Objective Structured Clinical Examination –Emerging Trend in Nursing Profession

 

Prof. G. Muthamilselvi¹, Mrs. P. Vadivukkarasi Ramanadin²

¹Professor cum Principal, Vinayaka  Mission’s  College of Nursing,, Pudhucherry

²Asst. Professor, Dept. of OBG (N), Mata Sahib Kaur College of Nursing, Mohali, Punjab.

*Corresponding Author Email: krishraghav2010@gmail.com

 

ABSTRACT:

Assessment of clinical competence is an essential, mandatory requirement for health care profession. But it became a tough job for nurse educator as it poses several challenges in terms of objectivity and reliability. The OSCE which is the performance based method helps to overcome these challenges. This study was undertaken with the aim of assessing the knowledge, attitude and exploring the opinion towards OSCE among the nursing faculty by using mixed method. Knowledge on OSCE was assessed by using Structured Questionnaire with 15 items and attitude was assessed by using five point Likert scale with 10 items. Unstructured Questionnaire was formulated to explore an opinion. Non – Probability, Convenient sampling technique was used to select Thirty Nursing Faculty.  Study findings shows that the Nursing Faculty have 40% Excellent knowledge, 47% of them have Adequate and 13% of them have inadequate knowledge and also it shows that 73% of them have positive attitude and 27% of them have negative attitude towards OSCE.  Correlation between Knowledge and Attitude towards OSCE reveals that moderately negative correlation. Opinion on OSCE was explored and grouped under “Opinion on OSCE”, “Client Care”, “Clinical Evaluation”, “Utilization of Resources” and “Difference between OSCE and Traditional method of Clinical Examination”. The study recommends that the Nursing Faculty should develop positive Opinion and skill in preparing the students by using OSCE.

 

 

 

INTRODUCTION:

Assessment plays a major role in the process of nursing education, in the lives of nursing students and in society by certifying competent practitioner who can take care of the people. The objective Structured Clinical Examination (OSCE) is an approach to students’ assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent and structured manner, with close attention to the objectivity of the process (Byrne and Smyth, 2007). Objective Structured Clinical Examination” (OSCE) evolved from medical education in Scotland, and has been used extensively in nursing worldwide.

 

It is now widely accepted as a fit-for-purpose instrument for measuring clinical reasoning skills with a high degree of technical fidelity (Ahmad, Ahmad and Abu Bakar, 2009). The OSCE was introduced by Dr. Ronald M. Harden in 1970s as ‘‘an approach to the assessment of clinical competence in which the components of competence are assessed in a planned or structured way with the attention being paid to the objectivity of the examination.’’ McAleer S and Walker R (1990) described that the examination consists of multiple, standard stations at which students must complete 1 to 2 specific clinical tasks, often in an interactive environment involving patient actors (ie, standardized patients). OSCE has become a common method to assess learner performance across a variety of health professions disciplines. Most notably, OSCE is a component of entry-to-practice licensing examinations, including the United States Medical Licensing Examination, the Canadian Pharmacist Qualifying Examination, and the Medical Council of Canada Qualifying Examination. Barman A (2005) state that to maintain examination validity and authenticity, a representative sampling of real-world skills should be tested. As Austin Z et al (2003) shows that consequently, use of a blueprint that defines examination domains (eg, knowledge, skills, behaviors, complexity) to guide OSCE station development along with group (rather than individual) writing of OSCE cases with peer review has been recommended.

 

OSCE is now an established part of the repertoire of clinical assessment skills in many nursing schools around the world. Nursing faculties in Egypt use a range of assessment techniques that are appropriate for testing students’ outcome. However, in Egypt, there is no available evidence for using OSCE in nursing education. OSCE is a new issue that needs capacity building for Egyptian nursing faculties. A baseline survey in the assessment of competency resulting from medical and nursing education in Egypt (2006) reported that skills assessed are poorly performed by four learner groups (medical and nursing undergraduates, nurse intern and house officers) in both medical and nursing faculties Furthermore, clinical training as it is currently organized and implemented for the competencies assessed is inadequate for all learner groups of all regions in Egypt (Health Workforce Development, 2006).

