|Year : 2021 | Volume
| Issue : 3 | Page : 145-148
Employment of objective structured clinical examination tool in the undergraduate medical training
Saurabh RamBihariLal Shrivastava1, Prateek Saurabh Shrivastava2
1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpattu, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Chengalpattu, Tamil Nadu, India
|Date of Submission||18-Apr-2021|
|Date of Acceptance||22-May-2021|
|Date of Web Publication||28-Dec-2021|
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
Source of Support: None, Conflict of Interest: None
The delivery of medical education has shown a significant shift from the conventional mode of training to the competency-based training. Assessments have been identified as the most significant difference between the two approaches of training. The purpose of the current review was to explore the employment of objective structured clinical examination (OSCE) tool in the delivery of medical education. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 30 articles were selected based upon the suitability with the current review objectives. It is quite obvious that during assessments, we plan to assess knowledge, skill, and affective domains, which actually gives inference about the overall learning progression. OSCE is an assessment tool that is being employed in medical training owing to its objectivity and structured nature. With the passage of time, OSCEs have been widely used in both undergraduate and postgraduate examinations. Acknowledging the fact that the OSCE can be of immense significance in monitoring the learning and its progression, it becomes quite essential to ensure its quality. In conclusion, the scope of OSCE as an assessment tool in medical education training is immense. It is the need of the hour to use the tool in an objective and structured manner to assess the level of learning in students and even monitor the progression in learning.
Keywords: Medical education, objective structured clinical examination, assessment
|How to cite this article:|
Shrivastava SR, Shrivastava PS. Employment of objective structured clinical examination tool in the undergraduate medical training. J Sci Soc 2021;48:145-8
|How to cite this URL:|
Shrivastava SR, Shrivastava PS. Employment of objective structured clinical examination tool in the undergraduate medical training. J Sci Soc [serial online] 2021 [cited 2022 Jan 18];48:145-8. Available from: https://www.jscisociety.com/text.asp?2021/48/3/145/333844
| Introduction|| |
The delivery of medical education has shown a significant shift from the conventional mode of training to the competency-based training. In principle, the medical students are considered fit to graduate upon the demonstration of competence rather than upon completion of the prescribed time in training. Assessments have been identified as the most significant difference between the two approaches of training, with frequent formative assessments supplemented with feedbacks has attracted maximum attention., The high-stakes decision to send students to the next level depends upon the analysis of series of formative assessments and informal assessments and not only on the basis of summative assessment., The purpose of the current review was to explore the employment of objective structured clinical examination (OSCE) tool in the delivery of medical education.
| Methods|| |
An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on research skills among medical students published in the period 2002–2020 were included in the review. A total of 33 studies similar to current study objectives were identified initially, of which, three were excluded due to the unavailability of the complete version of the articles. Overall, 30 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include OSCE, OSCE and medical education in the title alone only (viz. objective structured clinical examination [ti]; objective structured clinical examination [ti] AND medical education[ti]; OSCE[ti] AND medical education[ti]). The articles published in only the English language were included for the review. The collected information is presented under the following sub-headings, namely Assessment and Learning domains, OSCE, Utility of OSCE, Virtual OSCEs, Planning and implementation of OSCE, Sustaining quality of OSCE, Lessons from the field, implications for practice, and implications for research.
