Medicine Journal 2014; 1(1): 17-20 Published online March 10, 2014(http://www.openscienceonline.com/journal/med)
Students’ perception of surgical objective structured clinical examination (OSCE) at final year MBBS, University of Khartoum, Sudan Saadeldin Ahmed Idris1, *, Aamir Abdullahi Hamza2, Mohayad AB Elhaj3, Kamal Elzaki Elsiddig3, Mohamed Mahmoud Hafiz1, Mohammed Eltayeb Adam4 1
Department of Surgery, Faculty of Medicine, Alzaeim Al-Azhari University, Khartoum, Sudan Department of Surgery, College of Medicine, Bahri University, Khartoum, Sudan 3 Department of Surgery, Faculty of Medicine, University of Khartoum, Khartoum, Sudan 4 Department of Surgery, Faculty of Medicine, Alnilain University, Khartoum, Sudan 2
Email address
[email protected](S. A. Idris)
To cite this article Saadeldin Ahmed Idris, Aamir Abdullahi Hamza, Mohayad AB Elhaj, Kamal ElzakiElsiddig, Mohamed Mahmoud Hafiz, Mohammed Eltayeb Adam. Students’ Perception of Surgical Objective Structured Clinical Examination (OSCE) at Final Year MBBS, University of Khartoum, Sudan.Medicine Journal.Vol. 1, No. 1, 2014, pp. 17-20.
Abstract Background: There is a lack of in-depth research into medical students’ perceptions regarding Surgical Objective Structured Clinical Examination (OSCE). Objective: To determine the undergraduate student’s perception regarding surgical OSCE. Methodology: The study conducted in Soba Hospital OSCE center using a self-administered questionnaire at the end of the surgical OSCE examination for final MBBS, University of Khartoum that held in December 2013. Main outcome measures were student perception of examination attributes. The collected data was analyzed statistically using SPSS version 21. Results:Total 297 final year medical students voluntarily and anonymously completed a self-administered questionnaire at the end of the OSCE examination. OSCE was considered as a fair examination method by 87.2% students. More than half of the students rated this examination as covering wide range of knowledge (58.6%), improves clinical skills and knowledge (68.4%), and is very useful and relevant to study and the type of work students will be doing after graduation (79.1%). Among respondents 87.2% highlighted OSCE may influence methods of teaching and 69.4% stated that it should be followed as the method of assessment in undergraduate surgical examination. Conclusion:OSCE was highly appreciated by the students as a tool to evaluate clinical competence among surgical students.
Keywords Medical Students, Objective Structured Clinical Examination (OSCE), Perceptions, Surgery
1. Introduction Clinical skills are the core competencies that are required by the medical students to effectively perform duties in their professional life. One of the main attribute that must be measured in assessments is the clinical skills, and medical profession is enriched with several means for evaluating student performance in this domain(1). OSCE which was first introduced by Harden in 1975(2) and received an increasing interest is a suitable form of testing student's clinical competence as it has high degree of validity, reliability and practicability(2-5), and since then
OSCE has been globally recognized as a gold standard of performance based assessment that aids in evaluating the clinical competency of medical and pharmaceutical undergraduate students(6). An OSCE is a timed, multi-station examination in which learners perform tasks such as interviews, physical exams, clinical/ resuscitative procedures and counseling in realistic settings. At each station learner performance is evaluated with specific checklists and global rating scales. OSCE’s enable the same clinical scenarios to be presented to many candidates, so it becomes the gold standard for performance-based assessment(7).
