TIME OBJECTIVE CONTENT TEACHING A.V.
EVALUATION
LEARNING AIDS
ACTIVITIES
INTRODUCTION:
3 min. To introduce SELF:
own self and Myself Miss Neha G. Prajapati, student of F.Y.M.Sc.
give Nursing studying in JG College of Nursing.
introduction TOPIC: Objective structured clinical examination
about topic. An OSCE is a modern type of examination often used in
Health sciences (like Medicine, chiropractic, physical Discussion Power
therapy, Radiography, Nursing, Pharmacy and Dentistry) to point
test clinical skill performance and competence in skills such slides
as communication, clinical examination, medical
procedures/prescription, exercise prescription,etc.
Definitions
2 min. To define the ‘An exam whereby ‘students demonstrate their competence
learning. under a variety of simulated conditions’.
- Waston,2002
“Examinations in which the student is required to perform Lecture What is the
specific skills and behaviors in a simulated clinical or patient definition of
care environment”. osce?
3 min. To explain the OSCE DESIGN: Lecture
design of An OSCE usually comprises a circuit of short (usual is 5 to
OSCE. 10 minutes although some use up to 15 minute) stations, in
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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.
10 To discuss the Objective (O) Lecture come
min. meaning of ‘O’ in the word OSCE stands for “objective and objectivity” discussion What is the
objective, is a defining feature of this type of assessment. meaning of O, S
structure, All candidates are assessed using exactly the same stations C, E?
clinical, (although if real patients are used their signs may vary
examination. slightly) with the same marking scheme. In an OSCE
candidates get marks for each step on the mark scheme that
they perform correctly which therefore makes the assessment
of clinical skills more objective rather than subjective, where
one or two examiners decide whether or not the candidate
fails based on their subjective assessment of their skills. By
the nature of their role, assessors have the responsibility of
marketing professional judgments about the performance of
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students whom they are assessing.
The assessor is required to make decisions based on two key
judgments:
1. The extent to which a student has met the learning
outcomes and standards of the particular course or
subject that is being examined.
2. Whether the student has demonstrated the level of
competency that is expected and consequently,
whether the student is able to practice safety in the
clinical setting.
The OSCE is designed to achieve transparency by
minimizing potential bias.
Clinical practice and what you have seen while working in
the practice environment, you will recognize that most
practitioners have a preferred way of doing something.
However, if an examiner had a specific way of assessing
student performance in accordance with her/his own
particular likes, dislikes or habits, this could cause
difficulties in terms of equity and consistency, especially if
there were more than one examiner assessing the same skill.
Problems would arise if students were not assessed
objectively on their competence but instead on how well
their performance complied with the examiner’s likes and
dislikes. You can see that if this were to happen, the
assessment process would not be fair. In fact, it could be
considered biased towards the examiner. Therefore, it is very
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important that the clinical exam is free from any prejudice or
bias. In other words, it needs to be objective.
Structured
The letter ‘S’ stands for structure. Stations in OSCEs have a
very specific task where simulated patients are used detailed
scripts are provided to ensure that the information that they
give is the same to all candidates, including the emotions that
the patient should use during the consultation. Instructions
are carefully written to ensure that the candidate is given a
very specific task to complete. The OSCE carefully
structured to include parts from all elements of the
curriculum as well as a wide range of skills.
When planning for the OSCE, a team of course lecturers
will spend time considering in detail each of the skills that
will be examined. Each skill will be broken down into its
component parts, and marking criteria, in the from of a
checklist, will be developed. Essentially, this is a list of the
key components of the skill that the student should perform
in order to demonstrate that he is competent, safe and
thorough.
During the examination the assessor will use the checklist
to mark each student’s performance. This is typically done
by observing if each part of the skill has been performed and
whether it has been demonstrated correctly and safely.
By using such a structured approach, any examiner’s
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bias is substantially minimized as they can only mark a
student’s performance in accordance with whether the
student has or has not met each criterion set out on the
marketing sheet. The allocation of marks between different
stations will be agreed upon by the examiners in advance of
the OSCE and the student’s final score will usually be based
on the overall number of correct responses on the marking
criteria checklist.
