Tripura institute of paramedical sciences, Nursing

Subject: nursing education

ASSIGNMENT ON:- objective structure clinical evaluation

Date of submission: 03/01/2024

SUBMITTED TO- SUBMITTED BY-

Ms. ANUPA MALAKAR Ms. PRIYASHI DEB
(ASSO. PROFESSOR) M.Sc NURSING, 1ST
SEMESTER.
HOD, Dept of Child Health
Nursing ROLL NO- 01
OBJECTIVE STRUCTURED PRACTICALTIPS,
TIPS, NURSING EXAMINATION
NURSING
INTRODUCTION:-
 OSCE means Objective Structured Clinical Examination. It is a form of multi-station
examination of clation subject. It was first described by Harden et al. in 1975. Objective
structured clinical examination (OSCE) is a modern type of examination often used in health
sciences (e.g. medicine, dentistry, nursing, pharmacy and physiotherapy) to assess clinical skill
performance and competence in skills such as communication, clinical examination, medical and
nursing procedures/ prescription, exercise prescription and interpretation of results.

A framework for the development of clinical competence has been described (Miller 1990)
which outlines four levels at which a learner can be assessed: knows, knows how, shows how
and does . The OSCE conforms to the third shows how the level of the Miller's pyramid , which
focuses on assessment of performance of specific skills in a controlled setting. This makes it
particularly relevant for the early stages of undergraduate curricula, where assessment comprises
compartmentalized exercises.

D
S o
e
h
s
o
K w
n
o h
w o
w
k h
n o
o w
w

Fig :- The development of clinical skills/competence/performance(adapted from miller)

1990
Meaning of OSCE:-

Objective: Because examiners use a checklist for evaluating trainers.

Structured:

 The marking scheme for each station is structured.

 A clinical skills or procedure is typically broken down into component parts in a very
structured way.
 Structured interactions between an examiner and student.
 Stations are short, numerous, highly focused.

Clinical: Because the tasks are representative of those faced in real clinical situations.

Examination: Because the skills are assessed in the form of examination.

Definitions of OSCE

Objective Structured Clinical Examination (OSCE) is a form of performance-based

testing used to measure candidates' clinical competence. During tan OSCE, candidates are
observed and evaluated as they go through a series of stations in which they interview, examine
and treat standardized patients who present with some type of medical problem.

According to Harden 1988, The OSCE or objective structured clinical examination

is an approach to the assessment of clinical competence in which the components are assessed in
a well planned or structured way with attention being paid to the objectivity of the examination.

Structure of Objective Structured Clinical Examinations

In an objective structured clinical assessment, a series of stations in an examination room is set

up to examine the students. At each station, students may be asked to carry out a procedure,
which may involve taking history, performing preset clinical tasks and diagnosing patients'
problems. When performing the clinical tasks, students may often interact with 'patients', who
may be healthy volunteers or mock patients. Students also have to answer questions based on
their findings and their interpretation. Students are observed and scored at some stations by
examiners with checklists. There are two types of stations in this assessment method:

1. Practice-based: Students are given a written instruction and have to carry out a
procedure.

2. Question-based: Students have to answer questions about their findings at the previous
station and interpret these findings. The questions may be open-ended or of multiple-choice type.

Purposes of OSCE

 Used in both formative and summative assessment in health professional education

 Identify objective performance criteria for the skill being examined
 Structure the performance criteria in a checklist to facilitate the identification of desired
clinical skills.
 A requirement for accreditation in many health professional programs.

Uses of OSCE:-

 Interpersonal and communication skills.

 History- taking skills.
 Physical examination of specific body system.
 Mental health assessment.
 Clinical decision making, including the formation of differential diagnosis
 Clinical problem solving skills.
 Interpretation of clinical findings and investigations.
 Management of a clinical situation, including treatment and referral
 Patient education
 Health promotion
 Basic and advanced nursing care procedures.
Advantages of Objective Structured Clinical Examinations

