Project reports of 8th basic workshop at AMC

1	Dr.Satyasai Panda	Professor, Department of Forensic Medicine	Great Eastern Medical School Srikakulam
2	Dr Rambabu Chennuru	Associate Professor Department of Gynaecology	Great Eastern Medical School Srikakulam
3	Dr.Nihar Ranjan Kothia	Assistant Professor Department of Orthopedics	Great Eastern Medical School Srikakulam
4	Dr.K.Sridhar	Assistant Professor Department of Microbiology	Great Eastern Medical School Srikakulam
5	Dr.M.Balachandra Rao Naidu	Assistant Professor Department of Biochemistry	Great Eastern Medical School Srikakulam
6	Dr.Sutar Priya Vasant	Assistant Professor Department of Medicine	Great Eastern Medical School Srikakulam
7	Dr.Ch. Ratna Kumar	Associate Professor Department of Biochemistry	Great Eastern Medical School Srikakulam
8	Dr.N.C.A. Narasimha Rao	Professor Department of Surgery	Maharaja Institute of Medical Sciences Nellimarla
9	Dr.N.Giridhar Gopal	Professor Department of Radiology	Maharaja Institute of Medical Sciences Nellimarla
10	Dr. S. Appala Raju	Assistant Professor Department of Orthopedics	Maharaja Institute of Medical Sciences Nellimarla
11	Dr.A.Usha Rani	Professor Department of Microbiology	Rangaraya Medical College Kakinada
12.	Dr.K.Sobha Devi	Associate Professor Department of Biochemistry	Rangaraya Medical College Kakinada
13.	Dr.D. Radhakrishnan	Associate Professor Department of Medicine	Rangaraya Medical College Kakinada
14	Dr.G.Soumini	Associate Professor Department of Gynaecology	Rangaraya Medical College Kakinada
15	Dr A.Lakshmi Kantham	Assistant Professor Department of Biochemistry	Rangaraya Medical College Kakinada

16		Dr.D.L. Vidya		Assistant Professor Department of Pediatrics	Rangaraya Medical College Kakinada
17	Dr.R.Bhimeswar		Professor Department of ENT			Rangaraya Medical College Kakinada
18	Dr.Syed Irfan Ali		Assistant Professor Department of SPM			GSL Medical College Rajahmundry
19	Dr.Jarina Begum		Assistant Professor Department of SPM			GSL Medical College Rajahmundry
20	Dr.K.Uma Maheswara Rao		Professor Department of Pediatrics			Alluri Sita Ramaraju Academy of Medical Sciences, Eluru
21	Dr.G.Hari Jagannadha Rao		Professor Department of Pharmacology			Alluri Sita Ramaraju Academy of Medical Sciences, Eluru
22	Dr.P.Sudarsini		Professor Department of Pediatrics			Alluri Sita Ramaraju Academy of Medical Sciences, Eluru
23	Dr.P. Vitthal Prasad		Assistant Professor Department of ENT			Alluri Sita Ramaraju Academy of Medical Sciences, Eluru
24	Dr.Manas Ranjan Rout		Assistant Professor Department of ENT			Alluri Sita Ramaraju Academy of Medical Sciences, Eluru
25	Dr.P.Sujatha		Associate Professor Department of Pharmacology			Rajiv Gandhi Institute of Medical Sciences, Srikakulam
26	Dr.P.Madhavi		Associate Professor Department of SPM			Siddhartha Medical College Vijayawada
27	Dr.A.Madhu Bindu		Professor Department of Gynaecology			Katuri Medical College Guntur
28	Dr.S.Rajkumari		Professor Department of GynaecologyRI			Katuri Medical College Guntur
29.	Dr.B.Siva Prasad Reddy		Assistant Professor Department of Microbiology			Narayana Medical College Nellore
30.	Dr.A. Venkata Lakshmi		Associate Professor Department of Pathology			Andhra Medical College Visakhapatnam

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VITTAL PRASAD - ENT - ASRAM 

Comparitive study of improvement in performance following revision class vs group discussion

AUTHORS:

1. Dr.P.VITHAL PRASAD,   *is correspondent author.

 ASST PROF, ASRAM MEDICAL COLLEGE, ELURU,  ANDHRA PRADESH, 534004.

 vittalent@rediffmail.com       mobile:9848168611

2..

3. ,   ASRAM MEDICAL COLLEGE, ELURU,(A.P)

4.

KEY WORDS:

INTRODUCTION: The main aim of education is to improve the knowledge of a student for his benefit as well as to do better service to society. 

MATERIALS AND METHODS: This study was conducted at Dept of otolaryngology and head and neck surgery, asram medical college, andhra pradesh from dec 20, 2014 to january 20, 2015  in our dept we have selected 30 students from our internal assessment examination who got less than required passmarks. cutoff marks is 40%.  These 30 students include are divided into two groups randomly, each group comprising of 15 students. Group A students are subjected for revision of syllabus by lectures. Group B are subjected to group discussion. We conducted the examination again after 1 month period and papers have been valuated and results are analysed. all the marks are in percentage.

