Objective Structured Clinical Examination Research Articles

Development and operationalisation of a mixed reality interactive virtual patient application for online nursing Objective Clinical Examinations

During the 2020 iteration of a Bachelor of Nursing Clinical Health Assessment skills course delivered in Singapore, the sudden cancellation of all face-to-face classes due to the COVID-19 pandemic resulted in innovative strategies being required and quickly created to enable students to successfully complete clinical skills laboratories and Objective Structured Clinical Examinations (OSCEs) online. However, the realism of the experience was rudimentary. At the end of the 2020 teaching semester, and the possibility that the next iteration of the course would also need to be online, it was decided to explore technologies to provide a more realistic and interactive user experience for the 2022 iteration of the Clinical Health Assessment skills course and particularly for the OSCEs. A research project was initiated in 2021, to develop and test the use of virtual or mixed reality applications for online simulated learning and clinical skills assessment. This paper discusses the development and operationalisation phases of a mixed reality interactive virtual patient application used for online OSCEs in a Clinical Health Assessment skills course.

Cross-sectional study in Madagascar demonstrates efficacy of virtual mentoring and flipped classroom modifications of neonatal resuscitation programme Helping Babies Breathe.

The Covid-19 pandemic necessitated virtual adaptation of the neonatal resuscitation programme Helping Babies Breathe (HBB). This study assessed one such virtually mentored and flipped classroom modification in Madagascar. A cross-sectional study was performed in September 2021 and May 2022. Healthcare providers were identified by local collaborating organisations. United States-based master trainers collaborated with local trainers on virtually mentored trainings followed by independent trainings. Master trainers were available for consultation via Zoom during the virtual training. A flipped classroom modification and traditional didactic method were compared. Primary outcomes were knowledge and skill acquisition, evaluated by written assessments and objective structured clinical examinations. Overall, 97 providers completed the curriculum. Written assessment scores improved in both training models (traditional-74.8% vs 91.5%, p < 0.001; flipped classroom-89.7% vs 93.6%, p < 0.05). There was no significant difference among written assessment scores (92.8% vs 91.5%, p = 0.62) and significantly higher objective structured clinical examination scores (97.3% vs 89.5%, p < 0.001) for the independent training compared to the virtually mentored training. The virtually mentored HBB training was followed by a successful independent training as measured by participant knowledge and skill acquisition, supporting the efficacy of virtual dissemination.

A pilot clinical skills coaching program to reimagine remediation: a cohort study

Background New approaches are needed to improve and destigmatize remediation in undergraduate medical education (UME). The COVID-19 pandemic magnified the need to support struggling learners to ensure competency and readiness for graduate medical education (GME). Clinical skills (CS) coaching is an underutilized approach that may mitigate the stigma of remedial learning. Methods A six-month CS coaching pilot was conducted at Harvard Medical School (HMS) as a destigmatized remedial learning environment for clerkship and post-clerkship students identified as ‘at risk’ based on objective structured clinical examinations (OSCE). The pilot entailed individual and group coaching with five faculty, direct bedside observation of CS, and standardized patient encounters with video review. Strengths-based coaching principles and appreciative inquiry were emphasized. Results Twenty-three students participated in the pilot: 14 clerkship students (cohort 1) and 9 post-clerkship students (cohort 2). All clerkship students (cohort 1) demonstrated sustained improvement in CS across three OSCEs compared to baseline: at pilot close, at 6-months post pilot, and at 21-24 months post-pilot all currently graduating students (10/10, 100%) passed the summative OSCE, an HMS graduation requirement. All post-clerkship students (cohort 2) passed the HMS graduation OSCE (9/9,100%). Feedback survey results included clerkship students (9/14; 64%) and post-clerkship students (7/9; 78%); all respondents unanimously agreed that individual coaching was “impactful to my clinical learning and practice”. Faculty and leadership fully supported the pilot as a destigmatized and effective approach to remediation. Conclusion Remediation has an essential and growing role in medical schools. CS coaching for remedial learning can reduce stigma, foster a growth mindset, and support sustained progress for ‘at risk’ early clerkship through final year students. An “implementation template” with suggested tools and timelines can be locally adapted to guide CS coaching for UME remediation. The CS coaching pilot model is feasible and can be generalized to many UME programs.