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Saadeldin Ahmed Idris et al.: Students’ Perception of Surgical Objective Structured Clinical Examination (OSCE) at Final Year MBBS, University of Khartoum, Sudan
In Sudan with more than thirty medical schools, no unified OCSE format is applied in the final surgical exam. However the general guiding rules were practiced. The students rotate consecutively through the different stations, which were well prepared, staffed and within specified time. The concept of standardized patients (SPs) was introduced by Howard Barrows and Abrahamson in 1964s to facilitate the learning of clinical skills under the name of programmed patients and subsequently used for assessment since 1968. Many other descriptive terms were used latter but the most common are simulated patients and standardized patients. Standardized patients or role players were used in OSCE in substitution for real patients. They comprehend their scenarios and respond to candidate’s questions or examinations accordingly (8, 9). SPs have been used in the context of formal examination such as OSCE by Harden and Gleeson in 1979(10). Although psychometric measures are available and should be used to evaluate OSCE examination(4), student’s perception of assessment method is an important quality yardstick and should be evaluated formally(1,6). OSCE implementation for students’ assessment had some shortcomings. It is tedious to prepare and conduct, costly and require a lot of personals. Examiners can hardly protect time for the whole exam especially if more rounds are planned for a large number of students with a limited set up. Real patients and role players might get exhausted and frustrated (11). The use of the OSCE has not been studied extensively in the setting of general surgery MBBS examination, and there is little evidence to support that. This examination may be introduced in a feasible manner. Perception of OSCE by examinees, examiners and examined personals (patients / role players), is important feedback for corrective measures to be taken in subsequent exam. This will facilitate it is acceptability by the stakeholders as an assessment tool for the coming generations of medical graduates(11). Therefore, we conducted this study to evaluate overall perception of MBBS final year medical students at the end of surgical OSCE examination.
2. Material and Methods This prospective descriptive study was conducted in the academic year 2012-2013 on final year MBBS medical students who had an OSCE experience upon completion of their surgery course. At the end of surgical clinical course which is 18 weeks, students underwent evaluation and assessment in form of extended matched questions (EMQs) and single best answer (SBA) followed by OSCE exam. The OSCE stations were developed with the surgery curriculum in mind, testing important concepts that residents were expected to learn. Blueprint was made for developing an examination. The OSCE structure consists of 15x5 (Fifteen stations of five minutes duration for each). It composed of eight interactive and seven static stations. Stations designed to test physical examination, history taking, and data interpretation. (Table I), details the current OSCE stations in surgery at the faculty of medicine, University of
Khartoum. The following components were the requirements for OSCE Station; patient scenario, instructions for both candidate and examiner, check list or model answer sheet and a list of prerequisites for each and every station (such as radiographs, pathology slides or mannequins). All these were prepared by the OSCE team and station constructors Instruction for candidates were clearly stated, defining exactly the type of competencies needed to be performed whether focus history taking, physical examination, performing certain procedure or others as specified. All personals concern with the exam arrived one hour in advance. Stations setup was checked, examiners were orientated in 10 minutes session and roles and responsibilities of the others were assured. Signage for movement, station numbers and bell man were in order. The overall 348 students were included in the final exam that completed in three consecutive days. The OSCE was held in OSCE center, Soba University Hospital. Pretested questionnaire of views and perception regarding OSCE was distributed to all students immediately after their participation in the OSCE exam and the survey was on voluntary basis entirely. The collected data was managed statistically using SPSS computer package for windows version 21. Results were tabulated and studied. Table 1.OSCE stations of the final surgicalexam. OSCE exam station details Interactive History taking General Surgery General Surgery Urology Orthopedics Clinical examination General Surgery General Surgery General Surgery Orthopedics General Surgery; Static Cognitive Orthopedics; Identification Trauma; Technique Emergency; Cognitive Urology; Therapeutic Vascular; Diagnostic
Patient used Role player Role player Role player Role player Real patient Real patient Real patient Real patient Monitoring charts Object One station A & B Picture Picture One station A & B Picture & Object Picture One station A & B
3. Result A total of 297 completed questionnaires were received, back from the 348 distributed, representing 85.3% of those who have successfully completed the OSCE. The majority of students 259 (87.2%) have considered OSCE as a fair examination method when compared with Traditional Clinical Exam (TCE). In addition, OSCE was recognized as a useful learning experience by 235 (79.1%) participants, highlighting that the examination provided them with an opportunity to learn and get an exposure to real life situations in surgery Other positive aspects of the OSCE exam were identified by students, such as 174 (58.6%) stated that it covered a wide range of knowledge; 227 (76.4%) found it less
Medicine Journal 2014; 1(1): 17-20
stressful as compared to other assessment formats to which they were previously exposed; 179 (60.3%) concluded that OSCE with standardized patients is better than ward assessment with real patients; 263 (88.5%) felt that the OSCE is easier to pass; 259 (87.2%) highlighted OSCE may influence methods of teaching and 182 (69.4%) felt that it should be followed as the method of assessment in Surgery (Table-2). There were 195 (65.7%) students stated that the attitude of examiners in OSCE stations is better as compared to traditional clinical examination. One of important factors in designing OSCE stations is the duration of the station and whether it is sufficient to achieve the task or not, so 147 (49.5%) of the respondents stated that there is little difficult to manage time at stations. In addition, 209 (70.4%) of students were perceived as having more conceptual learning (Table 3). Table 2. Perspectives of the participants about OCSE. Perspectives about OCSE OSCE is fair compared with Traditional Clinical Exam (TCE). OSCE covered a wide range of knowledge compared with TCE. OSCE is easier to pass compared with TCE OSCE with standardized patients is better than ward assessment with real patients OSCE may be exhausting and lengthy with increased number of stations OSCE is more stressful compared with the old method TCE Viva – Voce is better than OSCE OSCE is very useful and relevant to study and the type of work students will be doing after graduation. Variability of examiners & patients can be removed to a large extent by OSCE OSCE may influence methods of teaching. OSCE should be followed as the method of assessment in Surgery Attitude of examiners during OSCE was better as compared to TCE.