 It provides a uniform marking scheme for examiners and consistent examination

scenarios for students.
 It provides an authentic way to assess nursing students, including pressure from patients
 Generates formative feedback for both the learners and the teaching program. Immediate
feedback collected may improve students' competency at subsequent stations and even
enhance the quality of the learning experience
 Minimizes the effect of cueing: When students go to a station, they will need to diagnose
patients' problems or carry out some clinical procedures. When they go to a subsequent
station, they have to answer some questions relevant to their diagnosis or clinical tasks.
However, students cannot go back to correct any mistakes or omissions on what they did
in the previous station
 More students can be examined at any one time. When a student is carrying out a
procedure, another student who has already completed that stage is answering the
question at another station
 In the Objective Structured Clinical Examination, the setting is more controlled (only two
variables exist: the patient and the examiner) and a more objective assessment of the
student's clinical competency can be made
 Provides more insights about students' clinical and interactive competencies
 It can objectively assess other important aspects of clinical expertise, such as physical
examination skills, interpersonal skills, technical skills, problem- solving abilities,
decision-making abilities, and patient treatment skills
 More valid than the additional approach to clinical examinations
 The examiner can decide in advance what is to be Teated and can then design the
examiner to test competencies.
 Emphasis can be moved away from testing factual knowledge to testing factual
knowledge to testing a wide range of skills including advanced clinical skills
 More reliable because variables of the examiner and the patient are removed to a large
extent
  The use of checklist by examiners and the use of multiple choice questions result in a
more objective examination
 More practical because it can be used with a large number of student.

Disadvantages of OSCE :-

 Students' knowledge and skills are tested in compartments and they are not tested on their
ability to look at the patient as a whole
 Demanding for both examiners and patients
 Examiners are required to pay close attention to students repeating the same task on a
number of occasions
 The time involved in setting up the examination is greater than for the traditional
examination
 Maintaining uniform difficulty level is not always possible
 It is expensive in terms of manpower, resources and time (such as number of examiners,
patients, and even the space of examination room)
 It may discourage students from looking at the patient as a whole because the students'
knowledge and skills are being put into compartments
 The assessment examines a narrow range of knowledge and skills and does not test for
history- taking competency properly. Students only examine a number of different
patients in isolation at each station instead of comprehensively examining a single patient
 It requires an extensive amount of organizing.

OSCE Methodology

The OSCE examination consists of about 15-20 stations, each of which requires about 4-5
minutes of time. All stations should be capable of being completed at the same time. The
students rotate through all stations and moves to the next station at the signal. Each candidate is
examined on a one to one basis with one or two impartial examiners on each station They are
marked by the examiner on standardized mark sheet. Using 15 stations of 4 minutes each, 15
students can complete examination within 1 hour.

Steps in developing an Objective Structured Clinical Examination:

 1. Decide the types of skills to be examined
2. Decide the types of assessment (such as a uniform checklist)
3. Consider the number of skill assessment stations (it is recommended to have 10 and six
minutes for each station) because the length of the examination is determined by the
number of assessment stations and the time each candidate will spend at each station.
4. Allocate resources for the examination (such as space for examination rooms, marking
sheets and plastic models)
5. Prepare the staff resources needed (including examiners, timekeepers and
patient/volunteers)
6. Determine/arrange the day/period of exams.
7. Conduct a review/evaluation of the arrangement of the exam after it is over
8. To design concise marking schemes that focus on actions that distinguish To design
concise marking schemes that focus on actions that distinguish between good and poor
performance .

9. To provide marking scheme instructions on what students would do at each station for the
examiner

10. To provide instructions which outline exactly the task required at each station for
students.

Steps in taking OSCE as examination for students

1. Registration

The first step is registration. In this you will go through the following process:

 Show your roll number or identity card

 General instructions are provided regarding examination.
 Invigilator will inspect articles and prohibit those which are not allowed in
examination. e.g. use of mobile.
 Receive your exam envelop which contains your ID, stickers, pencil, notebook or
clipboard.
2. Orientation: The next step after registration is orientation

 Exam format, procedures and policies will be reviewed

 Introduce to your team and team leader.
 Instructed about your starting station and how to proceed.
 Students can ask their queries regarding OSCE exam.

3. Escorting to exam position: After briefing and orienting students to rules and
procedure of OSCE, students will be escorted to stations. Students will be instructed about time
at each station and about time buzzer. Students will start exam as soon as long bell or buzzer
announce the start of the exam..

4. Station Instruction time: This is one or two minutes to read the instruction about the
station, the situation, patient and required task. Students read carefully and enter the room at the
next bell.

5. The encounter: Start your encounter with the standardize patient. There is a 5-20
minutes encounter. Perform the required task. Stop at the next bell.

6. Post encounter period: Some OSCE will have no post encounter period. Some will
have 1-2 min of the encounter period assigned to an oral question asked by the examiner inside
the examination room. No more communication is allowed with the patient, and then written
questions to be answered on a paper or computer outside the exam room for 5-10 min. At the
next bell, first station ends as well as next station starts. Student proceeds to the next station
quickly..

7. Repeat step 4 to 6: Step 4-6 will be repeated until student have been in all the stations.
Some OSCE will offer 1 or 2 short rest period.