| Assessment and Learning Domains|| |
It is quite obvious that during assessments, we plan to assess knowledge, skill and affective domains, which actually gives inference about the overall learning progression., Considering the fact that no single assessment tool can comprehensively assess all the learning domains, it becomes a must to employ a wide range of valid, reliable, feasible assessment tools that also tend to have an educational impact. The idea behind conduction of periodic tests using different assessment tools in different assessment settings by different assessors is to give the maximum number of learning opportunities to the students and at the same time eliminate the concern of subjectivity.,
| Objective Structured Clinical Examination|| |
OSCE is an assessment tool that is being employed in medical training owing to its objectivity (viz. the students are assessed against a predefined set of criteria) and structured nature, wherein the students move through a number of time-limited stations and in the process all 3 learning domains are assessed.,, With enough preparation, the tool can be made valid and reliable by the inclusion of 15–20 stations during the assessment. OSCE tends to assess “Shows How” aspect in the Miller's pyramid of assessment, which in other words can be looked as assessment of performance in the simulated environment.,,
| Utility of Objective Structured Clinical Examination|| |
With the passage of time, OSCEs have been widely used in both undergraduate and postgraduate examinations, in both formative (preferable) and summative assessments., OSCE is being used as exit examination for the undergraduate students in most of the medical schools in the United States, United Kingdom, and Canada.,,, In addition, OSCEs are also used as a formative assessment tool across different professional years in the undergraduate period of training, wherein feedback is given to the students about their performance. At the postgraduate level, OSCE in the form of Practical Assessment of Clinical Examination Skills is being employed in the United Kingdom to decide about the licensing and certification of students to practice medicine.,,
As competency-based medical education has emerged as the new face of medical education, it has become indispensable to strengthen the assessment domain. In that regard, OSCEs have been used in different settings to assess the “shows how” level of competency and there is always a component of feedback that enables deep learning., OSCE can be easily accommodated within the assessment tool box adopted by any medical institution and the need of the hour is to streamline its smooth integration with the other existing assessment tools.
OSCE in the field of medical education delivery has found a wide range of applications ranging from being an effective assessment tool for clinical skills in different specialty subjects., In a study done in the United States, the OSCE tool was employed to evaluate and monitor the proficiency of interns in maintaining hand hygiene and with regard to the appropriate usage of personal protective equipment. Further, OSCE tool has also been employed in summative assessments with an objective to take a high-stakes decision for the borderline students and to assess the competency levels of anesthesia postgraduate residents with regard to ultrasound., Similarly, studies have been done to assess the impact of formative OSCE in improving the clinical performance of the students during summative assessments.
Further, OSCE tool has been used for taking a call about the certification of postgraduate residents. The certification scope of OSCE tool has been widely used in the field of Anesthesia in the United States and also for specific courses like Rheumatlogy., In addition, a study has been carried out with an objective to assess the role of OSCE during clerkship period in improving the clinical performance of the students and encouraging results were obtained.
| Virtual Objective Structured Clinical Examinations|| |
Amid the ongoing COVID-19 pandemic, the delivery of medical education has significantly been affected. As we all have resorted to the online mode of teaching-learning and assessment to continue the process of learning, some of the medical institutions have adopted virtual OSCE within their set-up. In-fact, in the Department of Pediatrics in a medical institution in Bethesda, tele OSCE was employed using Zoom application. The results of the study indicated that this approach of conducting assessment through virtual OSCE is an effective strategy to continue learning during these difficult times.,
| Planning and implementation of Objective Structured Clinical Examination|| |
The success of the OSCE as an effective assessment and learning tool depends upon the planning and the groundwork done before it is actually implemented. The planning has to start with orienting the faculty members of the clinical departments about the scope of OSCE, the competencies that can be assessed, the do's and don'ts, the importance of the checklist and the scoring pattern, the types of stations that can be used, the role of the observers, the need to pilot run the entire process, etc., On a similar note, the students have to be sensitized about the entire tool and how the tool will help them to become a better clinician and improve their clinical practice.
It is essential that the time-frame of the OSCE stations has to be defined and all the logistic requirements are taken care off well before the implementation., In short, the process of conducting an OSCE assessment is a resource-intensive process and requires loads of coordination and support from the faculty members., Further, the organizers should also look to introduce the component of giving immediate feedback to the students in the observers' station, so that OSCE no longer remains an assessment tool.,,
| Sustaining Quality of Objective Structured Clinical Examination|| |
Acknowledging the fact that the OSCE can be of immense significance in monitoring the learning and its progression, it becomes quite essential to ensure its quality., This quality assurance can be ensured by conducting training of the teachers, peer-review of the planned stations and the formulated checklists, and involvement of the external examiners who can comment about the maintenance of academic standards., Further, the reliability of the OSCE can be ascertained using Cronbach's test and depending upon the scores obtained, a decision about the reliability can be made. Finally, it is a must that the overall assessment using OSCE is subjected to evaluation, so that it can be improved for the subsequent assessments based on the received feedbacks.,,,
| Lessons from the Field|| |
At Shri Sathya Sai Medical College and Research Institute, a constituent unit of the Sri Balaji Vidyapeeth, Deemed-to-be University, Puducherry, OSCE as an assessment tool has been used in third semester, fifth semester and seventh semester. In addition, just before completion of the internship, the medical interns are again subjected to exit-OSCE to ascertain their knowledge-skills-attitude in different areas. During these exit-OSCE assessment, different clinical departments, para-clinical departments (viz. Community Medicine) and supportive departments (like Blood Bank) arrange 1–2 stations per department as per the instructions released by the Exit OSCE coordinator.
