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ORIGINAL ARTICLE
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 145-149

Perceptions of the introduction of objective structured practical examination (OSPE)/objective structured clinical examination (OSCE): A pilot study carried out in Government Medical College, Ananthapuramu, Andhra Pradesh, India


1 Department of Physiology, Government Medical College, Ananthapuramu, Andhra Pradesh, India
2 Department of Pharmacology, Government Medical College, Ananthapuramu, Andhra Pradesh, India
3 Department of Pathology, Government Medical College, Ananthapuramu, Andhra Pradesh, India

Date of Web Publication15-Sep-2015

Correspondence Address:
Gujjala Radhika
# 6-3-986, Maruthi Nagar, Ananthapuramu - 515 001, Andhra Pradesh
India
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Source of Support: Nil., Conflict of Interest: There are no conflicts of interest.


DOI: 10.4103/2277-8632.165401

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  Abstract 

Background: A uniform and reliable clinical and practical evaluation of medical students is always desirable. The method of objective structured practical examination (OSPE)/objective structured clinical examination (OSCE) tests the students on what they can do rather than what they know. This method is now believed to meet the deficiencies of the conventional system of practical/clinical examination.
Aims: The aim of the present study is to take the perceptions and opinions of the medical education training (MET)-trained faculty regarding OSCE/OSPE, and their interest in introducing it as an assessment tool.
Materials and Methods: This is a detailed, structured questionnaire study carried out in Government Medical College, Ananthapuramu, Andhra Pradesh, India in the period from May 2014 to July 2014 and was conducted on 50 members of MET-trained faculty.
Results: Among the faculty, 96% agreed that it was a good and useful learning methodology; 98% agreed that it was a good assessment tool; 100% agreed that it assessed all the three domains; 80% agreed that it was a transparent, comprehensive, and fair assessment tool, 90% were of the opinion that it was mentally and physically taxing and required additional faculty hours to construct, review, and implement the arrangement of stations initially; 100% agreed that the combination with classical practical examination (CPE) produced good results; and 84% responded that it could partially replace CPE.
Conclusion: We conclude that any change must first be thoroughly evaluated before it can uproot a well-defined and time-tested assessment methodology. OSCE/OSPE has several distinct advantages. In the current situation, it may be realistic to expect its inclusion in the evaluation schedule of universities and in day-to-day assessment of students to improve their clinical competence.

Keywords: Assessment tool, classical practical examination, domains, objective structured clinical examination (OSCE)/objective structured practical examination (OSPE)


How to cite this article:
Radhika G, Dara AK, Varalaxmi KP, Bhavani C. Perceptions of the introduction of objective structured practical examination (OSPE)/objective structured clinical examination (OSCE): A pilot study carried out in Government Medical College, Ananthapuramu, Andhra Pradesh, India. J NTR Univ Health Sci 2015;4:145-9

How to cite this URL:
Radhika G, Dara AK, Varalaxmi KP, Bhavani C. Perceptions of the introduction of objective structured practical examination (OSPE)/objective structured clinical examination (OSCE): A pilot study carried out in Government Medical College, Ananthapuramu, Andhra Pradesh, India. J NTR Univ Health Sci [serial online] 2015 [cited 2020 Nov 29];4:145-9. Available from: https://www.jdrntruhs.org/text.asp?2015/4/3/145/165401


  Introduction Top


The objective structured clinical examination (OSCE)/objective structured practical examination (OSPE) is a method of objectively testing the clinical and practical knowledge and skills acquired during the medical curriculum. This method was standardized by the All India Institute of Medical Sciences.[1] In our medical institute, the student's practical assessment is carried out by conventional methods. OSCE/OSPE is not implemented. For the first time, the medical education unit conducted medical education training (MET) in our institute and OSCE/OSPE was included in MET. The aim of the present study is to take the perceptions and opinions by MET-trained faculty regarding OSCE/OSPE, and their interest in introducing it as an assessment tool.


  Materials and Methods Top


This is a detailed, structured questionnaire pilot study carried out in Government Medical College, Anantapur, Andhra Pradesh, India during the period from May 2014 to July 2014. This study was conducted on 50 members of MET-trained faculty of Government Medical College, Anantapur, Adhra Pradesh, India.

