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Original Article

Perceptions of the introduction of objective

structured practical examination (OSPE)/objective
structured clinical examination (OSCE): A pilot
study carried out in Government Medical College,
Ananthapuramu, Andhra Pradesh, India
Radhika Gujjala, Aruna Kumari Dara1, Kalyandurg Pujjari Varalaxmi2, Chinnappagari Bhavani2
Departments of Physiology, 1Pharmacology and 2Pathology, Government Medical College, Ananthapuramu,
Andhra Pradesh, India

ABSTRACT
Background: A uniform and reliable clinical and practical evaluation of medical students is always desirable. The method of objective
structured practical examination (OSPE)/objective structured clinical examination (OSCE) tests the students on what they can do
rather than what they know. This method is now believed to meet the deficiencies of the conventional system of practical/clinical
examination.
Aims: The aim of the present study is to take the perceptions and opinions of the medical education training (MET)-trained faculty
regarding OSCE/OSPE, and their interest in introducing it as an assessment tool.
Materials and Methods: This is a detailed, structured questionnaire study carried out in Government Medical College,
Ananthapuramu, Andhra Pradesh, India in the period from May 2014 to July 2014 and was conducted on 50 members of
MET-trained faculty.
Results: Among the faculty, 96% agreed that it was a good and useful learning methodology; 98% agreed that it was a good assessment
tool; 100% agreed that it assessed all the three domains; 80% agreed that it was a transparent, comprehensive, and fair assessment
tool, 90% were of the opinion that it was mentally and physically taxing and required additional faculty hours to construct, review,
and implement the arrangement of stations initially; 100% agreed that the combination with classical practical examination (CPE)
produced good results; and 84% responded that it could partially replace CPE.
Conclusion: We conclude that any change must first be thoroughly evaluated before it can uproot a well-defined and time-
tested assessment methodology. OSCE/OSPE has several distinct advantages. In the current situation, it may be realistic
to expect its inclusion in the evaluation schedule of universities and in day-to-day assessment of students to improve their
clinical competence.

Key words: Assessment tool, classical practical examination, domains, objective structured clinical examination (OSCE)/objective
structured practical examination (OSPE)

Address for correspondence: This is an open access article distributed under the terms of the
Dr. Radhika Gujjala, # 6-3-986, Maruthi Nagar, Creative Commons Attribution-NonCommercial-ShareAlike 3.0
Ananthapuramu - 515 001, Andhra Pradesh, India. License, which allows others to remix, tweak, and build upon the
E-mail: radhika.gujjala@yahoo.com work non-commercially, as long as the author is credited and the
new creations are licensed under the identical terms.
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www.jdrntruhs.org How to cite this article: Radhika G, Dara AK, Varalaxmi KP, Bhavani C.
Perceptions of the introduction of objective structured practical
DOI: examination (OSPE)/objective structured clinical examination (OSCE): A
pilot study carried out in Government Medical College, Ananthapuramu,
10.4103/2277-8632.165401
Andhra Pradesh, India. J NTR Univ Health Sci 2015;4:145-9.

