6th MET basic workshop - participants & reports submitted - april 2014 9th to 11th
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1.
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Dr. P.Venkata Krishna
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Professor, Department of Medicine
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Guntur Medical College,
Guntur
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Project Report submitted & posted below |
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2.
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Dr.K. Maria Kumar
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Assistant Professor, Department of Biochemistry
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Guntur Medical College,
Guntur
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3.
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Naveen Kumar Paleti
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Assistant Professor, Department of Biochemistry
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Katuri Medical College,
Guntur
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4.
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Dr.Neelima Tirumalasetti
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Assistant Professor, Department of Pathology
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Katuri Medical College,
Guntur
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Project Report submitted & posted below |
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5.
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Dr.R..
Rajyalakshmi
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Associate Professor, Department of Pathology
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Rangaraya Medical College,
Kakinada
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6.
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Dr.G.Siddhartha Kiran
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Associate Professor, Department of Pediatrics
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Rangaraya Medical College,
Kakinada
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7.
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Dr.M.Sri Sailaja Rani
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Assistant Professor, Department of Surgery
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Rangaraya Medical College,
Kakinada
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8.
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Dr.Arindom Banerjee
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Associate Professor, Department of Anatomy
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Konaseema Inst.of Med. Sc.
Amalapuram
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Project Report submitted & posted below |
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9.
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Dr.I.Anil Kumar
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Associate Professor, Department of Anatomy
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Konaseema Inst.of Med. Sc.
Amalapuram
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Project Report submitted & posted below |
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10.
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Dr.V. Satyanarayana Murty
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Associate Professor, Department of Surgery
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Rajiv Gandhi Inst. Of Med. Sc.
Srikakulam
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11.
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Dr.Bula Aruna
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Assistant Professor, Department of Microbiology
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Rajiv Gandhi Inst. Of Med. Sc.
Srikakulam
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Project Report submitted & posted below |
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12.
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Dr.Cherukuri Prashanthi
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Assistant Professor, Department of Pathology
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NRI Inst of Med. Sc.
Sangivalasa
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13.
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Dr.K.Saradabai
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Professor,
Department of Gynaecology |
Andhra Medical College, Visakhapatnam
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14.
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Dr.P.Padmalatha
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Professor, Department of Pediatrics
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Andhra Medical College, Visakhapatnam
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15.
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Dr.T.Krishna Kishore
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Professor, Department of ENT
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Andhra Medical College, Visakhapatnam
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16.
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Dr.P.Himakar
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Professor, Department of Psychiatry
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Andhra Medical College, Visakhapatnam
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17.
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Dr.K.Satya Varaprasad
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Professor, Department of Neurosurgery
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Andhra Medical College, Visakhapatnam
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18.
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Dr.B.Purushottama Rao
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Associate Professor, Department of Medicine
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Andhra Medical College, Visakhapatnam
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19.
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Dr.V.Srinivas
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Associate Professor, Department of Medicine
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Andhra Medical College, Visakhapatnam
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20.
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Dr.K.Rambabu
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Associate Professor, Department of Medicine
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Andhra Medical College, Visakhapatnam
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21.
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Dr.A.Prem Kumar
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Professor, Department of Pulmonary Medicine
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Andhra Medical College, Visakhapatnam
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22.
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Dr.N.Lakshmi
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Associate Professor, Department of Microbiology
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Andhra Medical College, Visakhapatnam
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23.
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Dr.G.Rajsekhar Kennedy
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Assistant Professor, Department of Neurosurgery
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Andhra Medical College, Visakhapatnam
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24.
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Dr.J.Ramana Prasad
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Associate Professor, Department of Anesthesiology
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Andhra Medical College, Visakhapatnam
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25.
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Dr.Waddi Sudhakar
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Assistant Professor, Department of Surgery
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Andhra Medical College, Visakhapatnam
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26.
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Dr.G.Rajalakshmi
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Assistant Professor,
Department of Gynaecology
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Andhra Medical College, Visakhapatnam
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27.
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Dr.T.Parvati
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Assistant Professor, Department of Microbiology
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Andhra Medical College, Visakhapatnam
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28.
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Dr.Deena Usha
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Associate Professor, Department of Anatomy
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Andhra Medical College, Visakhapatnam
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29.