     Marks of all 30 students before project

Marks range	Number of students in group A	Number of students in group B
10-19%	3	2
20-29%	7	7
30-40%	5	6

OBSERVATION:    we conducted examination for these 30 students seperately and valued the papers. All the papers have ben valuated by other faculty members to prevent any bias. Marks are tabulated below.

Marks range	Group A	Group B
Less than 40%	1	0
40-50%	8	7
More than 50%	6	8

Average marks gain in group A is 15% and in group B is 23%.  This gain in marks is significant.

DISCUSSION: Revision lecture means using a black borad or other audiovisual device.  Students are just passive listeners. Hwere as in group discussion students are given the topic and they come reading the topic. That topic will be discussed in detail. Active participation of students makes the topic more understandable and they can memorise in examination more. As per millers pyramid,  listening is far inferior than readng followed by discusion or explaining to others. So group discussion is more useful teaching method for small group of students. 

CONCLUSION: for a small group of students as in the case of referred batch or during clinical discussions or for postgraduate teaching group discussion will be more useful than dialogic lecture. So group discussion is more useful teaching method for small group of students than a lecture or revision class.

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RAJKUMARI  -   OBG  -  KATURI

     DR. D. UDAYA KUMAR. PROFESSOR OF OPHTHALMOLOGY, GUNTUR MEDICAL COLLEGE. GUNTUR.

TITLE: Evaluation of role of  Objective Structured Clinical Examination in the formative evaluation of post graduate students – advantages and disadvantages

AUTHOR: Dr. D. Udaya Kumar. M.S., Professor of Ophthalmology. Guntur Medical College , Government general hospital ,Guntur, Andhra Pradesh.

ABSTARCT: The Objective Structured Clinical Examination (OSCE) is a versatile multipurpose evaluation tool that can be utilized to assess health care professionals- medical and paramedical- in a clinical setting. It assess competency based on objective testing through direct observation. It is precise, objective and reproducible allowing uniform testing of students for a wide range of clinical skills. Myself and the team conducted OSCE to post graduate students in the department of ophthalmology and their performance and opinion is taken to evaluate the OSCE.

INTRODUCTION: Since its introduction as a mode of students assessment in Medical school in 1975, by HADEN and GLEESON, the OSCE has become a standard method of assessment in both under graduate and post graduate students (1,2). Originally described as a timed examination in which medical students interact with a series of simulated patients in stations that may involve history taking, physical examination, counseling or patient management (1,2). The OSCE examination has been broadened in its scope and has undergone a lot of modification to suit peculiar circumstances.

       In U.K. , U.S.A., Canada and some universities in INDIA, the OSCE is the standard mode of assessment of competency, clinical skills and counseling sessions satisfactorily complementing cognitive knowledge testing in essay writing an objective examination.

       The OSCE is a versatile multipurpose evaluation tool that can be utilized to evaluate healthcare professionals in clinical setting. It assesses competency based on objective testing through direct observation. It is comprised of several “stations” formulated to the clinical skill, thus demonstrating competency of skills and or attitudes.

       The basic steps  in modeling an OSCE examination includes;

1.       Determination of the OSCE team

2.       Skills to be assessed (OSCE stations)

3.       Objective marking schemes

4.       Recruitment and training of standardized patients

5.       Logistics of the examination process

We conducted OSCE to postgraduate students in ophthalmology and opinion of students and the faculty (Examination Team) was taken and evaluated the various factors.

METHODS AND MATERIALS: A team was prepared consisting of one Professor and four Assistant Professors with  due training to conduct OSCE. 12 post graduate students were given orientation training on OSCE and they were tested by OSCE team. A questionnaire was given for following 5 stations with pre fixed marks and fixed timing.

1.       Assessment of depth of Anterior chamber with slit lamp

2.       Technique of Digital tonometry

3.       Method of Examination for pupillary reactions

4.       Ocular motility examinations

5.       Prescribing glasses for Presbyopia in the given patient

After examination, opinion was taken from the students and also from the faculty and the  advantages  and disadvantages of OSCE were evaluated.

RESULTS: Out of 12 students, 8 students preferred the OSCE over traditional method of examination, as they can learn clinical signs more thoroughly and only those who are well versed with the clinical methods can score more marks in OSCE. Further it is more useful for clinical practice. Two students preferred only traditional system of examination. The other 2 are equivocal, saying both systems are good. 11 students preferred OSCE to be conducted periodically at the end of each topic in the subject. All the faculty members felt that both are good, but preferred OSCE at the end of each clinical posting and traditional system of examination to be conducted in the final examination which is more comprehensive with only 10% marks allotted for OSCE.

