Creative Applications of Objective Structured Clinical Examination OSCE

Creative Applications of Objective Structured Clinical Examination (OSCE) in Health Professional Education With thanks to the HEA for their support towards funding and organising this workshop Kathy Curtis November 2006

What is an OSCE? An examination of students’ clinical skills OSCEs: • are used in both formative and summative assessment within health professional education • identify objective performance criteria for the skill being examined • structure the performance criteria in a checklist to facilitate identification of desired clinical skills • use a set structure to encourage parity between students • use ‘Stations’ designed to assess a specific skill or component of health professional clinical practice Conventionally, students move between multiple OSCE ‘stations’, each one focussing on a different skill, so students demonstrate the breadth of skills required for clinical practice expected at their stage of learning and development

Examples of OSCE Stations: 1 1. resuscitation of a child 2. consultation skills 3. physical examination skills 2 3

The value of OSCEs: • have been extensively researched and found to have academic rigour for summative assessment in health professional education, if they are conducted using robust processes (number of stations, preparation of simulated patients/examiners, global judgement alongside checklist) • are a requirement for accreditation in many health professional programmes • encourage a collaborative approach between HEI and practice in the creation of health professionals who are ‘fit for purpose’ • are adaptable across professions, clinical skills and academic levels • have potential for peer feedback and assessment • promote development of functioning knowledge (Biggs 2006) • have scope for application outside the health arena: Objective Structured Professional Examination (OSPE)

Creative Applications of OSCE at Uni. S • Uni. S OSCEs are primarily used in the education of nurses, midwives, and ODPs and some allied health professionals such as Emergency Care Practitioners, and Dieticians • OSCEs are applicable to testing skills at any academic level and are used from level 1 with pre-registration students to Masters level in both formative and summative assessment • The creative approaches to OSCE are adaptable between health professions and outside the health professional education arena, as the principles can be applied irrespective of clinical content • The creative approaches used and under development at EIHMS include the long-case OSCE, the Masters level OSCE with a ‘knowledge for skills’ viva to test expertise for advanced practice, the use of formative OSCE to develop learning, and peer assessment at the formative OSCE stage to enhance student learning

The Long Case OSCE • A single clinical case with the OSCE checklist structured with subsections to assess a variety of skills • Ideal for assessing professional-client interaction such as history taking leading to collaborative management planning • the case specificity may reduce reliability of assessing performance across cases, but may gain validity through increased realism and depth • If performance criteria are set to assess generic skills, irrespective of case specificity, then loss of case breadth has less impact on reliability of assessing student skill • Students need to be active participants in authentic real-life tasks to develop skills and prepare for practice (Bryan & Clegg 2006)

OSCE plus Viva for testing skills at Masters Level • Identifying the performance criteria for advanced practice skills or ‘expertise’ can be challenging • Experts as examiners must be liberated to assess using global judgement alongside set performance criteria • Knowledge associated with specific advanced practice skills can be assessed within a viva subsection of the OSCE checklist • Important to differentiate between academic levels in OSCE, not just in the advanced skills performance required but in the higher challenge for, and expectations of, these students • Teachers’, examiners’ and students’ feedback on the Masters Level OSCE is very positive

Using peer assessment in formative OSCE • There is substantial evidence to support the use of peers in feedback and assessment (Topping 2005) • Peer involvement is beneficial to the students by promoting deeper learning as they increase their effort knowing peers will be evaluating their work (Brown et al 2003) and by making students rethink their understanding of the skill in order to be able to provide appropriate feedback • Providing peer feedback prepares students for professional practice where assessment of peers and students is expected (NMC 2004) • Peer assessment using formative OSCE provides the student with a clear understanding of the performance criteria required for clinical practice • Peer involvement in teaching and learning helps teachers, both by improving the success of student learning and by empowering students to progress through feedback

This workshop therefore aims to: • Encourage constructive dialogue between health professional educators in the use of OSCE for student learning and assessment, to develop best practice • Share experiences of the less conventional Uni. S approach to developing OSCE • Encourage creativity to developing student learning and assessment using OSCE • Encourage a liberation of minds, to meet the challenges of developing and assessing skills in health professional education for the 21 st century

References: Biggs, JC. 2003 Teaching for Quality Learning at University, 2 nd edition. Open University Press, Berkshire. Brown, E, Gibbs, G, Glover, C. 2003 Evaluation tools for assessing the impact of assessment regimes on student learning. http: //bio. ltsn. ac. uk/journal/vol 2/beej-2 -5. htm Accessed 26. 10. 06 Bryan, C and Clegg, K 2006 Innovative Assessment in Higher Education. Routledge, London Nursing and Midwifery Council 2004 The Code of Professional Conduct: standards for conduct, performance and ethics. NMC, London. Topping, KJ. 2005 Trends in Peer Learning. Educational Psychology, 25 (6), 631 -645.

Plan for the day: 09: 30 -10: 10 Plenary Session Welcome , Introduction to the day and group timetables/rotation plan, with coffee/tea 10: 10 -10: 30 OSCE session One: OS 1 10: 30 -10: 50 OSCE session Two: OS 2 10: 50 -11: 10 OSCE session Three: OS 3 11: 10 -11: 30 OSCE session Four: OS 4 11: 30 -11: 50 OSCE session Five: OS 5 11: 50 -12: 10 OSCE session Six: OS 6 12: 10 -13: 10 Networking Lunch 13: 10 -13: 40 Plenary session ‘Three Kings’ actors talk and demonstration with coffee 13: 40 -14: 00 OSCE session Seven: OS 7 14: 00 -14: 20 OSCE session Eight: OS 8 14: 20 -15: 00 Plenary Session Panel questions and Discussion 15: 00 End of day All plenary sessions and the lunch will be in 01 DK 02 All OSCE sessions will be in the skills labs on the ground floor

Delegates will be divided into 8 groups: A, B, C, D, E, F, G & H and rotate around 7 OSCE stations in set sessions Station sessions are 20 mins except the Masters Level station which is 40 mins Rotation plan for groups: OS 1 OS 2 OS 3 OS 4 OS 5 OS 6 OS 7 OS 8 Masters Level Advanced Assessment (Dr Margaret Coulter) A&B C&D E&F G&H Physical Assessment – neurological system (Dr Wesley Scott-Smith) C D E F G H A B Emergency Care (Joan Juniper) D C F E H G B A Respiratory inpatient assessment (Mary Raleigh) E F G H A B C D Catheterisation skills (Carrie James) F E H G B A D C Professional preparation acute care (Jo Coleclough) G H A B C D E F H G B A D BLS to ALS (Gil Taylor & Liz Rockingham) C F E