommended.

11.Contingency Plans

• A contingency plan includes reserve standardized patients who are trained to assume a number of roles, and a patient trainer who circulates to deal with any patient problems that arise.

• A number of reserve stations should be available. A contingency plan must be developed for students who must leave the exam when the situation arises.

12.Assessment of the Performance of the OSCE

• The OSCE should be tested for appropriate measurement characteristics such as validity, reliability, feasibility and credibility.

• A valid OSCE station measures what it was designed to measure. A reliable station measures it consistently.

• Grading can be based on a criterion-referenced system, norm-referenced system, or a combination of both. The Examination committee needs to decide in advance which system best meets its fundamental purposes for the exam.

Objective Structured Practical Examination (OSPE)

• Objective structured practical examination

(OSPE) is a new pattern of practical

examination, in which each component of

clinical competence is tested uniformly and

objectively for all the students who are taking

up a practical examination at a given place.

Steps of OSPE

• In order to organize an OSPE successfully, one

has to spell out the objectives of practical

experiences in a given discipline related to a

particular subject.

1. Demonstrate Practical Skills. For example, for

demonstration of practical skills, monitoring and

recording oral temperature, blood pressure,

converting 39.4 degree centigrade to Fahrenheit

and testing urine for sugar, etc. can be given

cont

2. Make Accurate-Observations Differentiate

between the normal and abnormal ECG,

identify the type of arrhythmias from the ECG.

3.Analyze and Interpret Data Hemogram

report, liver function report, urine or blood

sugar report and other laboratory reports.

4. Identify the Patient's Problems

• The student has to identify the patient's problem in order to organize her work.

• Problems such as Dyspnea, • Rigor following blood transfusion and

• CSF rhinorrhea following head injury.

5. Plan Alternative Nursing Interventions

• In case of airway obstruction, the student is expected to keep the patient in side lying position.

• Do Oro pharyngeal suction.

• Start O2 inhalation if required

Types of Stations

• Procedure station: It requires a student to

perform a task, e.g. monitoring of oral

temperature. When a student performs the task,

simultaneously she is observed and marked

against the checklist being prepared in

advance, by a silent but vigilant examiner.

The question station/the response

station

• The student answers the question being asked

on the answer sheet provided and leaves it in

the place specified

Scoring Students in OSPE

• For each specific skill, a checklist is prepared

by breaking the skill being tested into essential

steps and score is assigned to each step which

is proportional to the importance of the step

related a particular procedure.

Procedure of Conducting OSPE

• Examiners A, B, C stand in a place from where

they can have a good view of what a candidate

is doing at a particular station. They have a

checklist on which they tick as they observe.

The score of each student is entered separately

and confidentially.

• The students are given clear instructions

regarding how they will rotate around the

stations and the time limit in each station and

what they are supposed to do in each station

(demonstrate a skill, make observation, make

calculation from the data provided or answer

the question asked).

Conclusion

The OSCE has several distinct advantages. In view of these, the nurse educators can adopt it as an objective method for clinical evaluation. This will help the students to improve their clinical competence. The emphasis is on assessing what students can do rather than what they know. Therefore, OSCE gives direction for attaining the ultimate aim of the teaching- learning process.

Thank you