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Dr.I.Vijaya Bharati
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Associate Professor, Department of Pathology
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Andhra Medical College, Visakhapatnam
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30.
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Dr.K.Satyasri
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Assistant Professor, Department of Pathology
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Andhra Medical College, Visakhapatnam
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B. ARUNA - Assistant Professor Microbiology- RIMS Srikakulam
EVALUATION OF EFFECTIVENESS OF BLACK BOARD VERSUS
POWERPOINT IN ASSIMILATION OF KNOWLEDGE AMONG UNDER GRADUATE STUDENTS
(Summary - A majority of the students preferred both blackboard and powerpoint for classroom teaching.)
The opinion of 105 V and VI semester
MBBS students of RIMS,Srikakulam was
taken regarding the usefulness of each teaching aid.
A questionnaire was prepared and distributed to them.
61 % of the students preferred both blackboard and powerpoint for
teaching in class room
31% preferred blackboard teaching & 13 % preferred powerpoint
presentations
53% of the students preferred powerpoint for revision of topic
38% blackboard & 10 % preferred both the teaching aids
68 % preferred blackboard for understanding the content, 18 % powerpoint&
19 % preferred both the teaching aids
All the students opined that, with blackboard
teaching,
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It is easy to understand
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Students concentrate more
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Subject is well retained
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Best for complex topic teaching
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Good for taking down the notes
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Helps students to be more attentive in classes
because of more interaction between the student and the teacher
But it has its own disadvantages
like
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Having less visibility to last benches
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Inability to show complex diagrams and microscopic
pictures
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Takes much time to teach a small topic
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Whole subject may not be completed in the stipulated
amount of time
Comparativelypowerpoint presentations overcome the
disadvantages of black board teaching and are best for showing flow
charts,diagrams,operative or procedure audio/video clips and for covering large
topics in less time.
But the concentration levels of
the student are comparatively low&less student –teacher interactionmakes
the class less attentive for the student.
For improving the teaching skills in Medical colleges,the following are
being suggested by the students
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Usage of collar mikes
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Compulsory generator facility
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Online education
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Educational tours for external exposure to different
institutes or other medical hospitals across India
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Having a student friendly environment.
This particular issue was
stressed by many students and it reflects the changing trend of the students
thinking.
And last but not the least
...students expect the teacher to come for the class well prepared and to have
a clear idea about what he/she is teaching ,to assess the students IQ levels
and adjust their teaching plans accordingly and have that dedication to teach
them to understand the subject and not mere finishing the class.
*******************
NEELIMA TIRUMALASETTI - Assistant Professor Pathology, Katuri MC, Guntur
ROLE
OF MCQs IN THE EVALUATION OF II MBBS STUDENTS
(Conclusion - Initial impact of the study has been reflected in the form of increased demand for more MCQs especially by the students and its better acceptance from the colleagues. A ground has been created for frequent and regular implementation of the MCQs in the class tests along with subjective tests.)
Introduction:
Assessment of students is a matter of continuing concern for medical teachers as it is supposed to steer student learning. It drives learning in four ways, through its content, its format, its timing and through subsequent feedback given to the examinee.[1] The approach to learning is a dynamic characteristic and is always modified according to students’ perceptions of the learning environment.[2]
Multiple methods of assessment namely MCQs, SEQs, OSPE and VIVA are commonly used to assess Basic Science knowledge in undergraduate medical education. Multiple choice questions (MCQs) are the most frequently used type of tests deployed on their own or in combination with other types of test tools for assessment. MCQs are appropriate for measuring knowledge, comprehension and could be designed to measure application and analysis.[3] MCQs are being used increasingly due to their higher reliability, validity, and ease of scoring.[4,5]
Written examinations are of subjective type which stress on long, medium and short answer type questions. These are criticized to be highly subjective and inadequate for covering the full range of topics. Further there is little scope for providing feedback to the students for continuous learning and improvement. In the present study, MCQs were given along with the subjective questions to the students. The main objective of this study was to improve objectivity in student assessment by introducing MCQs and also to increase validity and reliability of the written examinations.
