OBJECTIVE STRUCTURED CLINICAL EXAMINATION ( OSCE )

1. OBJECTIVESTRUCTURED CLINICAL EXAMINATION (OSCE)

2. LEARNING OBJECTIVES • At the end of the class the student will be able to- • Define OSCE • List down purpose of OSCE • Mention the uses of OSCE • Explain the organization of OSCE • Describe the advantages and disadvantages of OSCE

4. OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE)

5. INTRODUCTION : • An Objective Structured Clinical Examination (OSCE) is a modern type of examination often used in health sciences to test clinical skill performance and competence in skills such as communication, clinical examination, medical procedures / prescription, exercise prescription, joint mobilization / manipulation techniques, radiographic positioning, radiographic image evaluation and interpretation of results.

6. MEANING OF OSCE: • “O” stands for Objective. • Every student gets the same patient (same chance). • “S” stands for Structured. • Several skills are tested at one time. • Each skill is tested in a separate station. • The examiner have a checklist for doing the • marking.

7. cont. • “C” stands for clinical. • -Testing the skills of students: - Manual skills, like examining the anterior chamber of the eye. - Communication skills like taking patient’s history. • “E” stands for Examination.

8. Highlights • OSCE is designed to assess clinical competence and communication skills. • No. of stations: 10-15 (5 min. each) • Three areas have to be tested: - Communication skills. - Physical examination. - Short answer stations.

9. “A multi DEFINITION OFOSCE dimensional practical examination of clinical skills , as a tool for assessing clinical competence”

10. What is an OSCE/OSPE OSCE/OSPE is an instrument to assess the components in practical skills such as simple procedures, interpretation of lab results, communication, attitude etc. These are tested using agreed check lists and rotating the student round a number of stations some which have observers with check lists.

11. HISTORY • OSCE is a form of multi-station examination for clinical subjects first described by Harden et al from Dundee (1975). It was firstly adopted in North America in a widespread manner.

12. PURPOSES OFOSCE Use in bothformativeandsummativeassessmentin health professioneducation Identify objective performance criteria for the skill being examined structuredtheperformancecriteriainchecklistto facilitate the identification of desired clinicalskill A requirementforaccreditationinmanyhealth professionalprograms

13. • USES OFOSCE • Interpersonal and communicationskills • History-takingskills • Physical examination of specific bodysystems • Mental healthassessment • Clinicaldecisionmaking,includingtheformationof differentialdiagnosis • Clinical problem-solving skills.

14. CONT.. Interpretation investigations. Management ofclinical findingsand ofaclinical situation, including treatment andreferral Patient education. Healthpromotion. Acting safelyand clinicalsituation. appropriately inanurgent procedure Basic and practices. advancednursing care

15. Assessment of clinical skills/competence/ performance

16. ORGANIZING THEOSCE • • The OSCE examination consists of about 10-15 stations, each of which requires about 4-5 minutes. The number of stations and time spent on each station may vary based on needs ofevaluation. • All stations should be capable of being completed in the sametime. • The studentsarerotatedthroughallstationsand have to move to the next station at thesignal.

17. CONT.. • As the stations are generally independent, students can start at any procedure stations and complete thecycle. •Thus, using 15 stations of 4 minutes each, 15 students can complete the examination within 1 hour. • Each station is designed to test a component of clinical competence.

19. Problems of using OSCE inthe Indian scenario • Lack of feasibility due to timeconstrains. • Shortage of training for use ofOSCE. • Shortage of observers/examiners. • Lack of interest inexaminers. • Lack of enforced guidelines for practical examination by universities number of students examined and format of evaluationused

20. Advantages ofOSCE More valid than the traditional approach to clinicalexaminations. Examiners can decide in advance what is to he tested and can then design the examination to test thesecompetencies. 3.Examinerscan have bettercontrol onthe content andcomplexities. 4. Emphasis can be moved away from testing factual knowledge to testing a wide range of skills including advanced clinicalskills.

21. CONT.. More reliable because variables of the examiner and the patient are removed to a largeextent. The use of checklists by examiners and the use of multiple choice questions results in a more objective examination. More practical because it can be used with a large numbers ofstudents.

