Objective structured clinical examination for formative assessment of final year part-1 MBBS students

INTRODUCTION

The aim of medical education is to develop overall medical student’s clinical competency at all the levels. Students are assessed by theory type questions and practical examinations. Various methods of assessments in theory examinations are long answer questions, short answer questions and multiple choice questions where only cognitive domains of the students are assessed.

Practical examinations play a major role in the overall assessment of the cognitive, affective as well as psychomotor domains of the individuals. It can be used in assessment of interpersonal skills, application of knowledge and attitude of the students.

Traditional methods of assessment may have many lacuna or deficiencies. These may be due to subjectivity of examiner, patient’s subjectivity, biased examiners, time constraints, language issues etc.

Different variability in clinical examination, student’s variability, the examiner’s variability and the patient’s variability and the attitude towards disease may have effect on the assessment of the students.¹ More over marking by same examiner for same examination for similar candidate may differ time to time. Traditional examination tends to overlook the skills of individual competencies and the scoring system measures only the global performance of the individuals.^2,3 Appropriate assessments in medical education are important part in overall development of medical students as well as faculty. To improve the reliability of clinical examination in USA has led to a tendency to move away from bed side to patients management problems. Objective structured clinical examination (OSCE) was designed to test the clinical competence by bed side while simultaneously improving objectivity and reliability. Earlier innovation in this regard is objective structured clinical examination later extended to practical examination (objective structured practical examination) described in 1975 and 1979.^1,4,5

The objective of OSCE is to assess the student’s performance without any bias of examiners and assess the student’s knowledge, skills, attitude and applications of knowledge. It ensures the evaluation of set of predetermined clinical competencies. The method is more objective because each clinical competency is divided into different segments and the marks are allotted.

Methodology of OSCE

Students move around the examination stations and specific time and task are allotted and are under observation for the skills, attitude or application of their knowledge depending on task given at the station. Assessment is done by examiners with a predetermined examination pattern schedule and check list which includes the testing of ability of the students like obtained detail clinical history, systematic examination, reaching a provisional diagnosis, management of case, impart health education etc

Aim and objective of the study

• (i) To assess the effectiveness of OSCE for assessment tool as compared to traditional method of assessment.
• (ii) To know the perception of students participated toward OSCE.

METHODS

A comparative study was conducted at Department of Community medicine, KAMSRC, LB Nagar, Hyderabad, Telangana, India.

Study participants

One batch of VI semester students posted for clinical postings.

All the five faculties who were trained in medical education technology conducted the study

All the participating faculty and students were sensitized regarding traditional method of examination and OSCE.

Exclusion criteria

Students who were not willing to participate in the study.

Ethical clearance

From the institutional ethical committee.

Study period

Study was conducted among the students of VI semester students posted for clinical postings during month of June 2017. In the first week of postings the topics for the viva voce examination and OSCE was announced.

During second week, the viva voce examination was conducted.

During third week the OSCE was conducted among the students who have attended the viva voce.

Data collection

All the data collected was entered and analyzed with MS excel software 2007 and Epi info 3.5.3. All tests were considered significant at p<0.05 level.

All the faculty members were involved in planning of OSCE. The questions, guide for assessment, key for solutions or answers, the planning of examination stations were planned by the faculty. A total of 09 stations were finalized which includes 02 rest stations. Thus examinations were conducts for 35 marks. A checklist was prepared and was validated by the senior faculty. Prior information and the topics for the examination were given to the students. Confidentiality of the stations was maintained till the end of examination.

First round of the assessment includes: All the participating students underwent a viva voce examination and the marks were recorded. Questions here were from the question bank prepared by the faculty and these questions were revolved around the topic used in OSCE. Same questions were excluded in the OSCE. Second round of assessment: After undergoing traditional method of examination, all the participating students underwent OSCE and the marks were recorded. A question bank and check list for assessment was prepared which includes viva voce questions as well as solutions for OSCE was used in order to eliminate the bias. The total marks obtained in Traditional method of examination (viva voce) were compared to marks scored in OSCE.

Analysis was done using descriptive statistics like frequency & percentage. Paired t-test was applied to the data. The p<0.05 considered significant.

RESULTS

All the students participated in both the rounds of traditional method of assessment (viva voce) and OSCE.

The mean marks obtained by students by traditional methods were 19.04±3.14 as compared to score in OSCE was 24.84±3.16. Student’s scoring was significantly more in OSCE than viva voce (p < 0.00) (Table 2).