An evaluation of the inter-rater reliability in a clinical skills objective structured clinical examination

Background. An objective structured clinical examination (OSCE) is a performance-based examination used to assess health sciences students and is awell-recognised tool to assess clinical skills with or without using real patients.Objectives. To determine the inter-rater reliability of experienced and novice assessors from different clinical backgrounds on the final mark allocationsduring assessment of third-year medical students’ final OSCE at the University of the Free State.Methods. This cross-sectional analytical study included 24 assessors and 145 students. After training and written instructions, two assessors per station(urology history taking, respiratory examination and gynaecology skills assessment) each independently assessed the same student for the same skill bycompleting their individual checklists. At each station, assessors could also give a global rating mark (from 1 to 5) as an overall impression.Results. The urology history-taking station had the lowest mean score (53.4%) and the gynaecology skills station the highest (71.1%). Seven (58.3%) ofthe 12 assessor pairs differed by &gt;5% regarding the final mark, with differences ranging from 5.2% to 12.2%. For two pairs the entire confidence interval(CI) was within the 5% range, whereas for five pairs the entire CI was outside the 5% range. Only one pair achieved substantial agreement (weightedkappa statistic 0.74 ‒ urology history taking). There was no consistency within or across stations regarding whether the experienced or novice assessorgave higher marks. For the respiratory examination and gynaecology skills stations, all pairs differed for the majority of students regarding the globalrating mark. Weighted kappa statistics indicated that no pair achieved substantial agreement regarding this mark.Conclusion. Despite previous experience, written instructions and training in the use of the checklists, differences between assessors were found inmost cases.

The relationship between facilitating emotional cues and medical students’ clinical communication performance in qualifying exams

A cross-sectional study design explored the relationship between medical students’ Objective Structured Clinical Examination (OSCE) clinical communication ratings and their responsiveness to simulated patient (SP) verbal emotional cues in their qualifying OSCE. Data were collected from two cohorts of fourth-year medical students (n = 37), and responses to patient cues that facilitated further disclosure or related discussion – known as provide space responses – from two OSCE communication stations were measured by coding video footage with the Verona Coding Definition of Emotional Sequences (VR-CoDES). The 37 medical students were representative of the larger cohort (n = 508) in terms of age. A significant positive correlation with a medium effect was found between OSCE clinical communication ratings and provide space responses. OSCE clinical communication ratings could differentiate between students who adopted patient-centred facilitative behaviours and those who did not.

Student experiences of simulation-based learning and its impact on their performance in Objective Structured Clinical Examination in Pediatrics - A mixed method study.

This study aims to assess the effectiveness of integrating simulation for teaching pediatric clinical examination skills to undergraduate, MBBS Year-IV medical students at The Aga Khan University, Karachi, Pakistan. In this mixed method study, the Objective Structured Clinical Examination (OSCE) scores of the students who were taught using simulation (batch 2017-2018) were compared with the batch of the academic year 2016 -2017 (taught via traditional methods). In order to explore the experiences of the intervention group, a questionnaire with four open-ended questions was administered at the end of the clerkship. Students who were taught by simulation, scored significantly higher on the clinical skills stations in Objective Structured Clinical Examination, than in the pre-intervention group (p-value <0.01). The students quoted safety of the learning environment, opportunities for deliberate practice, debriefing and facilitation skills maximized quoted that their experience of learning through simulation, however, some challenges were identified for future improvement. The result of the study suggested simulation as a useful instructional strategy for teaching examination skills to students in their early years. The student gained confidence through deliberate practice and feedback without compromising patient safety, which translated into improved performance in the high-stakes OSCE examination at the end of the clerkship.

Development of objective structured clinical examination-based assessment methods in drug information services lectures

Background: Research has been carried out on the development of objective structured clinical examination OSCE-based assessment methods in Drug Information Services lectures. Objective: This study aims to prepare the assessment, and teaching-learning methods to improve student competence. Method: This research was conducted in three stages, 1) development of the assessment method; 2) development of the syllabus for Drug Information Services lectures; and 3) trial of the assessment method. For the assessment method and syllabus, validation was carried out by experts based on rubric evaluation. As a benchmark for the acceptance of a limited trial, the value is 56.00. The research subjects were 36 undergraduate students of Sanata Dharma University (SDU). Result: The results of the study show that: 1) the assessment method and syllabus have been declared valid by the experts; 2) a limited trial of the assessment method, resulting in an assessment range between 56.39- 75.69. Conclusion: Based on this research, a valid assessment and teaching-learning method has been produced, and in line with the quality of OSCE-based examination as a national standard, so that they can be used in the next lecture in the 2020/2021 term.