Materials and methods: After doing literature search concerning benefits and drawbacks of
different items, 30 MCQs per test were framed from different topics and 5 tests were conducted. MCQs of one best response out of four, extended matching type, multiple True/False and case based formats were included.
The cognitive levels of the assessment tools were analyzed using the Buckwalter’s (Buckwalter et al. 1981)[6] modification of the Bloom’s taxonomy (Bloom 1956).[7]
Level I: Include questions which attempt to check recall of information.
Level II: Include questions which attempt to test understanding and interpretation of data.
Level III: Include questions which attempt to test the application of knowledge for solving a particular problem.
Prevalidation of MCQs was done in the assessment of the content relevance and construction of each question.
Participants: A batch of 155 students of II MBBS at our institution were asked to appear in five tests consisting of subjective & objective types of questions on topics including, General and Systemic Pathology. After the test, manual scoring of both subjective & objective paper was done followed by class discussion of the test. Immediately after the discussion, anonymous feedback was taken from the students by asking them to fill feedback questionnaire in order to avoid bias.
Statistical Analysis: The data obtained from feedback questionnaire was compiled and analyzed manually by frequency analysis. The MCQs were evaluated on cognitive levels.
Results:
The student’s response was evaluated by feedback questionnaire and also by direct questioning during the discussion hour. After the first test, student’s feedback revealed that they were contented and grateful for the changes made in the method of assessment. They also requested for increase in the number of MCQs per test and inclusion of USMLE pattern questions.
The data obtained from feedback was compiled and analyzed.(Table 1)
Table 1: Student's response based on feedback questionnaire
Variable
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Strongly disagree
N(%)
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Moderately disagree N(%)
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Agree
N(%)
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Moderately agree
N(%)
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Strongly agree
N(%)
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Learning experience
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0( 0%)
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01(0.65%)
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04(2.6%)
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09(5.81%)
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40(25.80%)
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Self study skills
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01(0.65%)
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01(0.65%)
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03(1.94%)
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04(2.6%)
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14(9.03%)
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Reasoning skills
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01(0.65%)
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01(0.65%)
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05(3.2%)
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22(14.2%)
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28(18.06%)
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Clinical skills
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0(0%)
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02(1.3%)
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03(1.94%)
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08(5.16%)
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08(5.16%)
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Total
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02(1.3%)
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05(3.2%)
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15(9.68%)
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43(27.77%)
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90(58.05%)
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Analysis of feedback revealed that 58.05% students strongly agreed and only 1.3% of students strongly disagreed that MCQs improved their self study, reasoning and clinical skills.
A total 150 of MCQs that were administered in all five module examinations were reviewed. The cognitive level of 114 MCQs (76%) was at recall level while remaining 25 MCQs (16.66%) were of interpretation of data and there was no MCQ evaluating problem solving domain of knowledge.
Discussion:
Assessment has many powerful effects on student learning.[8,9] These effects include not only what is learned, but also students’ approach to learning. Students study more thoughtfully when they anticipate certain examination formats, and changes in the format can shift their focus to clinical rather than theoretical issues.[10]
The present research found that most of the MCQs were testing the recall of isolated facts and the skill of interpretation of data. There were only few MCQs(7.3%) assessing the higher cognitive domains of application and analysis. It may be due to the fact that MCQs at recall level are easier to construct and need less time and knowledge as compare to problem solving MCQs which needs expertise and training.[8,9]
Role of MCQ tests and discussions in learning various topics was favored strongly by 58% Students. However 85% students were of the opinion that both subjective and objective tests are needed for the assessment and MCQs alone are not sufficient to adequately assess their knowledge. Almost all the students (95%) approved that the quality of MCQs was good, relevant and clear.
Subjective test alone is also not sufficient to assess the students learning as they are criticized to be highly subjective and inadequate for covering full range of topics. It is also dependent on lots of variables such as students’ handwriting, legibility, teacher appreciation of written matter etc. so on the whole the actual knowledge of the students is not judged in a fair and valid manner.[11]
All the methods of assessment have strength and intrinsic flaws. The use of multiple methods of assessment can overcome many of the limitations of individual assessment formats.[12-15]
Conclusions:
Assessment drives learning.To make testing and assessment fair, MCQs should be used strategically to test important subject content and it should be used along with subjective tests. Initial impact of the study has been reflected in the form of increased demand for more MCQs especially by the students and its better acceptance from the colleagues. A ground has been created for frequent and regular implementation of the MCQs in the class tests along with subjective tests.
