2) Criteria for Successful Completion Session Disclosure 1) Approval Statement This continuing education activity was approved by the Western Multi-State Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Arizona, Colorado, Idaho, and Utah Nurses Associations are members of the Western Multi-State Division. Approval # 72-17 2) Criteria for Successful Completion To receive contact hours, participants must check-in to the session using the barcode scanner, attend the entire session and then complete both the session evaluation and full conference evaluation by July 31, 2017. 3) Conflicts of Interest This educational activity does not include any content that relates to the products and/or services of a commercial interest that would create a conflict of interest. 4) Commercial Support There is no commercial support being received for this session.

Diane Marcyjanik, PhD, RN Objective Structured Clinical Examination (OSCE), Lasater, and Clinical Self-competence Diane Marcyjanik, PhD, RN

Presentation Objectives Describe the use of OSCE in an undergraduate curriculum. Identify potential use of OSCE for end of program outcome assessment of clinical competence. Explain use of OSCE as a holistic summative assessment strategy.

Activity What is Objective Structured Clinical Examination (OSCE)? 30 seconds to write down Introduce yourself and share with neighbor Image: https://pixabay.com/en/meeting-talk-entertainment-together-1002800/

Definition of OSCE An observed examination of clinical skills in a controlled simulated environment, with the utilization of structured checklists, simulators, and standardized patients. (Jones, Pegram & Fordham, 2010; Meechan, Jones, & Valler, 2011; Paul, 2010)

Basic Principles Objective structured assessment of clinical skills A series of stations Predefined competency Use of simulators or standardized patients Students move between stations at timed intervals

OSCE examiner (faculty) is an observer. Examiner does not ask questions Only observe performance and mark the standardized scoring sheet accordingly Some stations may require students to answer written questions without observer present Image: https://pixabay.com/en/computer-desk-man-pictogram-work-310426/

Why OSCE? Industry acknowledged students not ready for clinical practice (Kardong-Edgren, 2013) Highly adaptable to a variety of competencies (McWilliam & Botwinski, 2012) Needed a way to objectively assess clinical skills prior to graduation Last time clinical skills objectively assessed- First semester junior Gap in literature

Statement of the Problem Nursing Students Clinical Self-competence Lasater Clinical Judgement Rubric OSCE

Research Question Is there a significant difference in clinical self-competence scores as measured by Laster Clinical Judgement Rubric (LCJR) between second semester senior baccalaureate nursing students who participate in OSCE and similar students who did not participate in OSCE?

OSCE-Kolb-Lasater OSCE Kolb Lasater Holistic Summative Assessment Knowledge, Skills, Attitude Kolb Interaction between content and experiences Reflection Lasater Clinical Self-competence Self Reflection

The OSCE Orientation Cognitive (Knowledge): Ten point quiz wound healing Psychomotor (Skill): Dressing change Wet to dry dressing change (mannequin- with voice over- standard set of responses) Affective (Attitude): Patient Teaching Homecare instructions for dressing change (standardized patient) Debriefing

Criteria For Passing OSCE STATION 1 = 10% of Total Score STATION 2 = 70% of Total Score STATION 3 = 20% of Total Score   No missed Critical Behaviors and >85% of total points

Kolb (1984) Experiential Learning Theory Image: https://www.google.com/search?q=cyclic+process+arrows+in+blue&tbm=isch&tbs=sur:f,rimg:CbvhTfLp1A8KIjiZ7DbGYGuXWKgKYSg5nTZug2aewRZQxFrYGbKiN9mdN9PcGjx53rib3V25oBgFeeY8jQcqZi5FpyoSCZnsNsZga5dYEZyAR9GKKaaIKhIJqAphKDmdNm4RdfcWd4vW85YqEgmDZp7BFlDEWhFTD1YMSdfVOCoSCdgZsqI32Z03EXM7HfwJNx1gKhIJ09waPHneuJsRBDRHWp8oo9kqEgndXbmgGAV55hEDAbHswAyoOyoSCTyNBypmLkWnEQccZ-bB5sMR&tbo=u&sa=X&ved=0ahUKEwjX8eelj8HUAhWq7YMKHR17AgEQ9C8IHA&biw=1366&bih=651&dpr=1#imgdii=z_8bE5XVvrP-iM:&imgrc=vJnGBQ8V3Xap_M:&spf=1497573311387

Lasater (2007) Common Language Single Composite Score (Range 11- 44) Four Dimensions Score Noticing, Interpreting, Responding, Reflecting Image: https://commons.wikimedia.org/wiki/File:Rubric.jpg