Clinical skill competency of nurse educators in Ethiopia: A cross-sectional observational study

Because the clinical skills of nurse educators in Ethiopia have not yet been determined, this study aimed to assess the clinical competence of nurse educators working in public higher education institutions. We administered a 10-station objective structured clinical examination (OSCE) to randomly chosen educators. Both global rating and checklists were used to score performance, and the Borderline Regression Method (BRM) was applied to determine competency status. A total of 207 educators participated, with a mean age of 31.6 years; 67 (32.36%) had no clinical experience before assuming the educator role. Using 3.47 [3.41-3.97, 95%CI] as reference and cut score, only 56 (27.05%) nurse educators were competent in the overall skill assessment. However, station-specific competence attainment ranged from 29.47% (Progress report assessment and maintenance fluid calculation) to 62.32% (Cardiac health history). The clinical competence of nurse educators in Ethiopia was found to be very low, posing serious challenges to the quality of nursing education. There is an urgent need to build the clinical skills of nurse educators. Moreover, policy support is needed to ensure mandatory prior and ongoing clinical practice.

Student Performance on an Objective Structured Clinical Exam Delivered Both Virtually and In-Person

ObjectivePassing a milestone objective structured clinical examination (OSCE) is a graduation requirement for the University of Waterloo Pharmacy students. In January 2021, the milestone OSCE was offered concurrently both virtually and in-person, with students being able to choose their desired format. The purpose of this study was to compare student performance between the 2 formats and to identify factors that may have predicted student choice of format. MethodsObjective structured clinical examination scores for in-person and virtual exam-takers were compared using 2-tailed independent t tests with Bonferroni correction. Pass rates were compared using χ2 analysis. Prior academic performance variables were analyzed to identify predictors of the chosen exam format. Student and exam personnel surveys were used to capture OSCE feedback. ResultsA total of 67 students (56%) participated in the in-person OSCE, and 52 students (44%) participated virtually. There were no significant differences in overall exam averages or pass rates between the 2 groups. However, virtual exam-takers scored lower in 2 of 7 cases. Previous academic performance did not predict the choice of exam format. Feedback surveys indicated that the exam organization was perceived as a strength regardless of format, but in-person students felt more prepared for the exam than virtual exam-takers with technical challenges and difficulty navigating station resources being noted as barriers in the virtual offering. ConclusionVirtual and in-person administration of a milestone OSCE resulted in similar student performance, with slightly lower performance on 2 individual case scores with virtual delivery. These results may inform the future development of virtual OSCEs.

An Applied Linguistics Study of How Students Prevent Embarrassments and Impositions During Interactive Examination OSCEs

ObjectiveTo assess the effectiveness of politeness strategies used by pharmacy students to avoid embarrassing or imposing on others during objective structured clinical examinations. MethodsA total of 19 objective structured clinical examinations video recordings of 10 students (participants) interacting with mock patients were examined using the framework of Politeness Theory (PT). All relevant participant acts (speech activities) were coded using PT into (1) type of face threatening acts (ie, potentially sensitive situations—as regarded by PT) and (2) politeness strategies used to mitigate them. Conversation Analysis was then used to examine the effectiveness of conversational strategies by judging the ‘patient’ responses to these strategies. ResultsMost acts had the potential to impact patients’ negative face needs (ie, desire to act autonomously, eg, upon the practitioner making a request), positive face needs (ie, desire to be liked, eg, upon the practitioner making a diagnosis), or both. Despite applying a variety of positive politeness strategies (eg, avoiding disagreement, or expressing understanding) to prevent embarrassment to the patient, and negative politeness strategies (eg, being indirect, using hedging, or minimizing the imposition) to avoid directly imposing on them, “dispreferred responses” showed participants mostly focused on avoiding impositions, corresponding to what they have been taught, rather embarrassments. ConclusionParticipants were less aware that discussing sensitive topics could cause embarrassment to patients, with the potential to upset them. Developing teaching and evaluation methods to consider patients’ face needs could help in assessing and improving pharmacy students’ communication skills.