References:
1. Van Der Vleuten CPM. The assessment of professional competence: developments, research and practical implications. Adv Health SciEduc,1996;1:41-67.
2. Struyven K, Dochy F, Janssens S. Students’ perceptions about evaluation and assessment in higher education: a review. Assess Evaluation Higher Educ. 2005;30:325–341.
3. Abdel-Hameed AA, Al-Faris EA, Alorainy IA. The criteria and analysis of good multiple choice questions in a health professional setting. Saudi Med J. 2005;26:1505-1510.
4. Case S, Swanson D. Constructing written test questions for the basic and clinical sciences. 3rd ed. Philadelphia: National Board of Medical Examiners, 2003.
5. Tarrant M, Ware JA. Framework for improving the quality of multiple-choice Assessments. Nurse Educator. 2012;37:98-104.
6. Buckwalter JA, Schumacher R, Albright JP. Use of an educational taxonomy for evaluation of cognitive performance. J Med Educ. 1981;56:115-121.
7. Bloom B, Englehart M, Furst E. Taxonomy of educational objectives: The classification of educational goals. Handbook I: Cognitive domain. New York, Toronto: Longmans. 1956.
8. Croak T. The impact of classroom evaluation practices on students. Rev Educ Res, 1988; 55, 438–481.
9. Sebatanne E. Assessment and classroom learning: a response to Black and Wiliam. Assessment Educ,1998; 5, 123–130.
10. Newble D and Jaeger K. The effect of assessment and examination on the learning of medical students. Med Educ,1983; 17, 165–171.
11. Singh T. Evaluation of knowledge. In Singh T, Singh D, Paul VK. Principlesof Medical Education.2nded. New Delhi:IAP Education centre; 2000. p54
12. Van Der Vleuten CPM. The assessment of professional competence: developments, research and practical implications. Adv Health SciEduc,1996; 1, 41-67.
13. Van Der Vleuten CP, Norman GR, De Graaff E. Pitfalls in the pursuit of objectivity: issue of reliability. Med Edu,1991; 25, 110-118.
14. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002; 287: 226-35
15. Epstein RM, Dannefer EF, Nofziger AC, et al. Comprehensive assessment of professional competence: the Rochester experiment. Teach Learn Med,2004; 16, 186-196
****************
ARINDOM BANERJEE - Associate Professor Anatomy, Konaseema IMS Amalapuram
ASSESSMENT OF PSYCHOMOTOR SKILLS OF FIRST PROFESSIONAL MBBS STUDENTS BY GROUP STUDY IN THE DISSECTION HALL OF ANATOMY DEPARTMENT AT KIMS & RF
(CONCLUSION – This short study clearly showed that the students were able to perform best when they did the dissection on
their own after repeated practice on the third day. It also helped them to improve
their cognitive domain and vice versa.Therefore, if the students are only told about
something or only shown /demonstrated some practical procedure then they are
bound to forget it but on the other hand if they are involved and asked to do themselves
then they will understand it and subsequently apply it suitably in their
professional careers.)
INTRODUCTION:
- according to the domains of
learning, all of medical knowledge can be classified into three groups –
cognitive, psychomotor and affective domains. This is also called as the
taxonomy of learning domains (Benjamin S Bloom 1956).
Out of these three domains the psychomotor group involves
the practical knowledge that the student has acquired during his MBBS
curriculum either by observation or practically doing himself either under
guidance or individually. Therefore this domain is further broken up into A) Imitation – where the student will
observe and do exactly the same dissection or operation or any skill done in
front of him by a professional or specialized person. B) Doing under supervision
– here the student will perform the work on his own but will be under constant
observation of a professional (ex. A tutor or assistant professor in anatomy )
who will supervise the entire work and guide the student where ever he is
making any mistake C) Automate / naturalize – this is the
stage where with repeated practice the student is able to do the practical work
on his own without any supervision. D) Innovate – this is the last phase
which is seldom reached because under this the specialist is required to do the
procedure in an entirely new way (outside the standard procedure).