 

OSCE has been widely and increasingly used since it was developed. Researchers have shown that it is an effective evaluation tool to assess practical skills. Currently, the ability of simulation to meet the needs of practice education remains limited (Pierre, Wierenga, Barton, Branday and Christie, 2004). In addition, (Ahmad, Ahmad and Abu Bakar, 2009) added that OSCE is developed to reduce bias in the assessment of clinical competence; it is not now without the pitfalls of other assessment methods. In particular, the need for more rigorous evaluation of OSCEs in nursing education programs has been highlighted (Brosnan, Evans, Brosnan, and Brown 2006); (Miller, 2009) as these assessments are directed towards assurances that passing students can practice safely in the clinical setting with patients. In many instances the OSCE process has been adapted to test trainees from different healthcare related disciplines. Shadia A.E (2010) shows that in nursing education principles of OSCE can also be used in a formative way to enhance skills acquisition through simulation (Alinier, 2009).

 

OBJECTIVES:

·        To assess the knowledge regarding Objective Structured Clinical examination among the nursing faculty working in selected Nursing Institutions at Puducherry”.

·        To assess an attitude regarding Objective Structured Clinical examination among the nursing faculty working in selected Nursing Institutions at Puducherry”.

·        To correlate the knowledge and attitude regarding Objective Structured Clinical examination among the nursing faculty working in selected Nursing Institutions at Puducherry”.

·        To explore an opinion on OSCE among nursing faculties working in selected Nursing Institutions at Puducherry”.

 

MATERIALS AND METHODS:

As Sequential research design was adopted for this study both Quantitative and Qualitative approach was used simultaneously. Thirty Nursing Faculty working in Vinayaka Mission’s College of Nursing, Pudhucherry were selected by using Non- Probability, Convenient Sampling method. Quantitative method was used to assess the Knowledge and Attitude. Knowledge on OSCE was assessed by using Structured Knowledge Questionnaire with 15 items and four option was provided. Each correct response were scored one and wrong response was scored zero. Attitude towards OSCE was assessed by using five point Likert scale with 10 items. The scoring was ranging from -2 to +2 for strongly disagree to strongly agree. Qualitative method was used to explore an opinion on OSCE. Interview schedule was planned with Unstructured Questionnaire to explore an opinion towards OSCE. Content Validity of the tool was obtained from the experts of Nursing Profession and Statistician. Reliability of the tool was done by using Split half technique and Spearman Brown Prophecy Formula which shows 0.82 that is highly reliable. Data were analyzed by using both descriptive and inferential statistics. Correlation between Knowledge and Attitude was assessed by Karl Pearson Correlation Co-efficiency. 

 

TABLE: 1 Nursing Faculty Level of Knowledge on Objective Structured Clinical Examination                                     N = 30

Table No 1 shows that 40% of the Nursing Faculty had excellent knowledge on OSCE, 47% of them had an adequate knowledge and 13 % of them had inadequate knowledge.

 

TABLE: 2 Nursing Faculty Attitude towards Objective Structured Clinical Examination                                                     N = 30

S. No	Attitude
	Positive		Negative
	Frequency	Mean Percentage	Frequency	Mean Percentage
1	22	73%	8	27%

Table No 2 denotes that 73% of them had Positive attitude and 27% of them had negative attitude towards OSCE.

 

TABLE: 3 Correlation between Knowledge and Attitude on Objective Structured Clinical Examination among the Nursing Faculty

N = 30

S. No	Knowledge		Attitude		Correlation (r)	Inferences
	Frequency	Mean Percentage	Frequency	Mean Percentage
1	161	54%	96	16%	-0.044	Moderately negative correlation

Table: 3 depicts that there is moderately negative correlation between knowledge and attitude on OSCE.

 

 

FINDINGS:

QUALITATIVE ANALYSIS:

EXPLORING OPINION ON OSCE:

—  Opinion on OSCE:

        Present study reveals the inner aspects of Nursing Faculty on OSCE. Study participants were expressed that “OSCE can be one of the method of clinical evaluation” to measure the clinical performance of nursing students.

—  Client care:

        Participants felt that “holistic care and direct client care may not be possible, but the student’s skill may be evaluated”.

—  Clinical Evaluation:

      They expressed that “OSCE may not help to evaluate the maximum number of students. But it may offer equal opportunity to all the students to perform nursing skill.  Evaluation on the entire domain is questionable”

—  Utilization of Resources:

      Subjects felt that “OSCE requires more than two examiners for evaluation. It is very exhaustive procedure. It may need more time, effort for preparation, money and material”.

—  Difference between OSCE and Traditional method of Clinical Examination:

        Samples felt that “Overall OSCE is a more stress full and superficial method of clinical examination. It may be very thorny for today’s scenario with faculty turnover.