© 2015 Journal of Dr. NTR University of Health Sciences | Published by Wolters Kluwer - Medknow 145
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Gujjala, et al.: Perceptions on OSCE/OSPE
INTRODUCTION
The objective structured clinical examination (OSCE)/
objective structured practical examination (OSPE) is a
method of objectively testing the clinical and practical
knowledge and skills acquired during the medical
curriculum. This method was standardized by the All
India Institute of Medical Sciences.[1] In our medical
institute, the student’s practical assessment is carried
out by conventional methods. OSCE/OSPE is not
implemented. For the first time, the medical education
unit conducted medical education training (MET) in our
institute and OSCE/OSPE was included in MET. The
aim of the present study is to take the perceptions and
opinions by MET-trained faculty regarding OSCE/OSPE,
and their interest in introducing it as an assessment tool.
MATERIALS AND METHODS
This is a detailed, structured questionnaire pilot study
carried out in Government Medical College, Anantapur,
Andhra Pradesh, India during the period from May
2014 to July 2014. This study was conducted on
50 members of MET-trained faculty of Government
Medical College, Anantapur, Adhra Pradesh, India.
The questionnaire was adapted from previous studies.
A few modifications were made in the questionnaire
to best fit with the reference to introduce OSCE/OSPE
in our institute. Questionnaire validation was done in
10% of the faculty to review the questionnaire and to
determine whether the questionnaire measured what it
was designed to measure. After getting the protocol
approved by the Institutional Ethics Committee, a
total of 50 MET-trained faculty were administered a
prevalidated questionnaire containing 15 questions;
after completion of MET training, they were asked to
fill up the questionnaire. Suggestions were also sought
regarding the improvement of OSPE/OSCE and its
implementation in their discipline. The questionnaires
were collected immediately after being filled up.
Statistics
Descriptive statistics was used for the analysis of data
and results were expressed as percentages.
RESULTS
Designation
In this study, the faculty were of different
designations; 8 professors, 17 associate professors,
146
and 25 assistant professors were involved As
mentioned in Table 1. Faculty with different years of
experience were involved as mentioned in Table 2.
The views of the trained faculty regarding the
awareness of OSCE/OSPE were gauged using
certain questions out of which the first was “Were
you aware of OSCE/OSPE before attending the
workshop on MET?” The majority of the faculty
(98%) was unaware of OSCE/OSPE before attending
the workshop on MET.
The second question was “What is your opinion
about OSCE/OSPE as a learning methodology?”
Of the faculty, 96% agreed that it was a good and
useful learning methodology. The remaining faculty
was not satisfied. The third question was “What is
your opinion about OSCE/OSPE as an assessment
tool?” Of the faculty, 98% agreed that it was a good
assessment tool and 2% were of the opinion that it
might not test the complete knowledge. 6% were of
opinion that students could be assessed in an unbiased
manner. 6% were of the opinion that it was the best
tool for assessment due to division and feedback.
The fourth question was “Does it assess all the three
domains (cognitive, affective, and psychomotor)?”
Hundred percent of the faculty agreed that it assessed
all the three domains.
The views of the trained faculty regarding acceptance
of OSCE/OSPE:
Acceptance of OSCE/OSPE Faculty (%)
Comprehensiveness 80
Transparency 98
Authenticity of required tasks 40
Fairness 94
The views of the trained faculty regarding concern of
OSCE/OSPE:
Concern regarding Faculty (%)
Anxiety-producing experience 30
Ambiguity of questions 10
Fixed time allotment for stations 100
Taxing mentally and physically 80
The views of the trained faculty regarding OSCE/
OSPE versus classical practical examination (CPE)
for assessment of skills are given below. One faculty
was of the opinion that OSCE/OSPE needs a lot of
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Gujjala, et al.: Perceptions on OSCE/OSPE

TABLE 1: DEPARTMENTS: FACULTY OF THE The views of the trained faculty regarding any other
DIFFERENT DEPARTMENTS INVOLVED positive and negative of OSCE/OSPE are given
Department No. of Department No. of
faculty faculty
below. They were of the opinion that it improved
Pediatrics 8 Social and 4
the psychomotor skills as well as attitude toward the
preventive medicine patient, assessed a wide range of skills, and assessed
Radiology 1 Pathology 7 a large number of students in a short period of time.
Obstetrics and gynecology 3 Forensic 4 But they held that it required additional faculty hours
General surgery 1 Pharmacology 2
to construct, review, and implement. Three were of the
General medicine 2 Microbiology 3
Orthopedics 2 Anatomy 2
opinion that it consumed a lot of time and required
Anesthesia 1 Physiology 3 team work and cooperation among examiners. Few
Ophthalmology 1 Biochemistry 5 were of the opinion that OSCE/OSPE could identify
ENT* 1 those students who needed more instruction time. All
Total 50 were of the opinion that as all the stations invariably
*ENT = Ear, nose, and throat
demanded equal time, it required careful organization.
TABLE 2: TEACHING EXPERIENCE: FACULTY WITH
DIFFERENT NUMBER OF YEARS OF TEACHING
The views of the trained faculty regarding the
EXPERIENCE INVOLVED necessity of training on OSCE/OSPE under medical
Teaching experience No. of faculty education technique are given below. All were of the
<5 years 8 opinion that OSCE/OSPE training should be under
5-10 years 17 MET while 80% of the faculty considered the training
10-15 years 17 duration (one session) allotted to OSCE/OSPE to be
>15 8
sufficient. 40% commented that the training duration
needed to be increased.
coordination by the staff and consumes a lot of time
and so though it is useful in internal assessment, The views of the trained faculty regarding their
CPE is preferred for university examinations. Another interest in introducing OSCE/OSPE in their discipline
faculty was of the opinion that OSCE/OSPE assesses are given below. Of the faculty, 86% were interested
the individual in detail regarding many skills while in introducing OSCE/OSPE in their discipline while
CPE assesses particular skills in detail. the remaining 14% had a negative view regarding it.