Proof of Concept: Using ChatGPT to Teach Emergency Physicians How to Break Bad News.

Background Breaking bad news is an essential skill for practicing physicians, particularly in the field of emergency medicine (EM). Patient-physician communication teachinghas previously relied on standardized patient scenarios and objective structured clinical examination formats. The novel use of artificial intelligence (AI) chatbot technology, such as Chat Generative Pre-trained Transformer (ChatGPT), may provide an alternative role in graduate medical education in this area. As a proof of concept, the author demonstrates how providing detailed prompts to the AI chatbot can facilitate the design of a realistic clinical scenario, enable active roleplay, and deliver effective feedback to physician trainees. Methods ChatGPT-3.5 language model was utilized to assist in the roleplay of breaking bad news.A detailed input prompt was designed to outline rules of play and grading assessment via a standardized scale. User inputs (physician role), chatbot outputs (patient role) and ChatGPT-generated feedback were recorded. Results ChatGPT set up a realistic training scenario on breaking bad news based on the initial prompt. Active roleplay as a patient in an emergency department setting was accomplished, and clear feedback was provided to the user through the application of the Setting up, Perception, Invitation, Knowledge, Emotions with Empathy, and Strategy or Summary (SPIKES) framework for breaking bad news. Conclusion The novel use of AI chatbot technology to assist educators is abundant with potential.ChatGPT was able to design an appropriate scenario, provide a means for simulated patient-physician roleplay, and deliver real-time feedback to the physician user. Future studies are required to expand use to a targeted group of EM physician trainees and provide best practice guidelines for AI use in graduate medical education.

The effect of lavender essential oil inhalation aromatherapy on students' anxiety induced by the objective structured clinical examination

Background &amp; Objectives: Exam anxiety can have an unpleasant effect on students and change exam results. This study aimed to investigate the effect of inhaled lavender essential oil aromatherapy on objective structured clinical examination (OSCE)-induced anxiety. Materials &amp; Methods: The present study was conducted as a double-blind, randomized clinical study with a control group. The participants were 51 college students who were randomly divided into two groups of placebo and intervention. The intervention group was given 2 drops of 2% lavender essential oil, and the placebo group was given 2 drops of distilled water. The samples inhaled the essential oil using an absorbable napkin attached to a face mask for 20 minutes. Before the OSCE test, each group's anxiety and vital signs were assessed and recorded before and after the intervention using the Spielberger State-Trait Anxiety Inventory (STAI) and Vital Signs Instruments. Results: The results of the independent t-test showed that before the intervention, the difference in mean anxiety between the intervention and placebo groups was not statistically significant (44.16±10.58 vs. 41.80±12.54). Even after the intervention, there was no statistically significant difference between the intervention and the placebo groups in terms of mean anxiety values (44.92±12.18 vs. 43.19±13.12). Conclusion: Inhalation aromatherapy with lavender essential oil does not affect anxiety caused by OSCE test in students.

Who are the members of the accreditation commissions? Portrait, requests and expectations

Primary accreditation of specialists plays a key role in the growth of young doctors. The members of the accreditation subcommittees (ASC) occupy an important place in the process of primary accreditation. The purpose of this pilot single-center prospective research with anonymous questionnaires was to study aspects of the work and training of ASC members in order to develop a reasonable design of a multicenter research to study the “portrait” of an ASC member in order to subsequently form a request for the members preparation of subcommittees and develop practical recommendations for effective interaction between the accreditation site and ASC members. The questionnaires of 27 members of the subcommittees were analyzed. The pilot study reviewed the duration of participation in the work of the ASC, ways of preparing for work as experts and readiness to undergo additional training, satisfaction with the training of accredited medical students. In addition, opinions were taken into account on the quality and the need to correct the passports of stations of an Objective Structured Clinical Examination (OSCE), optimize the work schedule during the period of accreditation of specialists, as well as proposals for improving, increasing the efficiency and coordination of the work of the ASC with accreditation sites. The pilot project aroused serious interest among the participants of the XI Congress of the Russian Society for Simulation Education in Medicine (ROSOMED) and the international conference 2022 in Moscow. The reason is this study showed the importance of taking into account the opinions of members of the ASC, as direct participants in the accreditation process, which makes it possible to develop the design of a multicenter international study, the data of which will make it possible to offer evidence-based recommendations to improve the interaction between participants in the accreditation process in medicine and improve its quality in the Russian Federation, with a possible broadcast on the territory of the interested countries participating in the study.