DISCUSSION: The scope of traditional clinical examination is basically patient histories, demonstration of physical examinations and assessment of a narrow range of technical skills. It has been shown to be largely unreliable in testing students’ performance   and has a wide margin of variability between one examiner and the other(2,7,8). Published findings of researchers on OSCE from its inception 1975 to 2004 has reported it to be reliable, valid and objective with cost as its only major drawback(8). The OSCE however covers broader range like problem solving, communication skills, decision-making and patient management abilities.(2,8). The advantages of OSCE apart from its versatility and ever broadening scope are its objectivity, reproducibility, and easy recall (2). All students get examined on predetermined criteria on same or similar clinical scenario or tasks with marks written down against those criteria thus enabling recall, teaching audit and determination of standards. In a study from Harvard medical school, students in second year were found to perform better on interpersonal and technical skills than on interpretative or integrative skills. This allows for review of teaching technique and curricula (2,9,10).  Performance is judged not by two or three examiners but by a team of many examiners in-charge of various stations of the examination. This is to the advantage of both the examinee and the teaching standard of the institution as the outcome of the examination is not affected by prejudice and standards get determined by a lot more teachers each looking at a particular issue in the training. OSCE takes much shorter time execute examining more students in any given time over a broader range of subjects (9,10,11)

        However no examination method is flawless and the OSCE has been criticized for using unreal subjects even though actual patients can be used according to need(2,10). OSCE is more difficult to organize and requires more materials and human resources (8,12,13)

   But according to our study and observation, we are here by summarizing the various advantages and disadvantages of OCSE as below:

ADVANTAGES:

The student can learn the clinical skills very thoroughly if it is practiced at the end of clinical class or weekend tests or as a method of formative examination

DISADVANTAGES:

1.       Evaluators should be trained thoroughly

2.       Large number of evaluators are necessary

3.       Large number of cases are necessary which may not be available all times(simulator backup necessary)

4.       Should be done in a separate (Neutral) center. If it is conducted in same center where the student is trained he may get the same preformed set of cases and questions and also there may be every possibility of knowing the cases prior to examination

5.       If the test is not limited to psychomotor test domain, even though the student may be failed in that domain, he will get pass marks if he scored in the questions (cognitive domain). So the very purpose of examination in clinical skills is diluted in the practical examination. So the scoring system in OSCE should be limited to pure psychomotor testing and also it should carry negative marking

SUGGESTION / CONCLUSION:  I feel that OCSE is more suitable for formative testing rather than as summative testing and also useful for clinical demonstration and for perfect learning of psychomotor acts. If it is to be placed in the summative testing it should be given as minor part of examination and also with negative marking and limited to pure psychomotor domain and preference should be given to old traditional method of testing ( examination by experienced teachers who will mix all varieties of testing properly- during long case, short case, etc,.)

   OSCE is the preferred choice of examination at the end of each clinical posting. 10% of marks in the final practical exams should be allotted to OSCE.

REFERENCES:

1.       Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination(OSCE). Med Educc 1979 Jan ;13(1);41-54.

2.       Marliyya Zayyan, Objective Structured Clinical Examination; The Assessment of Choice, Oman Medical Journal(2011) Vol.26, No. 4 ;219-22.

3.       Stillman PL, Wang Y, Ouyang Q, Zhang S , Yang Y, Sawyer WD. Teaching and assessing clinical skills; a competency- based programme in china. Med Educ 1997; Jan ; 31(1): 33-40.

4.       Jain SS, DeLisa JA, Eyles MY, Nadler S, Krishblum S, Smith A. Further experience in development of an objective structured clinical examination for physical medicine and rehabilitation residents. Am J Phys Med Rehabil 1998 Jul – Aug ; 77(4): 306-10.

5.       Novack DH, Volk G, Drossman DA, Lipkin M Jr. Medical interviewing and interpersonal skills teaching in US Medical schools. Progress, problems, and promise. JAMA 1993 Apr; 269(16): 2101-05.

6.       Leichner P, Sisler GC, Harper D. A study of reliability of clinical oral examination in psychiatry. Can J psychiatry 1984 Aug; 29(5); 394-97.

7.       Hubbard JP, Levit EJ,Schumacher CF, Schnabel TG Jr. An objective evaluation of clinical competence. N Engl J Med 1965Jun ; 272: 1321-28.

8.       Barman A. Critiques on the Objective Structured Clinical Examination. Ann A cad Med Singapore 2005sep; 34(8): 478-82.

9.       Hamann C, Volkan K, Fishman MB,et al. How well do second – year students learn physical diagnosis? Observational study of an objective structured clinical examination (OSCE) BMC Medical Education, 2002, 2:1  , 1186-1188.

10.    Vu NV, Barrows HS. Use of standardized patients in clinical assessments: recent developments and measurement findings. Educ Res 1994, 23:23-30.

11.    Barrows HS, Abrahamson S. The programmed patient:  a technique for appraising student performance in clinical neurology. J Med Educ 1964 Aug; 39: 802-5

12.   Norman GR, Tugwell P, Feightner JW. A Comparison of resident performance on real and simulated patients. J Med Educ 1982 Sep ; 57 (9): 708-15

13.   Sanson – Fisher RW, Poole AD. Simulated patients and the assessment of medical students interpersonal skills. Med Educ 1980 Jul; 14(4) : 249-53.

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