The views of the trained faculty regarding a The views of the trained faculty regarding OSCE/
combination of OSCE/OSPE with CPE are given OSPE workshop (feedback):
below. Hundred percent of the faculty agreed that
OSCE/OSPE as Excellent Good Satisfactory Poor
the combination of OSCE/OSPE with CPE produced
Teaching technique 8 90 2
good results. Accuracy of teaching 2 98
Rationale 90 10
The views of the trained faculty regarding rating of Insight 92 8
OSCE/OSPE:
DISCUSSION
Rating of OSCE/OSPE Percentage (%)
Reliability 80 None of the faculty, except one, was aware of OSCE/
Effective 70 OSPE before attending the workshop on MET. So
Interesting 90 MET training should be conducted at regular, frequent
Challenging 20
intervals with the motto of training the entire faculty.

The views of the trained faculty regarding suggestions
for the improvement of OSCE/OSPE are given
below. One was of the opinion that it should be
made mandatory after every practical for better
comprehension and skill development of the student.
Journal of Dr. NTR University of Health Sciences 2015;4(3)
OSCE/OSPE as a teaching-learning methodology
The majority of the faculty agreed that it was a
good and useful learning methodology, as it provided
adequate knowledge with a strong emphasis on
“understanding” rather than “knowing.”
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Gujjala, et al.: Perceptions on OSCE/OSPE
Assessment tool
The majority of the faculty agreed that it was a good
assessment tool. Forty percent were of the opinion
that it was a good tool to identify weak students who
needed more attention. Students could be assessed in
an unbiased manner; it was the best tool for assessment
due to division and feedback and it assessed all the
three domains (cognitive, affective, and psychomotor)
with especially the affective and psychomotor domains
that could be improved and also assessed. These cannot
be properly and completely assessed by conventional
assessment methods. OSCE/OSPE assesses a wide
range of skills and assesses a large number of students
in a short period of time. OSPE is a more objective,
reliable, and valid tool of assessment to assess the
practical aspects of the curriculum. It is designed
in such a way so as to get a reasonable idea of the
achievement of the student regarding every objective
of the practical exercises.
Our faculty opinion correlates with the Ananthakrishnan
study. Attitudes are usually not tested at all by the
conventional examination. Even regarding clinical
skills, the student is often questioned only with regard
to his final conclusion. The ability to examine a patient
and arrive at a conclusion is not observed by the
examiners. The final score indicating the student’s
overall performance gives no significant feedback
to him/her. These defects of clinical and practical
examinations have been realized for long and have given
rise to attempts at improving the current scenario.[2]
Our faculty opinion correlates with www.oscehome.
com (Oct-Nov 2014) regarding OSCE. The OSCE
examination is an assessment of clinical knowledge,
skills, and attitude. The communication skills one
demonstrates and the process that one goes through
in obtaining a history or performing a physical
examination are more important than determining
a diagnosis. [3] Our study correlates with Adome
regarding OSPE. The OSPE system advocated by
many could offer a better tool for assessment of
skills in the basic sciences. A different skill or task is
performed by a student at each station.[4]
Quality of OSCE/OSPE
More than 80% of the faculty agreed that it was
a transparent, comprehensive, and fair assessment
tool while 90% agreed that OSCE/OSPE was taxing
mentally and physically and it required additional
faculty hours to construct, review, and implement the
148
arrangement of stations initially. Perfection could be
attained after repeated conduction and it later became
an easy and smooth process. The main drawback
was fixed time allotment for the stations. Therefore,
it required careful organization. Most of the faculty
was of the opinion that it was reliable and interesting.
Our faculty opinion correlates with that of Hart.
The method of OSPE similar to OSCE, tests the
students on what they can do rather than on what
they know. This method is now believed to meet the
deficiencies of the conventional system of practical
examination. In an international conference held