The aim of the following study is to test the psychomotor
skills of the first year MBBS students in the dissection hall of anatomy department
at Konaseema institute of medical sciences, Amalapuram under the subdivisions
of psychomotor domain.
Methodology: - a
total of 90 students were selected divide into 6 groups of 15 students each. They were assigned to do the dissection of the
submandibular region upto the exposure of the submandibular ganglion. The same
dissection the student groups would do for 3 consecutive days and at the end of
the dissection the groups would be asked randomly to demonstrate a particular
step of the dissection in another cadaver.
Day 1 – on one
side an assistant professor will do the dissection and the students on the
other side would follow the steps of dissection in the exact manner.
(IMITATION)
Day 2 – on one
side the students will do dissection on their own but under the supervision of
an assistant professor (DOING UNDER OBSERVATION)
Day 3 – the
students will do the dissection on their own without any supervision.
(AUTOMATE/NATURALIZE)
On each day at the end of dissection, all the 6 groups were
asked to do a particular step of dissection and their performance assessed on a
scale of 1 to 10 which were noted down in a tabulated manneras follows-
Results: day 1
Assessment –the groups were
asked to do the following steps of dissection
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Group 1
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Group 2
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Group 3
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Group 4
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Group 5
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Group 6
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Dissect and demonstrate the branches of cervical part of facial
artery
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0
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4
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3
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3
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2
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4
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Dissect and demonstrate the structures lying on the lateral surface
of the hyoglossus muscle
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0
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2
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1
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3
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1
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2
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Dissect and demonstrate the sub-mandibular ganglion with its two
roots
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0
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1
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1
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2
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1
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1
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TOTAL
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0
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7
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5
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8
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4
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7
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Results: day 2
Assessment –the groups were
asked to do the following steps of dissection
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Group 1
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Group 2
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Group 3
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Group 4
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Group 5
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Group 6
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Dissect and demonstrate the branches of cervical part of facial
artery
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1
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6
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3
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4
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5
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4
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Dissect and demonstrate the structures lying on the lateral surface
of the hyoglossus muscle
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2
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4
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3
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4
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3
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4
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Dissect and demonstrate the sub-mandibular ganglion with its two
roots
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0
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2
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2
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2
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2
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2
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TOTAL
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3
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12
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8
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10
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10
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10
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Results: day 3
Assessment –the groups were
asked to do the following steps of dissection
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Group 1
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Group 2
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Group 3
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Group 4
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Group 5
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Group 6
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Dissect and demonstrate the branches of cervical part of facial
artery
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5
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8
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5
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7
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7
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8
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Dissect and demonstrate the structures lying on the lateral surface
of the hyoglossus muscle
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5
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6
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5
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6
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4
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7
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Dissect and demonstrate the sub-mandibular ganglion with its two
roots
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5
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6
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4
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5
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4
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4
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TOTAL
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15
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20
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14
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18
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15
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19
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COMPARISON OF THE
RESULTS OF THE GROUPS FOR 3 DAYS WITH THE HELP OF BAR DIAGRAM–
OBSERVATION –
As can be observed from the above mentioned bar diagram the
psychomotor skills of all the groups were very poor at the end of the first day
when they only imitated what their teacher was doing on the other side without
understanding the importance of each and every step of the dissection.
Their performance was better on the second day as they were
doing the dissection on their own. But still the last step of exposing the
submandibular ganglion was difficult for them.
But on the third day when they had to do the entire
dissection on their own their performance was much better because they understood
what they had to do (also because they had repeated practice for the last 2
days) and even in the last step of dissection their score was much better than
the previous two days.
It was not possible to assess the innovative subdivision of
psychomotor domain.
CONCLUSION –
It is very important for the medical students to have a
sound knowledge in the basic practical skills which are prerequisite for a
medical practitioner. To attain it they have to do these on their own after
learning it from their teachers by imitation and doing under observation.
‘Practice makes perfect’ is the dictum which each student must follow to become
expert in practical skills. This was clearly seen in the short study conducted
where the students were able to perform best when they did the dissection on
their own after repeated practice on the third day. It also helped them to improve
their cognitive domain and vice versa.