In the study 80% of the students feel that traditional method of examination is more subjective type than OSCE examination. 88% of students feel that examiners biased can be reduced by OSCE. More than 70% and 96% students says that OSCE covers wide range of knowledge and all the domains of assessment.

92% students agree that OSCE useful tool in overall assessment of the student, better form of assessment & learning, easy to pass and score better marks than traditional method of examination, less emotional stress in OSCE, when compared to viva voce. Only 32% participant’s feels Viva voce should be continued in assessment process. 96% feels the OSCE is a lengthy process.

DISCUSSION

In the present study, students scored better marks in OSCE (24.84±3.16) than in traditional method of examination (19.04±3.14). Results found in the study conducted by Relwani et al and Trivedi et al shows that similar results and OSCE as an assessment tool and OSCE students have a chance of better performance.^6,7

In the study 80% of the students feel that traditional method of examination is more subjective type than OSCE examination. 88% of students feel that examiners biased can be reduced by OSCE. More than 70% and 96% students says that OSCE covers wide range of knowledge and all the domains of assessment. In a study more than 70% students strongly OSCE is fairer than traditional method of examination and 90.5% students agreed that variability of examiners and patients can removed.⁶

In the present study, 92% students agree that OSCE useful tool in overall assessment of the student, better form of assessment and learning, easy to pass and score better marks than traditional method of examination, less emotional stress in OSCE, when compared to viva voce. Study conducted by Relwani et al and Wani et al found students perception on OSCE that majority of the students were relaxed during OSCE.^6,8 Results of studies shows OSCE is revalent as they assess cognitive, psychomotor and affective domains.^9,10

In this study only 32% participant’s feels Viva voce should be continued in assessment process. 96% feels the OSCE is a lengthy process. Only 39.6% and 36.6% of students disagreed that viva voce is better than OSCE in respective studies.^6,11

CONCLUSION

OSCE is an useful tool in overall assessment of the student, better form of assessment and learning helps score better marks and easy to pass. Examiner bias, variability of examiners and patients can be minimized by OSCE. Student’s perception regarding OSCE was, it less emotional stress, when compared to viva voce. Hence use of OSCE as assessment tool helps the teachers and examiners in enhancing the teaching and learning modalities.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Ananthakrishnan N, Sathuraman KR, Kumar S. Medical education Principles and practice. 2nd edition. Alumni association of National teachers training centre, JIPMER, Pondicherry, India. 2000: 145-147.
2. 2. Feroze M, Jacob AJ. OSCE in pathology. Indian J Pathol Microbiol. 2002;45:53-7.
3. 3. Manjula A, Shashikala P, Nagaraj P. Student’s Perception on Objective Structured Practical Examination in Pathology. 2013;1:12-4.
4. 4. Harden RM, Gleeson FA. Assessment of clinical competencies using objective structured clinical examination (OSCE) In: ASME medical education booklet No.8.Dundee: ASME; 1979.
5. 5. Harden RM, Stevenson M, Wilson DW, Wilson GM. Assessment of clinical competencies using objective structured clinical examination. Br J Med Educ. 1975;1:447-51.
6. 6. Relwani NR, Wadke RA, Anjenaya S, Sawardekar PN. Effectiveness of objective structured practical examination as a formative assessment tool as compared to traditional method for M.B.B.S students. Int J Community Med Public Health. 2016;3:3526-32.
7. 7. Trivedi RS, Diwan JS, Shah CJ, Jani RD, Anand AK. The influence of objectively structured practical examination (OSCE) on scoring pattern. Int J Biomed Adv Res. 2014;5:87-9.
8. 8. Wani PD, Dalvi VS. Objective structured practical examination vs. traditional clinical examination in Human Physiology: Student’s perception. Int J Med Sci Public Health. 2013;2:543-7.
9. 9. Harden RM, Cairncross RG. Assessment of practical skills: the objective structured practical examination (OSCE). Studies in Higher Education. 1980;5:187-96.
10. 10. Rachel Y. Performance tests. In: Steven MD, Rachel Y, editors. Assessment in Health Professions. New York, Routledge; 2009: 170-180.
11. 11. Wadde SK, Deshpande RH, Pathan MB. Assessment of III MBBS Students using OSCE/OSCE in Community Medicine: Teachers’ and students’ Perceptions. FJ Sch J App Med Sci. 2013;1(4):348-53.