All the interns complete all the OSCE stations on the designated day and they are finally graded on five parameters, namely Medical knowledge, Clinical reasoning, Communication skills, Procedural skills, and Professionalism. The results of their performance are shared with the interns in a graphical manner and also there is a scope for corrective measures, by posting the interns in specific departments (for instance, if a majority of the interns were not able to perform better in the OSCE station of the blood bank, they will be posted for some specific time to improve their competence levels).
| Implications for Practice|| |
The most important decision from the administrator and faculty perspective will be to express their readiness to plan and implement OSCE in their settings, as it both a time-consuming and resource-intensive process, at least in the planning stages. The Medical Education Unit of the institution plays a vital role in not only training the faculty members to conduct the assessment in a structured and validated manner, but also to orient the students about the OSCE and how it will help them in their future clinical practice. Further, we also need to specify the purpose of the OSCE sessions, like whether it is only for the sake of assessment or for teaching and assessment or in summative assessment or for certification.
| Implications for Research|| |
The employment of OSCE in the delivery of medical education has immense research potential, not only for the sake of better implementation, but also for helping the students in terms of expedition of their learning.,,, The research activities can be targeted towards obtaining the perspectives of both students and teachers about OSCE, so that remedial measures can be taken for benefiting the students. The research can also be planned to gain insights about the ways in which OSCE assessments can be planned. Further, there is always a scope to compare the performance of students in OSCE assessments with other tools and also correlating them with the refinement in the clinical skills in the future. Moreover, there is a definite scope to carry out qualitative studies to explore the experiences of students and teachers who have been a part of the OSCE planning, implementation and assessment.
| Conclusion|| |
The scope of OSCE as an assessment tool in medical education training is immense. It is the need of the hour to use the tool in an objective and structured manner to assess the level of learning in students and even monitor the progression in learning.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lurie SJ. History and practice of competency-based assessment. Med Educ 2012;46:49-57.
Halman S, Fu AY, Pugh D. Entrustment within an objective structured clinical examination (OSCE) progress test: Bridging the gap towards competency-based medical education. Med Teach 2020;42:1283-8.
Khan KZ, Ramachandran S, Gaunt K, Pushkar P. The objective structured clinical examination (OSCE): AMEE guide No. 81. Part I: An historical and theoretical perspective. Med Teach 2013;35:e1437-46.
Mavis BE, Henry RC. Between a rock and a hard place: Finding a place for the OSCE in medical education. Med Educ 2002;36:408-9.
Harding D. The objective structured clinical examination (OSCE) explained. BMJ 2017;358:j3618.
Alkhateeb NE, Al-Dabbagh A, Ibrahim M, Al-Tawil NG. Effect of a formative objective structured clinical examination on the clinical performance of undergraduate medical students in a summative examination: A randomized controlled trial. Indian Pediatr 2019;56:745-8.
Ali M, Pawluk SA, Rainkie DC, Wilby KJ. Pass-fail decisions for borderline performers after a summative objective structured clinical examination. Am J Pharm Educ 2019;83:6849.
Patrício MF, Julião M, Fareleira F, Carneiro AV. Is the OSCE a feasible tool to assess competencies in undergraduate medical education? Med Teach 2013;35:503-14.
Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The objective structured clinical examination (OSCE): AMEE guide No. 81. Part II: Organisation and administration. Med Teach 2013;35:e1447-63.
Dwyer T, Wright S, Kulasegaram KM, Theodoropoulos J, Chahal J, Wasserstein D, et al.
How to set the bar in competency-based medical education: Standard setting after an Objective Structured Clinical Examination (OSCE). BMC Med Educ 2016;16:1.
Zayyan M. Objective structured clinical examination: The assessment of choice. Oman Med J 2011;26:219-22.