Another way in which OSCEs can be considered to be a
structured form of assessment is the way in which they are
organized. OSCEs consist of different types of assessment
takes we will consider the most typical OSCEs, which
consist of a circuit or series of short activities, each of which
must be performed at a different ‘station.’ These activities
are tied and students are assessed at each station by one
examiner using the predetermined, objective marketing
sheet. In this way, each student is assessed in both a
structured and standardized way, thereby eliminating the risk
of inequality and inconsistency.
Clinical(C)
A clinical examination: The OSCE is designed to applied
clinical and theoretical knowledge. Where theoretical
knowledge is required (E.g. answering questions from the
examiner at the end of the station) then the questions are
standardized and the candidate is only asked questions that
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are on the mark sheet (if they are asked any others then there
will be no marks for them).
Examination (E)
An examination is the process of testing competence or
knowledge. As such, in an OSCE, clinical competency is
assessed by working it down into its various components. In
this way students are required to demonstrate not only what
they know but also that they know how to perform a clinical
skill. Therefore, they must also show how to perform it
competently by demonstrating the necessary actions required
for the execution of the skill in a safe, appropriate and
competent manner.
2 min. To explain the NEED OF OSCE: Lecture
need of osce. You may know from experience that a typical clinical What is the need
environment is often busy with multidisciplinary team of OSCE?
members working to meet the needs of the numerous patients
or clients for whom they are caring. Sometimes when
performing a clinical skill in the practice setting, it is not
unusual to be interrupted or distracted by what else is
happening. But clinical skills are fundamental to nursing
practice and specific skills are often needed for patients who
are very ill, experiencing pain or who are emotionally
distressed, Therefore, in many cases it would be
inappropriate or even unethical for an examination to be
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conducted in the clinical setting or for a skill to be
demonstrated several times by many different students using
a real patient. Likewise, it would be unrealistic to expect a
patient to recount is history repeatedly for the purpose of an
OSCE. To overcome these issues, simulation is commonly
used for OSCEs in order to create an environment similar to
that of the clinical setting. A variety of approaches can be
used.
e.g. A simple model of the skin can be used to enable the
student to demonstrate how to give an I/M injection
To set the scene at the beginning of each station, the student
will be given a short scenario to read. This will provide the
information necessary to establish the context in which the
specific set of skills in to be performed and will identify the
skills being examined.
10 To list down PURPOSES; Explanation
min. the purpose of - Used in both formative and summative assessment in health List down the
osce. professional education purposes of
- Identify objective performance criteria for the skill being OSCE.
examined
- Structure the performance criteria in a checklist to facilitate
identification of desired clinical skills
- Use a set structure to encourage parity between students
- Use ‘students’ designed to assess a specific skill or
component of health professional clinical practice
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- A requirement for accreditation in many health professional
programs
- Encourage a collaborative approach between HEI and
practice in the creation of health professionals who are ‘fit
for purpose’
- Adaptable across professions and clinical skills in all
academic levels
- Have potential for peer feedback and assessment
- Promote development of functioning knowledge
- Identify the performance criteria for advanced practice
skills or ‘expertise’ can be challenging
- Knowledge associated with specific advanced practice
skills can be assessed within a viva subsection of the OSCE
checklist
- Important to differentiate b/w academic levels in OSCE,
not just in the advanced skills performance required but in
the higher challenge for and expectations of these students
- “Teachers, Examiners and students” feedback on the
Masters Level OSCE is very positive.
- Conventionally, students move between multiple OSCE
‘students’, each one focusing on a different skill, so students
demonstrate the breadth of skills required for clinical
practice expected at their stage of learning and development.
- During an OSCE, the examiner will assess learners’
performance with regard to four distinct elements which
includes “Knowledge and understanding underpinning the
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skill (K); Motor or technical aspects of the skill (M); The
affective aspects (A), i.e., the professional attitude associated
with the performance; and structure(S), i.e. how you
approach the skill in terms of being systematic, logical and
organized.” A simple acronym that can help to remember
these components is KMAS (Knowledge, Motor skill,
Attitude, Structure).