The questionnaire was adapted from previous studies. A few modifications were made in the questionnaire to best fit with the reference to introduce OSCE/OSPE in our institute. Questionnaire validation was done in 10% of the faculty to review the questionnaire and to determine whether the questionnaire measured what it was designed to measure. After getting the protocol approved by the Institutional Ethics Committee, a total of 50 MET-trained faculty were administered a prevalidated questionnaire containing 15 questions; after completion of MET training, they were asked to fill up the questionnaire. Suggestions were also sought regarding the improvement of OSPE/OSCE and its implementation in their discipline. The questionnaires were collected immediately after being filled up.

Statistics

Descriptive statistics was used for the analysis of data and results were expressed as percentages.


  Results Top


Designation

In this study, the faculty were of different designations; 8 professors, 17 associate professors, and 25 assistant professors were involved As mentioned in [Table 1]. Faculty with different years of experience were involved as mentioned in [Table 2].
Table 1: Departments: Faculty of the Different Departments Involved

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Table 2: Teaching Experience: Faculty with Different Number of Years of Teaching Experience Involved

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The views of the trained faculty regarding the awareness of OSCE/OSPE were gauged using certain questions out of which the first was "Were you aware of OSCE/OSPE before attending the workshop on MET?" The majority of the faculty (98%) was unaware of OSCE/OSPE before attending the workshop on MET.

The second question was "What is your opinion about OSCE/OSPE as a learning methodology?" Of the faculty, 96% agreed that it was a good and useful learning methodology. The remaining faculty was not satisfied. The third question was "What is your opinion about OSCE/OSPE as an assessment tool?" Of the faculty, 98% agreed that it was a good assessment tool and 2% were of the opinion that it might not test the complete knowledge. 6% were of opinion that students could be assessed in an unbiased manner. 6% were of the opinion that it was the best tool for assessment due to division and feedback.

The fourth question was "Does it assess all the three domains (cognitive, affective, and psychomotor)?" Hundred percent of the faculty agreed that it assessed all the three domains.

The views of the trained faculty regarding acceptance of OSCE/OSPE:



The views of the trained faculty regarding concern of OSCE/OSPE:



The views of the trained faculty regarding OSCE/OSPE versus classical practical examination (CPE) for assessment of skills are given below. One faculty was of the opinion that OSCE/OSPE needs a lot of coordination by the staff and consumes a lot of time and so though it is useful in internal assessment, CPE is preferred for university examinations. Another faculty was of the opinion that OSCE/OSPE assesses the individual in detail regarding many skills while CPE assesses particular skills in detail.

Theviews of the trained faculty regarding a combination of OSCE/OSPE with CPE are given below. Hundred percent of the faculty agreed that the combination of OSCE/OSPE with CPE produced good results.

The views of the trained faculty regarding rating of OSCE/OSPE:



The views of the trained faculty regardingsuggestions for the improvement of OSCE/OSPE are given below. One was of the opinion that it should be made mandatory after every practical for better comprehension and skill development of the student.

The views of the trained faculty regarding any other positive and negative of OSCE/OSPE are given below. They were of the opinion that it improved the psychomotor skills as well as attitude toward the patient, assessed a wide range of skills, and assessed a large number of students in a short period of time. But they held that it required additional faculty hours to construct, review, and implement. Three were of the opinion that it consumed a lot of time and required team work and cooperation among examiners. Few were of the opinion that OSCE/OSPE could identify those students who needed more instruction time. All were of the opinion that as all the stations invariably demanded equal time, it required careful organization.

The views of the trained faculty regarding the necessity of training on OSCE/OSPE under medical education technique are given below. All were of the opinion that OSCE/OSPE training should be under MET while 80% of the faculty considered the training duration (one session) allotted to OSCE/OSPE to be sufficient. 40% commented that the training duration needed to be increased.

The views of the trained faculty regarding their interest in introducingOSCE/OSPE in their discipline are given below. Of the faculty, 86% were interestedin introducing OSCE/OSPE in their discipline while the remaining 14% had a negative view regarding it.

The views of the trained faculty regardingOSCE/OSPE workshop (feedback):




  Discussion Top


None of the faculty, except one, was aware of OSCE/OSPE before attending the workshop on MET. So MET training should be conducted at regular, frequent intervals with the motto of training the entire faculty.