Formative Objective Structured Clinical Examinations (OSCEs) as an Assessment Tool in UK Undergraduate Medical Education: A Review of Its Utility.

The Objective Structured Clinical Examination (OSCE) is a globally established clinical examination; it is often considered the gold standard in evaluating clinical competence within medicine and other healthcare professionals' educations alike. The OSCE consists of a circuit of multiple stations testing a multitude of clinical competencies expected of undergraduate students at certain levels throughout training. Despite its widespread use, the evidence regarding formative renditions of the examination in medical training is highly variable; thus, its suitability as an assessment has been challenged for various reasons. Classically, Van Der Vleuten's formula of utility has been adopted in the appraisal of assessment methods as means of testing, including the OSCE. This review aims to provide a comprehensive overview of the literature surrounding the formative use of OSCEs in undergraduate medical training, whilst specifically focusing on the constituents of the equation and means of mitigating factors that compromise its objectivity.

Assessment of an observed clinical skills exam in undergraduate medical education: a patient with opioid use disorder and chronic pain

It is crucial that future physicians understand the nature of opioid use disorder (OUD). We designed a pilot Observed Structured Clinical Examination (OSCE) using simulated patients (SPs) experiencing OUD with concurrent chronic pain. The case was piloted in 2021 and 2022 during the multi-station OSCE that all the medical school clerkship students take at the end of their third year of medical school. A total of 111 medical students completed the OSCE in 2021 and 93 in 2022. The authors developed a case description and an assessment instrument for the SP to evaluate the student’s performance on history taking, communication and professionalism. The evaluation was mixed-methods using SP evaluation data and a qualitative assessment of medical students’ answers to 4 questions which were analyzed with a priori codes. In both years, the total scores for the case were slightly slower than the established OSCE cases in both years. A total of 75% (148/197) of students who responded to the assessment found the case difficult to manage. Strengths of the case included a majority of the students reporting the case helped them to identify strengths and weakness in assessing and treating OUD. Weaknesses included the lack of enough patient history and the perception that the SP was unrealistic (too nice). This pilot OSCE was challenging for the third year medical students based on the evaluative data. Given the scope of OUD and deaths, training students to identify and treat OUD during undergraduate medical education is of paramount importance.

Principles for teaching sonography - current status.

Since many young medical residents require sonographic skills early on during training, increased attention has been paid to including sonography classes in undergraduate medical education, among both professional societies and medical educators responsible for medical licensing exams. Medical schools worldwide have developed and implemented a variety of ultrasound teaching formats.This article addresses evidence-based solutions to crucial challenges in planning and implementing undergraduate sonography education. In order to achieve a sustainable increase in practical sonographic competence, we suggest small-group classes with sufficient individual hands-on scanning time for each student. We recommend concentrating on a circumscribed topic and teaching it thoroughly and practically rather than superficially outlining a broad subject area. Provided that peer teachers undergo adequate training, student peer teachers are not inferior to physicians as teachers, as far as student satisfaction, theoretical knowledge and practical skills acquisition are concerned. The assessment of acquired practical skills should consist of practical examinations, such as an objective structured clinical examination (OSCE) or a direct observation of procedural skills (DOPS). In contrast to using healthy volunteers as training models, simulation trainers allow the demonstration of pathological findings in authentic sonographic images, with the disadvantages of unrealistically easy image acquisition, as well as the lack of interaction with the patient.