Study Purpose: Evaluate the effectiveness of OSCE Methodology: Quasi-experimental (Pre-test/post-test) OSCE Scenario: Holistic and cultural diversity Instrument: Lasater Clinical Judgement Rubric IRB: Approval obtained Data Analysis: SPSS version 20.0

Sample Sampling Design: Non-Probability Sampling Method: Non-Randomized Sample Size: Intervention - 28 Control - 7

Demographics Sample Size Age: Mean age: 22.5 years Intervention: n = 28 ( 76 %) Control: n = 7 ( 54 %) Age: Mean age: 22.5 years Ethnicity: 97 % Caucasian and 3 % Asian Image: https://pixabay.com/en/people-diversity-ethnic-three-23733/

Results: Total Scores Paired Samples Test Mean (SD) t P   Mean (SD) t P Intervention n = 28 Total pre-score Total postscore 33.0 (2.7) 34.4 (2.4) -3.840 < .05 Control n = 7 33.7 (1.1) 34.9 (2.7) -1.922 NS

Four Phases: ANOVA Phases Group Pretest Mean (SD) Posttest Noticing   Noticing Intervention * Control 2.9 (2.0) 3.0 (.13) 3.1 (.17) 3.1 (.38) Interpreting Intervention 2.9 (.37) 3.0 (.00) 3.0 (.19) 2.9 (.19) Responding 2.9 (.36) 3.0 (.14) 3.1 (.35) 3.2 (.22) Reflecting 3.3 (.39) 3.3 (.46) 3.3 (.48)

Recommendations Expand to a larger population Longitudinal study True control group Identify other tools to evaluate clinical self-competence Compare clinical self-competence score and OSCE score

Creating an OSCE

Brainstorming: Dressing Change OSCE Scenario Psychomotor OSCE Station: Scenario: Josefina Vicaro is a 47-year-old woman who was admitted to the hospital with an open wound on her left leg. The patient is in bed with a dressing in place. The Doctor has ordered a wound culture and dressing change schedule.

Dressing OSCE Rubric Development Faculty Orientation Responses Patient Student Preparation

Implementation of OSCE Rubric development Faculty orientation Standardized patient orientation Student preparation

Dressing Change Rubric

Dressing Change Rubric

Summary OSCE start small (one station at a time) Faculty orientation Debriefing Standardized patient orientation Student preparation Student orientation to include use of mannequins and/or live standardized patients.

References Adamson, K. A., & Kardong-Edgren, S. (2012). A method and resources for assessing the reliability of simulation evaluation instruments. Nursing Education Perspectives, 33(5), 334-339. Bensfield, L. A.,Olech, M. J., & Horsley, T. L. (2012). Simulation for high-stakes evaluation in nursing. Nurse Educator, 37(2), 71-74. doi: 10.1097/NNE.0b013e3182461b8c Bultas, M. W., Hassler, M., Ercole, P. M., & Rea, G. (2014). Effectiveness of high-fidelity simulation for pediatric staff nurse education. Pediatric Nursing, 40(1), 27-42. Jones, A., Pegram, A., & Fordham-Clark, C. (2010). Developing and examining and objective structured clinical examination. Nurse Education Today, 30, 137-141. doi:10.1016/j.nedt.2009.06.014 Kardong-Edgren, S. (2013). A wake up call…with an objective structured clinical examination. Clinical Simulation in Nursing, 9 (1), e3-e4. Retrieved from www.nursingsimulation.org/article/S1876-1399 (12)00356-8 Kirkman, T. R. (2013). High fidelity simulation effectiveness in nursing students' transfer of learning. International Journal of Nursing Education Scholarship, 10(1), 1-6. doi:10.1515/ijnes-2012-0009 Kirton, S., & Kravitz, L. (2011). Objective structured clinical examinations (OSCEs) compared with traditional assessment methods. American Journal of Pharmaceutical Education, 75(6), 1-7. Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall. Lasater, K. (2007). Clinical judgment develo9ment: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. McWilliam, P. L., & Botwinski, C. A. (2012). Identifying strengths and weaknesses in the utilization of objective structured clinical examination (OSCE) in a nursing program. Nursing Education Perspectives, 33(1), 35-39. doi:10.5480/1536-5026- 33.1.35 Meechan, R., Jones, H., & Valler-Jones, T. (2011). Students' perspectives on their skills acquisition and confidence. British Journal of Nursing, 20(7), 445-450. Paul, F. (2010). An exploration of student nurses’ thoughts and experiences of using a video-recording to assess their performance of cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination (OSCE). Nurse Education in Practice, 10, 285-290. doi:10.1016/j.nepr.2010.01.004

Thank You! Diane Marcyjanik, PhD, RN Assistant Professor marcyjdl@uwec.edu 715-836-4012

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