OSCE/OSPE as a teaching-learning methodology

The majority of the faculty agreed that it was a good and useful learning methodology, as it provided adequate knowledge with a strong emphasis on "understanding" rather than "knowing."

Assessment tool

The majority of the faculty agreed that it was a good assessment tool. Forty percent were of the opinion that it was a good tool to identify weak students who needed more attention. Students could be assessed in an unbiased manner; it was the best tool for assessment due to division and feedback and it assessed all the three domains (cognitive, affective, and psychomotor) with especially the affective and psychomotor domains that could be improved and also assessed. These cannot be properly and completely assessed by conventional assessment methods. OSCE/OSPE assesses a wide range of skills and assesses a large number of students in a short period of time. OSPE is a more objective, reliable, and valid tool of assessment to assess the practical aspects of the curriculum. It is designed in such a way so as to get a reasonable idea of the achievement of the student regarding every objective of the practical exercises.

Our faculty opinion correlates with the Ananthakrishnan study. Attitudes are usually not tested at all by the conventional examination. Even regarding clinical skills, the student is often questioned only with regard to his final conclusion. The ability to examine a patient and arrive at a conclusion is not observed by the examiners. The final score indicating the student's overall performance gives no significant feedback to him/her. These defects of clinical and practical examinations have been realized for long and have given rise to attempts at improving the current scenario.[2]

Our faculty opinion correlates with www.oscehome.com (Oct-Nov 2014) regarding OSCE. The OSCE examination is an assessment of clinical knowledge, skills, and attitude. The communication skills one demonstrates and the process that one goes through in obtaining a history or performing a physical examination are more important than determining a diagnosis.[3] Our study correlates with Adome regarding OSPE. The OSPE system advocated by many could offer a better tool for assessment of skills in the basic sciences. A different skill or task is performed by a student at each station.[4]

Quality of OSCE/OSPE

More than 80% of the faculty agreed that it was a transparent, comprehensive, and fair assessment tool while 90% agreed that OSCE/OSPE was taxing mentally and physically and it required additional faculty hours to construct, review, and implement the arrangement of stations initially. Perfection could be attained after repeated conduction and it later became an easy and smooth process. The main drawback was fixed time allotment for the stations. Therefore, it required careful organization. Most of the faculty was of the opinion that it was reliable and interesting.

Our faculty opinion correlates with that of Hart. The method of OSPE similar to OSCE, tests the students on what they can do rather than on what they know. This method is now believed to meet the deficiencies of the conventional system of practical examination. In an international conference held in Ottawa, Province of Ontario, Canada in 1985, OSCE and OSPE techniques were introduced as a teaching and evaluation tool and their advantages and disadvantages were compared.[5] Our study correlates with the opinion of Shankar. OSPE has been claimed to be a reliable device that has a good capacity to differentiate between different categories of students. It also tests the mental attendance and the student's attitude toward learning during the time of practical demonstration and performance.[6]

Comparision of OSCE/OSPE with CPE

OSCE/OSPE needs a lot of coordination by the staff and consumes a lot of time and so though it is useful in internal assessment, CPE is preferred for university examinations. OSCE/OSPE assesses the individual in detail regarding many skills while CPE assesses particular skill in detail. Hundred percent of the faculty agreed that the combination of OSCE/OSPE with CPE gives good results. Regarding a comparison of the faculty's perceptions of OSPE and CPE, 84% responded that OSCE/OSPE could partially replace CPE. OSCE/OSPE was judged as an objective and unbiased test as compared to CPE by 70% of the faculty. Our study correlates with the study of Malhotra, Shah, and Patel.[7]

As per the study of Kowlowitz, at present OSCE/OSPE is conducted in a few medical colleges in association with other conventional methods, and is being allotted a small percentage of marks. However, in the time to come it is expected to replace the other subjective assessment methods. The introduction of a new concept is always met with skepticism.[8] This assessment system is based on the competency levels for practical and procedural skills aimed to produce good products as it reportedly allows thorough evaluation and the deficiency is pointed out immediately.[9]

It should be made mandatory after every practical for better comprehension and skill development of the student. All were of the opinion that OSCE/OSPE training should be under MET and 80% of the faculty considered the training duration (one session) allotted to OSCE/OSPE to be sufficient. Everybody agreed that they came to know about new and good teaching-learning methodology through the OSCE/ OSPE assessment tool. The faculty was interestedto introduce OSCE/OSPE, along with CPE, in their discipline. One of the faculty suggested a OSCE/OSPE laboratory in every department.