1o To discuss the Preparation Explanation
min. preparation of Preparing for OSCEs is very different from preparing How to prepare
OSCE. for an examination on theory. In an OSCE, clinical skills are an OSCE?
tested rather than pure theoretical knowledge. It is essential
to learn correct clinical methods and then practice repeatedly
until one perfects the methods. Marks are awarded for each
step in the method; hence, it is essential to dissect the method
into its individual steps, learn the steps, and then learn to
perform the steps in a sequence. Most universities have
clinical skills labs where students have the opportunity to
practice clinical skills. It is often very helpful to practice in
small groups with colleagues, setting a typical OSCE
scenario and timing it with one person role playing a patient,
one person doing the task and (if possible) one person either
observing and commenting on technique or even role plating
the examiner using a sample mark sheet. In doing this, the
candidate is able to get a feel of running to time and working
under pressure.
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Miller (1990) recommends that, in order to demonstrate
competency, ‘knows’, ‘knows how’, ‘shows how’ and ‘does’
are necessary. This means that, in terms of demonstrating
clinical competency, knowledge (knows), competence
(knows how), demonstration (shows how) and clinical
performance (does) are all important.
Knowing, Showing, Doing, e.g. Pain Assessment
As part of an OSCE, you were required to undertake a pain
assessment on a simulated patient / client, the examiner
would assess you on the following clinical competences.
Knowledge
This is a bottom of the triangle, indicating that it is the most
basic and broadest component in the framework. It relates to
having the appropriate knowledge that underpins practice.
Pain is a very complex phenomenon. Because of this,
adequate knowledge and understanding of the potential
physiological, psychological and emotional elements of pain
is required in order to effectively undertake a pain
assessment. Knowledge and understanding of the different
types of pain and how these may relate to an individual is
also important.
Understanding
This is a higher component in the framework because it
depends on knowing how to do something and understanding
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why it should be done in a certain way. In the given example,
this would involve demonstrating knowledge and
understanding skills. Knowledge of different pain assessment
tools and how to use them is important. Likewise, knowing
hoe to interpret data obtained from a pain assessment is also
essential.
Demonstration
This is a further step up in the framework because it depends
on demonstrating or showing how to do something. It
requires familiarity with the process of pain assessment and
with demonstrating how to perform the assessment in a
systematic and structured way.
Clinical performance
The performance or the ‘doing’ part is the most important
and sometimes, most challenging part. It requires integrating
all three previous points and performing the skill in a
professionally competent way. In this example, it includes
communicating with the patient, assessing pain using an
appropriate method, documenting it and interpreting the
findings.
The OSCE provides an opportunity foe an assessment of
competency within a simulated environment. However, the
‘doing’ part requires this competency to be demonstrated in
practice.
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6 min. To Elaborate TYPES OF OSCE: Lecture Which are the
the types of different types of
OSCE. 1. OSCEs comprising a number of short stations within a OSCE?
circuit, these are known as ‘short cases’ or ‘multi-station
OSCEs’ used for the students in the beginning of the
program, e.g. the OSCE may last an hour, during witch time
students rotate around six stations, demonstrating a simple
clinical skill at each station. In this case each station would
be 10 minutes’ duration.
e.g. A nursing student approaching the end of first
year, an OSCE has to be conducted to assess clinical skills in
the course that are fundamental to nursing practice. It is
likely that the OSCE for this student would focus on the
assessment of competence in a range of key principles such
as safety and accuracy. In this type of OSCE the stations
would be developed with a focus on discrete skills, such as
aseptic technique, hand washing technique, measurement of
vital signs, First Aid, etc. rather than on the more complex
integration of skills
2. In addition to skills, some OSCEs may also comprise
knowledge stations, which a number of skills are assessed
referred a ‘long cases’ or ‘single stations’ and are most
commonly used for assessing competency in skills for final
year students. They are typically used to assess competency
in the integration of skills. This type of OSCE may be one
hour ling, but comprise just one station, lasting the whole
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hour or two stations, each one of 30 minutes duration. As
part of a ‘long case,’ knowledge may be tested while a
procedure is undertaken or after skills component has been
completed.
e.g. For final Year students, the clinical component of
the course requires to demonstrate competency in skills
related to clinical specialties in that academic year. It is
likely that the OSCE for this course would focus on
assessing competence in the skills learnt, but also be
expected to demonstrate the integration of those skills like
the ability to effectively answer any questions in the scenario
may ask.