Ogunyemi D, Dupras D. Does an objective structured clinical examination fit your assessment toolbox? J Grad Med Educ 2017;9:771-2.
Saceda-Corralo D, Fonda-Pascual P, Moreno-Arrones ÓM, Alegre-Sánchez A, Hermosa-Gelbard Á, Jiménez-Gómez N, et al.
Objective structured clinical examination as an assessment tool for clinical skills in dermatology. Actas Dermosifiliogr 2017;108:237-43.
Agarwal A, Batra B, Sood A, Ramakantan R, Bhargava SK, Chidambaranathan N, et al.
Objective structured clinical examination in radiology. Indian J Radiol Imaging 2010;20:83-8.
] [Full text]
Nagoshi Y, Cooper LA, Meyer L, Cherabuddi K, Close J, Dow J, et al.
Application of an objective structured clinical examination to evaluate and monitor intern's proficiency of hand hygiene and personal protective equipment use in the United States. J Educ Eval Health Prof 2019;16:31.
Mitchell JD, Amir R, Montealegre-Gallegos M, Mahmood F, Shnider M, Mashari A, et al.
Summative objective structured clinical examination assessment at the end of anesthesia residency for perioperative ultrasound. Anesth Analg 2018;126:2065-8.
Warner DO, Isaak RS, Peterson-Layne C, Lien CA, Sun H, Menzies AO, et al.
Development of an objective structured clinical examination as a component of assessment for initial board certification in anesthesiology. Anesth Analg 2020;130:258-64.
Warner DO, Lien CA, Wang T, Zhou Y, Isaak RS, Peterson-Layne C, et al.
First-Year Results of the American Board of Anesthesiology's Objective Structured Clinical Examination for Initial Certification. Anesth Analg 2020;131:1412-8.
Pascual Ramos V, Medrano Ramírez G, Solís Vallejo E, Bernard Medina AG, Flores Alvarado DE, Portela Hernández M, et al.
Performance of an objective structured clinical examination in a national certification process of trainees in rheumatology. Reumatol Clin 2015;11:215-20.
Dong T, Zahn C, Saguil A, Swygert KA, Yoon M, Servey J, et al.
The associations between clerkship objective structured clinical examination (OSCE) grades and subsequent performance. Teach Learn Med 2017;29:280-5.
Silverman JA, Foulds JL. Development and use of a virtual objective structured clinical examination. Can Med Educ J 2020;11:e206-7.
Lara S, Foster CW, Hawks M, Montgomery M. Remote assessment of clinical skills during COVID-19: A virtual, high-stakes, summative pediatric objective structured clinical examination. Acad Pediatr 2020;20:760-1.
Sainterant O, Clisbee M, Julceus EF. Introducing the objective structured clinical examination in haiti. J Grad Med Educ 2019;11:199-200.
Ataro G, Worku S, Asaminew T. Experience and challenges of objective structured clinical examination (OSCE): Perspective of students and examiners in a clinical department of Ethiopian University. Ethiop J Health Sci 2020;30:417-26.
Sholadoye TT, Tolani MA, Aminu MB, Maitama HY. Clinical examination among medical students: Assessment and comparison of the strengths and weaknesses of objective structured clinical examination and conventional examination. Niger J Surg 2019;25:208-12.
] [Full text]
Hastie MJ, Spellman JL, Pagano PP, Hastie J, Egan BJ. Designing and implementing the objective structured clinical examination in anesthesiology. Anesthesiology 2014;120:196-203.
Majumder MA, Kumar A, Krishnamurthy K, Ojeh N, Adams OP, Sa B. An evaluative study of objective structured clinical examination (OSCE): Students and examiners perspectives. Adv Med Educ Pract 2019;10:387-97.
Brown J. Preparation for objective structured clinical examination: A student perspective. J Perioper Pract 2019;29:179-84.
Yu J, Lee S, Kim M, Lee J. Comparison of students' performance of objective structured clinical examination during clinical practice. Korean J Med Educ 2020;32:231-5.
Ataro G. Methods, methodological challenges and lesson learned from phenomenological study about OSCE experience: Overview of paradigm-driven qualitative approach in medical education. Ann Med Surg (Lond) 2020;49:19-23.