Frequency
Percent
259
87.2
174
58．6
263
88.5
179
60.3
281
94.6
70
23.6
23
7.7
235
79.1
121
40.7
259
87.2
206
69.4
195
65.7
Table 3. Advantages and disadvantages of OSCE expressed by the participants. Advantages of OSCE It is highly accepted by students and faculty Improves clinical skills and knowledge of students No bias in time and questions by examiners More conceptual learning Feedback given by examiners was very helpful Disadvantages of OSCE Comprehensive assessment may not be possible Little difficult to manage time at stations No direct interaction with examiners
Frequency 219
Percent 73.7
203
68.4
275 209
92.6 70.4
4
1.3
93
31.3
147 281
49.5 94.6
4. Discussion The number of stations should be based on exam blue print, level of competence needed and the objectives of the
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different courses. In general, exam total time and station duration will guide the number of the stations. As OSCE of more than two hours become cumbersome and less than one hour might be inadequate for assessment. Our OSCE was fifteen stations of five minutes each. However Selby C, et al, suggested 10-25 stations(12). In this study we gathered the opinions of final year medical students in their final MBBS exam in surgery about a number of aspects regarding OSCE based on their experience with this tool of assessment. A high response rate of 85.3% was achieved, which makes bias unlikely in the study and provides sufficient evidence to base our conclusions. The previously conducted studies were shown excellent acceptance of OSCE examination by majority of the students. This was demonstrated by the positive responses regarding standardization, fairness, practicality and usefulness of the exam(13, 14).The study showed that a considerable proportion of the students (79.1%) were stated that the OSCE is a useful practical learning experience. Awaisu A et al. (15) in Malaysian study among pharmacy students also reported a higher result. The majority of the students view OSCE as a fair assessment method, Jawaid M et al.(1) in his study in Pakistan asserted similar result. Again, the majority of the students felt that OSCE assessing and covering a wide range of competencies, improves clinical skills and knowledge and it should be followed as the method of assessment in undergraduate surgical examination. Similar results were also obtained by Jawaid M et al.(1). It has been reported in earlier studies that OSCE provokes anxiety among students(16,17). In contrary, current study found that the majority of students asserted that the OSCE is less stressful. The majority of respondents asserted that the OSCE with standardized patients is better than ward assessment with real patients. This finding is in agreement with Mazin A.(18) in his study in Iraq where the majority of respondents from the sixth year medical students in their surgical OSCE preferred to deal with standardized patients. Clinical skills are the core competencies that are required by the medical students to effectively perform duties in their professional life(1, 19). The current study revealed that the majority of students emphasized that OSCE is very useful and relevant to the study and the type of work students will be doing after graduation. In this study, high response rate from the students helped us to ensure that OSCE serves as a valid representation of the opinion and perceptions of the students. The perceptions of students can serve as a good parameter for the better implementation of OSCE in future endeavors.
5. Conclusion OSCE was highly appreciated by the students as a tool to evaluate clinical competencies among surgical students. Student believes that this assessment method cover broad range of clinical competencies that needs to be mastered by everyone for better practice as physicians in their future carrier. Future researches can take help from the results provided
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Saadeldin Ahmed Idris et al.: Students’ Perception of Surgical Objective Structured Clinical Examination (OSCE) at Final Year MBBS, University of Khartoum, Sudan
in this study and can compare examiners’ perceptions regarding OSCE with that obtained from students.
[10] Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Medical Education 1979; 13(1):39-54.
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