1st OSCE is to assess how you perform the basic skills
required for a range of different tasks while later OSCEs
assess how well you are able to integrate appropriate skills in
specific patient scenarios.
peer assessment
Using peer assessment in formative OSCE
Peer involvement is beneficial to the students by promoting
deeper learning as they increase their effort knowing peers
will be evaluating their work and by making students rethink
their understanding of the skill in order to be able to provide
appropriate feedback.
- Provide peer feedback prepares students for professional
practice where assessment of peers and students is expected
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- Peer assessment using formative OSCE provides the
student with a clear understanding of peers and students is
expected
- Peer assessment using formative OSCE provides the
students with a clear understanding of the performance
criteria required for clinical practice
- Peer involvement in teaching and learning helps by
improving the success of student learning and by
empowering students to progress through feedback.
5 min. To explain OSCE MARKING: Lecture cum Explain how to
that how to do Marking in OSCEs is done by the examiner. Occasionally discussion. do OSCE
OSCE marking?
written stations, for example, writing a prescription chart, are
marking.
used and these are marked like written examinations, again
usually using a standardised mark sheet. One of the ways an
OSCE is made objective is by having a detailed mark scheme
and standard set of questions. For example, a station
concerning the demonstration to a simulated patient on how
to use a Metered dose inhaler [MDI] would award points for
specific actions which are performed safely and accurately.
The examiner can often vary the marks depending on how
well the candidate performed the step. At the end of the mark
sheet, the examiner often has a small number of marks that
they can use to weight the station depending on performance
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and if a simulated patient is used, then they are often asked
to add marks depending on the candidates approach. At the
end, the examiner is often asked to give a "global score".
This is usually used as a subjective score based on the
candidates overall performance, not taking into account how
many marks the candidate scored. The examiner is usually
asked to rate the candidate as pass/borderline/fail or
sometimes as excellent/good/pass/borderline/fail. This is
then used to determine the individual pass mark for the
station.
Many centers allocate each station an individual pass mark.
The sum of the pass marks of all the stations determines the
overall pass mark for the OSCE. Many centers also impose a
minimum number of stations required to pass which ensures
that a consistently poor performance is not compensated by a
good performance on a small number of stations.
CRITISISM:
There are, however, criticisms that the OSCE stations can
never be truly standardised and objective in the same way as
a written exam. It has been known for different patients /
actors to afford more assistance, and for different marking
criteria to be applied. Finally, it is not uncommon at certain
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institutions for members of teaching staff be known to
students (and vice versa) as the examiner. This familiarity
does not necessarily affect the integrity of the examination
process, although there is a deviation from anonymous
marking. However, in OSCEs that use several circuits of the
same stations the marking is repeatedly shown to be very
consistent which supports the validity that the OSCE is a fair
clinical examination.
3min. To summarize Questions.
the topic SUMMARY:
Definition
OSCE design
Preparation of OSCE
Purposes of OSCE
Types of OSCE
Marking of OSCE
Criticisms of OSCE.
1 min. To conclude
the topic CONCLUSION:
After completion of today’s session we come to know about
another type of clinical examination which will be helpful in
preparation of exams for students.
1 min. To give
references for BIBLIOGRAPAHY:
further study Anisha maheshwari, “communication and Educational
technology for nurses”; 2nd edition; 2009, N.R.brothers;
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indore, Pp –325-317
Basvanthppa B.T., “communication and Educational
technology for nurses”; 1st edition; 2011, Jaypee Brothers
medical publication; New Delhi, Pp–229.
Neerja K.P., “Textbook of communication and
Educational technology for nurses”; 1st edition; 2011,
Jaypee brothers medical publishers, New Delhi; Pp-314-319.
WEB REFERANCES:
http://www.bmj.com/cgi/content/abstract/1/5955/447
1 min. ASSIGNMENT:
List down the purposes of OSCE.
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