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Application and use of objective structured clinical examination nursing essay

OSCE design[ edit ] An OSCE usually comprises a circuit of short the usual is 5—10 minutes although some use up to 15 minute stations, in which each candidate is examined on a one-to-one basis with one or two impartial examiner s and either real or simulated actors or electronic patient simulators patients.

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Each station has a different examiner, as opposed to the traditional method of clinical examinations where a candidate would be assigned to an examiner for the entire examination. Candidates rotate through the stations, completing all the stations on their circuit. In this way, all candidates take the same stations. It is considered to be an improvement over traditional examination methods because the stations can be standardised enabling fairer peer comparison and complex procedures can be assessed without endangering patients health.

As the name suggests, an OSCE is designed to be objective — all candidates are assessed using exactly the same stations although if real patients are used, their signs may vary slightly with the same marking scheme.

In an OSCE, candidates get marks for each step on the mark scheme that they perform correctly, which therefore makes the assessment of clinical skills more objective, rather than subjective, structured — stations in OSCEs have a very specific task.

Objective structured clinical examination

Where simulated patients are used, detailed scripts are provided to ensure that the information that they give is the same to all candidates, including the emotions that the patient should use during the consultation. Instructions are carefully written to ensure that the candidate is given a very specific task to complete.

The OSCE is carefully structured to include parts from all elements of the curriculum as well as a wide range of skills. A clinical examination - the OSCE is designed to apply clinical and theoretical knowledge. Where theoretical knowledge is required, for example, answering questions from the examiner at the end of the station, then the questions are standardized and the candidate is only asked questions that are on the mark sheet and if the candidate is asked any others then there will be no marks for them.

Occasionally written stations, for example, writing a prescription chart, are used and these are marked like written examinations, again usually using a standardized mark sheet. One of the ways an OSCE is made objective is by having a detailed mark scheme and standard set of questions.

For example, a station concerning the demonstration to a simulated patient on how to use a metered dose inhaler [MDI] would award points for specific actions which are performed safely and accurately. The examiner can often vary the marks depending on how well the candidate performed the step. At the end of the mark sheet, the examiner often has a small number of marks that they can use to weight the station depending on performance and if a simulated patient is used, then they are often asked to add marks depending on the candidates approach.

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At the end, the examiner is often asked to give a "global score". This is usually used as a subjective score based on the candidates overall performance, not taking into account how many marks the candidate scored.

  • Although the OSCE assessment had yet to be widely embraced in the field of nursing, it was becoming increasing popular as a tool for assessing clinical competency in nursing Anderson and Stickley, 2002;
  • The question of validity and reliability of the OSCE as an objective system for assessing clinical skills competence among clinical practitioners and students was widely discussed in the literature Jones et al;
  • Proficiencies assessed through the OSCE are presumed to be relevant to the safe practice of medicine Peeraer et al;
  • The task at each station tested specific competencies that were marked using the mark sheet;
  • The assessor rated each student's performance using the checklist or rating scale Robbin and Hoke, 2008.

This is then used to determine the individual pass mark for the station. Many centres allocate each station an individual pass mark. The sum of the pass marks of all the stations determines the overall pass mark for the OSCE.

  • Gonczi 1994 describes this position of incorporate competence as a homogeneous mutualist mixture of attitudes, cognition, values and accomplishments, which undergirds and directs safe, independent professional pattern;
  • This type of format is by and large utilised for pupils, to measure both cardinal and advanced accomplishments and competences, dependant on who, and what competences are being assessed;
  • The cardinal focal point of the arrangement learning purposes and larning aims is the attainment of competent clinical accomplishments;
  • The assessor rated each student's performance using the checklist or rating scale Robbin and Hoke, 2008;
  • Nurse Education Today, dol;
  • The task at each station tested specific competencies that were marked using the mark sheet.

Many centres also impose a minimum number of stations required to pass which ensures that a consistently poor performance is not compensated by a good performance on a small number of stations. There are, however, criticisms that the OSCE stations can never be truly standardized and objective in the same way as a written exam.

Finally, it is not uncommon at certain institutions for members of teaching staff be known to students and vice versa as the examiner. This familiarity does not necessarily affect the integrity of the examination process, although there is a deviation from anonymous marking.

However, in OSCEs that use several circuits of the same stations the marking is repeatedly shown to be very consistent which supports the validity that the OSCE is a fair clinical examination.

There are arguments for and against quarantining OSCE examinees to prevent sharing of exam information. In an OSCE, clinical skills are tested rather than pure theoretical knowledge. It is essential to learn correct clinical methods, and then practice repeatedly until one perfects the methods whilst simultaneously developing an understanding of the underlying theory behind the methods used.

Marks are awarded for each step in the method; hence, it is essential to dissect the method into its individual steps, learn the steps, and then learn to perform the steps in a sequence.

Most universities have clinical skills labs where students have the opportunity to practice clinical skills such as taking blood or mobilizing patients in a safe and controlled environment. It is often very helpful to practise in small groups with colleagues, setting a typical OSCE scenario and timing it with one person role playing a patient, one person doing the task and if possible, one person either observing and commenting on technique or even role playing the examiner using a sample mark sheet.

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In doing this the candidate is able to get a feel of running to time and working under pressure. In many OSCEs the stations are extended using data interpretation. For example, the candidate may have to take a brief history of chest pain and then interpret an electrocardiogram. It is also common to be asked for a differential diagnosisto suggest which medical investigations the candidate would like to do or to suggest a management plan for the patient.