Therefore to conclude if the students are only told about
something or only shown /demonstrated some practical procedure then they are
bond to forget it but on the other hand if they are involved and asked to do themselves
then they will understand it and subsequently apply it suitably in their
professional carriers.
***********************
ANIL KUMAR - Associate Professor Anatomy Konaseema IMS Amalapuram
EVALUATION OF TEACHER & TEACHING /LEARNING MEDIA AFTER TAKING THEORY CLASS OF
FIRST YEAR MBBS STUDENTS AT KONASEEMA INSTITUTE OF MEDICAL SCIENCES, AMALAPURAM
(Conclusion: Chalk board is still a valuable T/L
aid; however as far as
diagrams are concerned thestudents find power point useful because visual concept is
best with the actual diagrams on PPT. Regarding teaching skills of the teacher concerned, more emphasis has to be given to the
introduction to the topic and time management because the time period for first
year in limited and the syllabus is huge).
INTRODUCTION
The role of the teacher in medical science is to be the
bridge between the student and the subject. He or she should help the student
to understand, provide constructive criticism and encourage students to develop
professional skills and discipline. Hence in doing so the teacher should also
develop and evaluate his teaching skills from time to time so that he can
impart knowledge in the best possible way.
Though there are so many teaching/learning methods which are
available to the teachers, the commonly used methods to take a theory class are
chalkboard, over-head projector or power-point presentation.
The aim of the present study is to take feedback from the
students about which T/L method they find the best and also about the teaching
skills of the concerned teacher in a constructive manner.
METHODOLOGY
A short questionnaire was prepared and was handed out to the
150 first year MBBS students at the end of theory class. They were asked to
fill it up without disclosing their name and submit it back. This was done
after taking theory classes (10 theory classes as allotted by the Head of the
Department in accordance with the existing department curriculum) for one
month.
Sample copy of questionnaire is as mentioned below-
q. 1 –which teaching method do you find best suitable for
you?
a) chalk board b) OHP c) power point
q.2 – which T/L method helps you to understand the
anatomical diagrams better?
a) chalk board b) OHP c) power point
q.3 teaching skill evaluation –
Please assess the teaching skills by rating the below
mentioned points on a scale of 1 to 10
Teaching skills
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Points (1-10)
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Introduction to the topic
|
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Voice modulation (audibility and
clarity)
|
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Cracking jokes
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Judicious use of t/L methods
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Asking questions
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|
Time management
|
RESULTS
After collection of filled in 150 questionnaire forms the
results were analyzed in a tabulated manner as mentioned below
Which teaching method do you find best
suitable for you?
|
||
Chalk board
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OHP
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Power point
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70
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20
|
60
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Which T/L method helps you to
understand the anatomical diagrams better?
|
||
Chalk board
|
OHP
|
Power point
|
50
|
30
|
70
|
·
Results are in the form of total number of
students out of 150
The results are also explained in the form of pie charts –
Which teaching method do you find best suitable for you?
Which T/L method helps you to understand the anatomical
diagrams better?
Teaching assessment skills-
Teaching skills
|
Points (1-10)
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Introduction to the topic
|
5
|
Voice modulation (audibility and
clarity)
|
7
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Cracking jokes
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7
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Judicious use of t/L methods
|
7
|
Asking questions
|
7
|
Time management (finishing the topic in
time)
|
5
|
·
The results mentioned here are average of the
points given by all 150 students
OBSERVATION AND
CONCLUSION
The students still find the chalk board to be a valuable T/L
aid as can be observed from the above mentioned results. However as far as
diagrams are concerned they find power point useful because visual concept is
best with the actual diagrams which can be displayed very easily with the power
point.
As far as the
teaching skills are concerned on a
personal level as shown in the results more stress has to be given on the
introduction to the topic and time management because the time period for first
year in limited and the syllabus is huge.
In conclusion a good and judicious mixture of all the
available T/L aids should be made to make the class more interesting so the
students are able to grasp and understand the subject in a better way.
***********************
P.Venkata Krishna - Professor of Medicine - Guntur Medical College
Title: Evaluation of role of
Objective Structured Clinical Examination in the formative
evaluation of under graduate Medical students – advantages and disadvantages.
Running title: Objective Structured Clinical Examination versus traditional examination.