8. Exam ended: Exam is over. Student will be escorted back to dismissal area for signing
out. He will be asked to handle back all what he has received on signing in; he may be asked to
stay for some time for exam security reason.

Tips for Organizing OSCE

Assessment: Produce a grid summarizing. What is to be tested during OSCE. Down the left
hand side list the competencies such as history taking, physical exam, patient education, etc.

Duration of stations: Once the duration has been fixed make sure that the task expected of the
student can be accomplished with time.

No. of stations: Within the time constraints include in the examination as many stations as
possible as there is good evidence that the reliability of the examination. tong Insbuja

Use of examiners: Make sure that examiners are fully briefed prior to the examination, both for
examination in general and particular with regard to the station to which they are assigned.
Provide them with a list of resources that will be available at these stations.

Range of approaches: When planning an OSCE for the first time, talk with number of
individuals from different settings who have previously made use of this technique. If possible,
visit and watch their examinations.

New stations: New station should be tested with one or more student before use in the
examination.

Organizations of the examinations: There should be co-coordinator appointed in advance of

the examination that has the responsibility for taking overall charge of the advance planning of
the exam and its implementation on that day.

Resource requirements: It is helpful to produce a checklist of the resources required for each
station in exam.

Plan examination and directions: After the exam is set up and the directions in place for
students that they can find their way easily from one station to the next. Use of tape on the floor
for direction can also be used.

Change signal: Before examination, check that the audible signal can be heard clearly at all
locations on the examination.

Records: Keep an OSCE file into which all resources required, such as station numbers,
direction arrows, master sheet of instruction to students, checklists, rating scales and so on.
OSPE: OBJECTIVE STRUCTURED PRACTICAL
EXAMINATION

Introduction

The term OSPE is derived from OSCE in 1975 which was later extended to practical exam and
modified by Harden and Gleeson. OSPE is the traditional system of practical examination in
nursing consists of either assigning a procedure to a student or a patient for identifying the needs
and problems. This depends upon student's ability and availability of the patient for a particular
procedure.

Definition of OSPE:-

 It is an assessment tool in which the competence of a student is evaluated for general

experiments; in terms of: Identification of equipment/accessories of an experiment,
procedure of the experiment, handling of instruments, making observations/ results,
interpretation of results, conclusion.
 It is a new pattern of the practical examination, in which each component of clinical
competence is tested uniformity and objectivity for all the students who are taking up a
practical. It can be used for formative and summative examination.

Features of OSPE:-

 Separate assessment of process and observation of performance and result. assessment of

result.
 Objectivity
 Adequate sampling of skills and content to test.
 An analytical approach to the assessment.
 Feedback to teacher and student.

Methodology of OSPE
  During this exam student pass through a number of stations.

 OSPE exam ideally consists of 15-20 stations for exam of a particular course. No. of
stations may be reduced according to higher no. of students to be evaluated. But in order
to maintain the validity of the exam, the time for each station should not be less than four
minutes.

 All the station should be completed in the same period of time. Students are rotated
through all the station and move to the next station on the ring of the bell. Thus 15
stations of four minutes duration each, 15 students can complete the exam within one
hour. Each station is designed to test experimental competences.

 At some stations called the procedures station students are given tasks to perform on
subjects. At all stations there is a observer with an agreed checklist to mark the student
performance.

 At other station called 'response station' student writes answer of objective type question
or record their findings of the previous procedure station.

Steps of OSPE

 Demonstrate practical skills:-

- For demonstration of practical skills, monitoring and recording oral temperature,
blood pressure, testing urine for sugar.

 Make accurate observations: -

-Differentiate between the normal and abnormal
- ECG, identify the type of arrhythmias from the ECG.

 Analyze and interpret data:

--- Hemogram report, liver function report, urine analysis.

 Identify the patients' problems:

 -The student has to identify the patient's problem in order to organize her work. A
Problem such as dyspnoea buttered Ilie einsbute 3D20

 Plan alternative nursing interventions:

--In case of airway obstruction, the student is expected to keep the patient in a side lying
position.

-- Do Oro-pharyngeal suction.

Explanation of procedure and response station by example. A model OSPE designed for
first year B.Sc Nursing students.

STATION QUESTION METHOD OF SCORING

Procedure Take oral temperature and record it Observed and scored by the
station examiner using checklist
Question Convert 40*c fever into F by using Student answer on a sheet
station the formula provided
Procedure Check and record BP Observed and scored by the
station examiner
Question List 5 factors that regulate the BP Student answer on a sheet
station provided

Types of Station

1. Procedure station: This station requires student to perform a task. E.g: monitoring of
oral temperature. When a student performs the task simultaneously re she is observed and
marked against a checklist being prepared in advance. So the students get score P according to
the skill demonstrated by her.