 

DISCUSSION:

OSCE is one of the best methods of clinical examination for the present scenario for the safe Practice. Many of the developed countries adopted OSCE is one of the method of clinical examination. OSCE as a performance-based assessment is a well established student’s assessment tool for many reasons: competency- based, valid, practical and wise effective mean of assessing clinical skills that are fundamental to the practice of nursing and other health care related professions (Ainier, 2003). Deborah A et al (2011) conducted the study in 108 US colleges and schools of pharmacy with interviews of a representative sample of 88 programs (81.5% participation rate). Thirty-two pharmacy programs reported using OSCEs; however, practices within these programs varied. Eleven of the programs consistently administered examinations of 3 or more stations, required  all students to complete the same scenario(s), and had processes in place to ensure consistency of standardized patients’ role portrayal. Of the 55 programs not using OSCEs, approximately half were interested in using the technique. Common barriers to OSCE implementation or expansion were cost and faculty members’ workloads. The study concluded that there is wide interest in using OSCEs within pharmacy education.

 

Stewart BK et al (2011) done the comparative study to evaluate the effectiveness between traditional and Objective Structured Clinical Examination shows that the moderate correlation found between individual attainment in OSCE examinations and on traditional pharmacy practice examinations at the same level. It was concluded that OSCEs add value to traditional methods of assessment.

 

Shadia A.E et al (2010) conducted a study on An Introduction of OSCE versus Traditional Method in Nursing Education: Faculty Capacity Building and Students’ Perspectives shows that the 57% of faculty members knew nothing about OSCE and 98.6% of them had no experience in using OSCE; also a high statistical significant differences between OSCE and traditional assessment groups in the first and second trial (t = 2.423, p= 0.016), and (t= 6.23, p= 0.000) respectively. The students' achievements were better with OSCE. Faculty staff members indicated that, OSCE saves time (76.3%), prepares highly qualified competent students (62.5%) and improve students’ performance (62.5%). It was concluded that OSCE examination offers an attractive option for assessment of students’ competency. It provided particular strengths in terms of faculty staff objectivity and reliability of the assessment process for all students, especially when compared with other methods of assessing practice.

 

CONCLUSION:

As we are always strive for the better way of education, this study was intended to bring out the actual knowledge, attitude and opinion of the nursing faculty towards OSCE. The present Study reveals that though knowledge is high attitude towards OSCE was slightly negative. So faculty should be imparted with enough knowledge on OSCE.

 

“OSCE not teach you mostly how to examine the student rather it teaches the students HOW to learn”

 

ACKNOWLEDGEMENT:

We are thankful to all the Nursing Faculty who participated and contributed their valuable time and opinion towards the study.

 

ETHICAL CLEARANCE:

Study objectives were explained to all the Nursing Faculty and Informed consent have been taken before the study.

 

REFERENCES:

1.       Austin Z, O’Byrne C, Pugsley J, Munoz LQ (2003) Development and validation processes for an objective structured clinical examination (OSCE) for entry-to-practice certification in pharmacy: the Canadian experience. Am J Pharm Educ. 67(3): Article 76.

2        Barman A (2005) Critiques on the objective structured clinical examination. Ann Acad Med Singap. 34(8): 478-482.

3        Deborah A, Sturpe (2010) Objective Structured Clinical Examinations in Doctor of Pharmacy Programs in the United States. American Journal of Pharmaceutical Education. 74 (8) Article 148.

4        Harden RM (1988) What is an OSCE? Med Teach. 10(1):19-22.

5        Harden RM (1990) Twelve tips for organizing an objective structured clinical examination (OSCE). Med Teach. 12(3-4): 259-264

6        McAleer S, Walker R (1990) Objective structured clinical examination (OSCE). Occas Pap R Coll Gen Pract. 46:39-42.

7        Shadia A.E,  Hanaa A, Hewida A.H, Nagwa Abd El, Fadil, Inas H. El Shaeer (2010)                    An Introduction of OSCE versus Traditional Method in Nursing Education: Faculty Capacity Building and Students’ Perspectives. Journal of American Science 6(12) retrieved from http://www.americanscience.org

8        Stewart BK, Laura K (2011) Objective Structured Clinical Examinations (OSCEs) Compared With Traditional Assessment Methods. American Journal of Pharmaceutical Education 75 (6): Article 111.

9        The Pharmacy Examining Board of Canada. http://www.pebc.ca. Accessed August 26, 2010.

10     The Medical Council of Canada. http://www.mcc.ca. Accessed August 25, 2010.

11     The United States Medical Licensing Examination. http://www.usmle.org. Accessed August 26, 2010

 

 

Received on 08.10.2013           Modified on 15.11.2013

Accepted on 20.11.2013           © A&V Publication all right reserved