22. DISADVANTAGES OFOSCE • Demanding for both examiners and patients. • Examiners are requiredtopaycloseattentionto studentsrepeating thesametaskonanumber of • occasions. • The timeinvolvedinsetting uptheexaminationis greater than for the traditionalexamination.

32. EXAMINE ABDOMEN ANS.-Q. ON ST.1 EXAMINE CHEST ANS.-Q ON ST.3 1 2 4 3 HISTORY 5 SPOT 20 QUE. ON ST. 5 6 SLIDE (SPOT) 19 EXAMPLE OF OSCE HISTORY 7 QUE.ON ST.17 18 QUE.ON ST. 7 NEURO EXAM. 8 17 QUE.ON ST.15 16 CT SCAN 9 13 14 12 11 CVS EXAM. LAB DATA 15 INSTRU. & QUE. QUE.ON ECG ECG ANS.-Q ON CT 10 32

33. ObjectiveStructured 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 givenplace.

34. Steps ofOSPE • In order to organize an OSPE successfully, one has to spell out the objectives of practical experiences in a given discipline related to a particularsubject. • 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 begiven

35. cont Make Accurate-Observations Differentiate between the normal and abnormal ECG, identify the type of arrhythmias from theECG. Analyze and Interpret Data Hemogram report, liver function report, urine orblood sugar report and other laboratoryreports.

36. 4. Identify the Patient'sProblems • The student has to identify the patient's problem in order to organize herwork. • Problems such as Dyspnea, • Rigor following blood transfusionand • CSF rhinorrhea following headinjury. • Plan Alternative NursingInterventions • In case of airway obstruction, the student is expected to keep the patient in side lyingposition. • Do Oro pharyngeal suction. • Start O2 inhalation ifrequired

37. Types ofStations • Procedure station: It requires a student to perform a task, • e.g. monitoring of oral temperature. When a student performs thetask, simultaneously she is observed and marked against the checklist being prepared in advance, by a silent but vigilantexaminer.

38. PROCEDURE STATION • QUESTION :You are provided with an oxygen-filled spirometer. Determine your vital capacity. • EXAMINER’S CHECKLIST: • YESNO • Does he check the spirometer for leakage ? • Mouth piece inserted properly • Nose clipped properly • Does he take a few normal breaths before • determining vital capacity ? • Takes a deep inspiration • Exhales maximally • Takes more than one reading • Takes the highest reading as the vital • capacity • 9. Also determines two-stage vital capacity 38

39. The question station/theresponse station • The student answers the question being asked on the answer sheet provided and leaves it in the placespecified

40. QUESTION STATION Three Multiple Choice Questions On Vital Capacity. 40

41. DEMO. MOVEMENTS X RAY Q.ANS ON 2 IDENTIFY PART 1 2 4 3 VITAL CAPACITY 5 PRESCRI- PTION 20 QUE. ON ST. 5 6 19 FDC- EVALUATE. EXAMPLE OF OSPE NEURO EXAM. 7 DOSAGE FORM 18 WITHDRAW FROM VIAL. QUE.ON ST. 7 8 17 QUE.ON ST.15 16 NEUB. CHAMBER 9 13 14 12 11 GROSS SPECIMEN. LAB DATA 15 SLIDE (SPOT LAB DATA Q.ANS ON10 URINE PROTEIN 10 41

42. Scoring Students inOSPE • 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 particularprocedure.

43. Procedure of ConductingOSPE • Examiners A, B, C stand in a place fromwhere 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 andconfidentially.

44. 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 questionasked).

45. EXAMPLE . No Station Task/Question I-Check and record BloodPressure II-List five factors which helps in maintaining Blood Pressure III -Take oral temperature and recordit IV-Reststation V -Using the formula, convert 39 °C into Farenheit VI -Test the urine for sugar andalbumin VII-List five causes ofalbuminuria

46. RATING

47. LIKERT SCALE

48. CHECK LIST

50. CONCLUSION • The OSCE/ OSPEhas several distinctadvantages.In view ofthese, 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, OS C E /OSPEgives direction for attaining the ultimate aim of the teaching-learningprocess