2. The question station/the response station: The student answer the question
being asked on the answer sheet provided and leave it in the place specified. Usually the question
station may have a question related to the procedure station.
Advantages of OSPE

 It is more objective, reliable and valid than the traditional system of examination
 All students are subjected to the same standardized test
 The emphasis is shifted from testing factual knowledge to testing of skills, that too in a
short time
 It helps to ensure a wide coverage of all practical skills
 It ensures interaction of teaching and learning
 There is increased faculty- student interaction
 A large number of students can be tested within a restricted time period..

Disadvantages of OSPE

 The stimulated situation may not reflect the real life situation

 Students cannot be assessed for different skills, such as IPR, communication skills and
dexterity in handling equipments.
 Empathy towards the patients cannot be evaluated
 The skill of the student in providing holistic nursing care cannot be assessed
 It may be time consuming to construct an OSPE
 It cannot be used a single person, it needs more resources in terms of manpower, time and
money
 There is no interaction between the examiner and the student
 There is a risk of fatigue
 Breaking clinical skills into individual competencies may be artificial

Objective Structured Clinical Examination (OSCE)

Participant Number:___________________________________ Date:_______________

Skill Station: Administration of hepatitis vaccine

Situation: Sumana, 25yrs, visited your health Centre with her one and a half month old baby
girl. Her immunization card shows that she has only received BCG. Which other vaccines will
you administer to her baby? Show the steps of administering Hepatitis vaccine.

Name (s) of the Vaccine:_________________________________ Score I for correct answer

Observation: Observe if the participant is performing the following steps of administration of

Hepatitis vaccine in the correct sequence (ns necessary) and technique,

Score "1" for each point conducted correctly or mark "0" if the task is not done as recommended
and calculate the Score.

Sl No. STEPS/TASK SCORE 1/0 REMARKS

1. Keeps necessary Items ready: vaccine carrier, hub
cutter, cotton. 0.5 ml AD syringe, immunization card.
2. Checks the expiry date on the vaccine vial to make
sure vaccine is in usable stage
3. Shakes the vial to observe freezing or floccules or
particulate matter Discards the vial if present
4. Position the child on the mother's lap, in such a way
that the child's head rests on mother's right arm with
left arm of the child placed at the back of mother and
mother's right hand holds child right hand. With the
left hand mother holds the child's both legs
5. Open a fresh 0.5 ml AD syringe and throws syringe
wrapper and cap in black bag. Loads the vaccine into
syringe
6. Expels excess air from syringe by tapping it and makes
sure that syringe has exactly 0.5 ml of vaccine
7. Puts finger and thumb of left hand on either side of the
injection site (Right anterolateral thigh)
8. Stretches the skin fiat between finger and thumb.
9. Hold the syringe like a pen in the night hand and push
the needle straight down at 90degrees
10. Press the top of the plunger with the thumb to inject the
vaccine
11. Withdraw the needle and press the site of injection
with a dry cotton swab
12. Cut the needle with the hot cutter and put the plastic
part of the syringe into the red bag.
13. Documents in immunization card and give 4 key
messages about immunization.
 Which vaccine was given and which disease
does the vaccine protects against.
 When to come for next vaccination
  Effects of immunization like localized pain,
redness, swelling at injection site, injection site
nodule, Low-grade fever
 and how to manage the same by giving
Paracetemol for fever, cold cloth at injection
site for local reaction
 Keeping immunization card safe and bringing it
on next visit.

Pass Score: 11/13

Students Score:

Pass- Yes/No.

CONCLUSION
The OSCE style of clinical assessment, given its obvious advantages, especially in terms
of objectivity, uniformity and versatility of clinical scenarios that can be assessed, shows
superiority over traditional clinical assessment. It allows evaluation of clinical students at
varying levels of training within a relatively short period, over a broad range of skills and issues.
OSCE removes prejudice in examining students and allows all to go through the same scope and

criteria for assessment. This has made it a worthwhile method in medical practice .

Bibliography
1. Shebeer P. Basheer, The Book of Nursing Education,2nd edition 2018,EMMESS medical
publishers, P.237-239.

2. R Sudha ,Nursing Education Principles & concept, First Edition 2013, Jaypee Brothers
Medical Publishers(P)Ltd., P. 219- 222
3. D. Elakkuvana Bhaskara Raj, Nima Bhaskar, Text Book of Nursing Education,2 nd
edition, EMMESS medical publishers, P. 258- 260