The Relationship between Kolb Learning Style and Academic Performances in Orthopedic Residents

Objective: The assimilating and converging Kolb learning style were reported to have positive correlation with critical thinking ability in Orthopedic resident. However, the relationship between Kolb learning styles and academic performance remained controversy. The objective of this study is to report the relationship between Kolb learning style and academic performance in Orthopedic residents. Materials and Methods: The causal comparative cross-sectional study on 48 Orthopedic residents of academic year 2020 was conducted. The demographic characteristics of the participants were reviewed. The scores from the multiple choices question (MCQ) in-training examination, the objective structured clinical examination (OSCE) and the global performance rating scale were collected to represent academic performances of each Miller’s pyramid of assessment level. The Kolb learning style inventory were allocated. The statistical analysis was performed and p &lt; 0.05 was considered statistically significant difference. Results: The response rate was 100%. There was no statistically significant difference of MCQ in-training examination, OSCE and global performance rating scale among each learning style as p=0.789, 0.493 and 0.407, respectively. The assimilating and converging styles were the 2 learning styles which had the academic performance scores above the average scores in all assessments. Conclusion: This study could not demonstrate the significant difference of academic performances among Kolb learning style in Orthopedic residents. However, the assimilating and converging style had the consistent scores above average scores in all domains. The Orthopedic learning experience should focus on the development of reflective observation, abstract conceptualization and active experimentation to facilitate effective improvement in academic performance of the residents.

Tobacco Education in Doctor of Pharmacy Programs in the United States (2021-2022)

ObjectiveTo characterize (1) tobacco cessation content, delivery, and assessment methods, (2) faculty perceptions of content adequacy, and (3) faculty interest in enhancing curricular content as a result of pharmacists’ new, expanding role in prescribing tobacco cessation medications. MethodsOne faculty member responsible for teaching tobacco cessation-related content at each college and school of pharmacy was invited to participate in a national, web-based survey. Survey items assessed various aspects of tobacco education and gauged faculty interest in attending a train-the-trainer program and integrating Tobacco Treatment Specialist training as part of the curriculum at their institution. ResultsOf 132 survey respondents (93.0% response), 98.5% reported integrating tobacco cessation into the required curriculum, and 15.2% integrated the content into an elective course. The median number of formal educational hours was 5.0 (range, 1.0–18.0). One-third (33.3%) assessed students’ tobacco cessation competency using objective structured clinical examinations. Most (83.8%) felt that their institution has adequate faculty expertise to teach comprehensive tobacco cessation, and 98.5% were interested in attending a train-the-trainer program for pharmacy faculty to learn to educate students on the latest developments of pharmacist-provided tobacco cessation. Similarly, 95.4% were interested in incorporating Tobacco Treatment Specialist training into their Doctor of Pharmacy curriculum. ConclusionGiven the expanding scope of pharmacists’ practice for prescribing tobacco cessation medications, there is a need to enhance curricular content in Doctor of Pharmacy programs. Current faculty expressed interest in expanding coursework to enable their graduates to work at the top of their license when treating tobacco use and dependence.

Student knowledge, confidence, and perceptions prior to and following an inhaler and tobacco cessation simulation

Background and purposeTo assess knowledge, perceptions, and confidence of second-year pharmacy students regarding implementation of an innovative inhaler and tobacco cessation simulation. Educational activity and settingA simulation was created that required students to counsel a standardized patient concomitantly on an inhaler prescription and tobacco cessation. To assess the primary outcome of student perceptions and confidence, a survey was administered pre- and post-simulation. Survey results were compared using chi-square analysis. To assess the secondary outcome of knowledge-based improvement, students were assessed on tobacco cessation content utilizing six consistent examination questions; students also completed a tobacco cessation objective structured clinical examination (OSCE) case, with comparison to the previous student cohort. FindingsFifty-seven students (93%) completed the pre-survey, and 49 students (80%) completed the post-survey. Improvements in confidence concerning use of motivational interviewing and ability to establish a quit date via motivational interviewing were found. Examination score comparisons revealed improvements in two of the six questions but were not statistically significant. Tobacco cessation OSCE data indicated an improvement in overall student score (72%) compared to the control group (69%). A larger proportion of students achieved the tobacco cessation case cut score (97% vs. 87%). Lastly, intervention vs. control group averages improved in gathering patient information (57% vs. 45%) and developing management strategies (71% vs. 65%). SummaryThis integrated simulation was an effective learning tool that reinforced tobacco cessation concepts and increased confidence and knowledge. Simulations that require students to integrate knowledge and skills are valuable additions to pharmacy curricula.

Assess the Knowledge Level on Objective Structured Clinical Examination (OSCE) among B.Sc Nursing Students at Selected Colleges, Puducherry

Assess the Knowledge Level on Objective Structured Clinical Examination (OSCE) among B.Sc Nursing Students at Selected Colleges, Puducherry