in Ottawa, Province of Ontario, Canada in 1985,
OSCE and OSPE techniques were introduced as a
teaching and evaluation tool and their advantages and
disadvantages were compared.[5] Our study correlates
with the opinion of Shankar. OSPE has been claimed
to be a reliable device that has a good capacity to
differentiate between different categories of students.
It also tests the mental attendance and the student’s
attitude toward learning during the time of practical
demonstration and performance.[6]
Comparision of OSCE/OSPE with CPE
OSCE/OSPE needs a lot of coordination by the
staff and consumes a lot of time and so though it is
useful in internal assessment, CPE is preferred for
university examinations. OSCE/OSPE assesses the
individual in detail regarding many skills while CPE
assesses particular skill in detail. Hundred percent
of the faculty agreed that the combination of OSCE/
OSPE with CPE gives good results. Regarding a
comparison of the faculty’s perceptions of OSPE and
CPE, 84% responded that OSCE/OSPE could partially
replace CPE. OSCE/OSPE was judged as an objective
and unbiased test as compared to CPE by 70% of
the faculty. Our study correlates with the study of
Malhotra, Shah, and Patel.[7]
As per the study of Kowlowitz, at present OSCE/OSPE
is conducted in a few medical colleges in association
with other conventional methods, and is being allotted
a small percentage of marks. However, in the time
to come it is expected to replace the other subjective
assessment methods. The introduction of a new concept
is always met with skepticism.[8] This assessment
system is based on the competency levels for practical
and procedural skills aimed to produce good products
as it reportedly allows thorough evaluation and the
deficiency is pointed out immediately.[9]
Journal of Dr. NTR University of Health Sciences 2015;4(3)
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Gujjala, et al.: Perceptions on OSCE/OSPE
It should be made mandatory after every practical
for better comprehension and skill development of
the student. All were of the opinion that OSCE/
OSPE training should be under MET and 80% of the
faculty considered the training duration (one session)
allotted to OSCE/OSPE to be sufficient. Everybody
agreed that they came to know about new and good
teaching-learning methodology through the OSCE/
OSPE assessment tool. The faculty was interested
to introduce OSCE/OSPE, along with CPE, in their
discipline. One of the faculty suggested a OSCE/
OSPE laboratory in every department.
CONCLUSION
OSCE/OSPE is a new concept in medical science.
Over many years, the major method of assessment has
been written examinations and conventional practical
examination. OSCE/OSPE provides an opportunity to
assess the clinical application of knowledge. OSCE/
OSPE tests the different desired components of
competence in a better manner. It is an objective,
valid, and reliable method and gets rid of variation
due to examiner bias. It has a better discrimination
index in spite of its drawbacks that are limited.
The trained faculty’s feedback serves to provide an
array of effective methodologies in MET. Also, there is
a definite need for modification so as to make OSCE/
OSPE more interesting and practicable. We conclude
that OSCE/OSPE can supplement the existing pattern
of conventional methods of clinical examination. But
it would require an elaborate and structured OSCE/
OSPE bank. We conclude that any change must
first be thoroughly evaluated before it can uproot a
well-defined and time-tested assessment methodology.
OSCE/OSPE has several distinct advantages. In the
current situation, it may be realistic to expect its
inclusion in the formal summative evaluation schedule
of universities and in the day-to-day assessment of
students to improve their clinical competence.
Journal of Dr. NTR University of Health Sciences 2015;4(3)
Acknowledgement
We thank Dr. M. Neeraja, MD Principal of Government
Medical College, Anantapur, Andhra Pradesh, India and
Dr. K. Chittinarasamma MD Co-coordinator, Medical
Education Unit, Government Medical College, Anantapur,
Andhra Pradesh, India for their valuable suggestions and
help rendered. We thank the entire MET-trained faculty,
Government Medical College, Anantapur, Andhra Pradesh,
India for their cooperation and feedback in this pilot study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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