Dr. Shruti Mohanty, FAIMER 2008,GSMC, KIMS, Narketpally OSCE OSPE Dr. Shruti Mohanty, FAIMER 2008,GSMC, KIMS, Narketpally

OVERVIEW OSCE OSPE Education spiral &Taxonomical domains Factors influencing performance Why OSPE ? What is OSCE/OSPE ? How to conduct an OSCE/OSPE? Validity And Reliability Advantages & Disadvantages OSPE

Education spiral Educational objectives Implementing Evaluation Planning Evaluation Education spiral T/L Process

Taxonomical Domains

Taxonomical Domains (Benjamin Bloom-1956)  COGNITIVE DOMAIN (Intellectual Skills)  PSYCHOMOTOR DOMAIN (Practical Skills)  AFFECTIVE DOMAIN (Attitude / Emotional Areas)

Factors influencing performance

Factors Influencing Assessment Student performance Patient performance Non standard marking system Examiner bias STUDENT ASSESSMENT

Why ? WHY OSPE /OSCE?

Lack of Standardisation Subjectivity Drawbacks of the traditional methods of assessing clinical performance: Lack of structure Lack of Standardisation Subjectivity

and ‘structure’. The two major underlying principles of the OSCE are ‘objectivity’ and ‘structure’.

A well-designed OSCE has a high level of Validity (the OSCE assesses what it is designed to assess) Reliability (the examination results are reproducible with very little error)

What ? What is OSCE/OSPE

What is an OSCE / OSPE? Objective Structured Clinical / Practical Examination Harden RG and Gleeson FA Assessment of clinical competence using an objective structured clinical examination (OSCE) Medical Education,1979, Vol 13: 41-54

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 Test of performance of clinical skills Candidates have to demonstrate their skills, the psychomotor skills and not theoretical knowledge

OSCE Definition: An approach to the assessment of clinical competence in which the components of competence are assessed in a planned or structured way with attention being paid to the objectivity of the examination”. Harden, 1988

Observation of professional practice The OSCE in relation to the Miller’s pyramid Observation of professional practice OSCE/OSPE MCQ, MEQ, Essay MCQ, SAQ Professional Behavior Behaviour/ Attitude skills Does Shows How Knows How Cognition knowledge Knows

How? How to conduct an OSCE?

1 2 3 4 5 6 7 14 13 12 11 10 9 8 15 16 17 18 19 20 Go To 1

STATION : TWO TYPES EXAMINER OBSERVES STUDENT ANSWERS ON PROCEDURE STATION e.g. Taking history of a patient Examine eye of a patient EXAMINER OBSERVES STUDENT ANSWERS ON THE ANSWER SHEET QUESTION STATION MCQs related to finding Interpretation of lab report etc. 23

1.Resuscitation of a child 2.Communication skills 3.Physical examination skills 2. 3.

Patient simulator

Obtain written consent Collapse history Cranial nerve examination Interpreting ECG Breaking bad news Insertion of NG tube Respiratory Examination I V Fluid prescription Chest pain history CPR Communication Skill History taking Skill Examination Skill Critical reasoning Skill Procedural skill

Specification Table Content Area Blood CVS Resp. CNS Endo. Competencies History taking 1,2 4 3 Physical Examination 5 6 7 8 Lab investigation 9 10 11 12 Interpretation of data 13,14 15,16 17,18 Treatment 19 20

PROCEDURE STATIONS Competencies that may be assessed Physical examination Diagnostic procedure e.g. ophthalmoscopy Explanation about tests and procedures Educating patient about management e.g. use of inhaler for asthma

Competencies that may be assessed QUESTION STATION Competencies that may be assessed Multiple choice questions related to findings Interpretation of lab findings x-rays of patient seen in the previous station. Calculating the BMI of a patient (given the details)

ADVANTAGES AND DISADVANTAGES OF OSCE

ADVANTAGES Wider sampling than traditional methods Every candidate does same examination Greater opportunity for objectivity OSCE Stations are re-useable Better psychometrics than traditional methods

DISADVANTAGES Costly Time consuming to design & administer Needs space Training needed to achieve reliability Experience to administer If students not familiar with OSCEs, must be oriented to this assessment format

Objective Structured Practical Examination (OSPE)

4 2 3 5 1 10 8 7 6 9

Example of an OSPE Task - Examine the specimen of urine provided for proteins. Check list: 1. Does he take a urine sample to 2/3 level in the test tube? 2. Does he boil upper 1/3 of the column? 3. Does he add 2% acetic acid drop by drop? 4. Does he compare change in the top layer with the bottom layer of urine?