  Conclusion Top


OSCE/OSPE is a new concept in medical science. Over many years, the major method of assessment has been written examinations and conventional practical examination. OSCE/OSPE provides an opportunity to assess the clinical application of knowledge. OSCE/OSPE tests the different desired components of competence in a better manner. It is an objective, valid, and reliable method and gets rid of variation due to examiner bias. It has a better discrimination index in spite of its drawbacks that are limited.

The trained faculty's feedback serves to provide an array of effective methodologies in MET. Also, there is a definite need for modification so as to make OSCE/OSPE more interesting and practicable. We conclude that OSCE/OSPE can supplement the existing pattern of conventional methods of clinical examination. But it would require an elaborate and structured OSCE/OSPE bank. We conclude that any change must first be thoroughly evaluated before it can uproot a well-defined and time-tested assessment methodology. OSCE/OSPE has several distinct advantages. In the current situation, it may be realistic to expect its inclusion in the formal summative evaluation schedule of universities and in the day-to-day assessment of students to improve their clinical competence.

Acknowledgement

We thank Dr. M. Neeraja, MD Principal of Government Medical College, Anantapur, Andhra Pradesh, India and Dr. K. Chittinarasamma MD Co-coordinator, Medical Education Unit, Government Medical College, Anantapur, Andhra Pradesh, India for their valuable suggestions and help rendered. We thank the entire MET-trained faculty, Government Medical College, Anantapur, Andhra Pradesh, India for their cooperation and feedback in this pilot study.

 
  References Top

1.
Bijlani RL, Nayar U. Objective Structured Practical Examination. Teaching Physiology, Trends and Tools. New Delhi: All India Institute of Medical Science; 1983. p. 151-9.  Back to cited text no. 1
    
2.
Ananthakrishnan N. Objective structured clinical/practical examination (OSCE/OSPE). J Postgrad Med 1993;39:82-4.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Integrated Comprehensive Clinical and Communication Skills Approach for Patient Interviews and OSCE Exams. Available from: http://www.oscehome.com. [Last accessed on 2014 Oct-Nov].  Back to cited text no. 3
    
4.
Adome RO. The introduction of Objective Structured Clinical/Practical Examination (OSCE/OSPE) in the Undergraduate Bachelor of Pharmacy Student Assessment in Makerere University. Available from: http://www.faimer.org/education/fellows/abstracts/06adome. [Last accessed on 2014 Oct-Nov].  Back to cited text no. 4
    
5.
Hart IR, Honden RM, Walton HJ. Newer developments in assessing clinical competence. In: Hart IR, Honden RM, Walton HJ, editors. International Conference Proceedings. Ottawa: Congress Centre; 1985. p. 82-4.  Back to cited text no. 5
    
6.
Shankar RP, Dubey AK, Mishra P, Deshpande VY, Chandrasekhar TS, Shivanda PG. Student attitudes towards communication skills training in a medical college in Western Nepal. Educ Health (Abingdon) 2006;19:71-84.  Back to cited text no. 6
    
7.
Malhotra SD, Shah KN, Patel VJ. Objective structured practical examination as a tool for the formative assessment of practical skills of undergraduate students in pharmacology. J Educ Health Promot 2013;2:53.  Back to cited text no. 7
    
8.
Kowlowitz V, Hoole AJ, Sloane PD. Implementing the objective structured clinical examination in a traditional medical school. Acad Med 1991;66:345-7.  Back to cited text no. 8
    
9.
Taskiran HC. A New Competency Level System for Practical and Procedural Skills in an Undergraduate Curriculum. Foundation for Advancement of International Medical Education and Research (FAIMER) Institute; 2003. Available from: http://www.faimer.org/education/fellows/abstracts/03taskiran.pdf. [Last accessed on 2009 Jun 30].  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]


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