Author:
Dr. P. VENKATA KRISHNA, M.D., Professor of Medicine,
Guntur Medical College, Guntur, A.P.
Abstract: The Objective
Structured Clinical Examination is a versatile multipurpose evaluative tool
that can be utilized to assess health care professionals in a clinical setting.
It assesses 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. I have conducted OSCE to undergraduate
medical students at the end of their one and half months of ward posting by
forming a team with faculty and post graduate students and their 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 objective structured clinical examination
(OSCE) has become a standard method of assessment in both undergraduate and
postgraduate 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 the United Kingdom,
United States, Canada and indeed most reputable colleges of medicine the OSCE
is the standard mode of assessment of competency, clinical skills, and
counselling sessions satisfactorily complementing cognitive knowledge testing
in essay writing and objective examination.[2,3,4,5,6]
The OSCE
is a versatile multipurpose evaluative tool that can be utilized to evaluate
health care professionals in a clinical setting. It assesses competency, based
on objective testing through direct observation. It is comprised of several
“stations” in which examinees are expected to perform a variety of clinical
tasks within a specified time period against criteria formulated to the
clinical skill, thus demonstrating competency of skills and/ or attitudes.
[2]
The basic
steps in modeling an OSCE exam include:
1. Determination of the OSCE team.
2. Skills to be assessed (OSCE Stations).
3. Objective marking schemes
4. Recruitment and training of the standardized patients.
5.
Logistics of the examination process. [2]
We have
conducted OSCE to undergraduate Medical students at the end of their ward
clinical posting and the opinion of students and the faculty (examination team)
was taken and evaluated the various factors.
Method and materials : A team was prepared comprising one professor,
one associate professor, one assistant professor and two post graduate students
and they were trained to conduct OSCE.
Nine undergraduate medical students are also trained regarding OSCE and
at the end of their ward posting they were tested by OSCE.
A questionnaire
was prepared with prefixed marks for each step for plantar reflex examination and
for palpation of spleen and nine students are tested for Plantar reflex
examination and for palpation of spleen. After examination opinion was taken
from the students and also from the faculty and the advantages and
disadvantages of OSCE was evaluated.
Results: Out of 9 students, 7 students preferred the
OSCE over traditional system of examination as they felt it is easier and score
more marks and also they can learn clinical signs more thoroughly. One student is
equivocal and other one want OSCE periodically at the end of each class or weekend evaluation
and traditional system of examination at the year end. Myself (Professor), One
Associate Professor and one post graduate felt that both are good and students
should be tested in both methods. But they opined that traditional method of
examination is more comprehensive. One Assistant Professor felt that both are
good but old traditional exam is preferred in the final examination (as
Summative test). Another post graduate student felt that OSCE is more
preferable and students should be tested in the OSCE method.
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 the 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 to 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 OSCE as below:
Disadvantages
–
1) Evaluators should be trained
thoroughly
2) Large number of evaluators are
necessary
3) Large number of cases is 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 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
6) Usually in the University
examinations (for post graduate students), there are only 4 examiners (2
externals and 2 internals) and examination appearing candidates vary from 6 to
9. If we take 8 students per day and only 4 cases (stations)are placed in the OSCE and 10 minutes
are given at each station, then it will take nearly one and half hour time
(little time will be available for other evaluation (cases, thesis, log book,
viva voce, pedagogy etc). During the same time two pairs (1 external and 1
internal) will cover 2 short cases for the same candidates carrying examination
in a more methodical and authentic way testing more clinical skills and probing and testing knowledge of the
candidates in wide areas. For under graduate examinations there are usually 20
to 25 students and only four examiners and time adjustment is simply impossible
7) Of course OSCE is nothing but
miniature of traditional examination for the skilled and experienced examiners
(traditional examination was cut into multiple pieces bits and they are given
to candidates to get more standardization at the cost of correct grading of the
knowledge and skills of the candidates
for Normal examiners But for the experienced examiners, they can
achieve both standardization and correct
grading even in traditional method if not better also.
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
Suggestion
/ Conclusion: I feel that OSCE is more suitable for formative testing rather
than as summative testing and also useful for clinical demonstration and for
perfect leaning 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.)
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