Obstet Gynecol Sci.  2023 Jul;66(4):316-326. 10.5468/ogs.22266.

Pre-COVID and COVID experience of objective structured clinical examination as a learning tool for post-graduate residents in Obstetrics & Gynecology-a quality improvement study

• Sharma C
• Singh P
• Shekhar S
• Bhardwaj A
• Jhirwal M
• Ghuman NK
• Gothwal M
• Yadav G
• Kathuria P
• Mishra V

• KMID: 2544387
• DOI: http://doi.org/10.5468/ogs.22266

Abstract

Objective
Due to its comprehensive, reliable, and valid format, the objective structured clinical examination (OSCE) is the gold standard for assessing the clinical competency of medical students. In the present study, we evaluated the importance of the OSCE as a learning tool for postgraduate (PG) residents assessing their junior undergraduate students. We further aimed to analyze quality improvement during the pre-coronavirus disease (COVID) and COVID periods.
Methods
This quality-improvement interventional study was conducted at the Department of Obstetrics and Gynecology. The PG residents were trained to conduct the OSCE. A formal feedback form was distributed to 22 participants, and their responses were analyzed using a five-point Likert scale. Fishbone analysis was performed, and the ‘plan-do-study-act’ (PDSA) cycle was implemented to improve the OSCE.
Results
Most of the residents (95%) believed that this examination system was extremely fair and covered a wide range of clinical skills and knowledge. Further, 4.5% believed it was more labor- and resource intensive and time-consuming. Eighteen (81.8%) residents stated that they had learned all three domains: communication skills, time management skills, and a stepwise approach to clinical scenarios. The PDSA cycle was run eight times, resulting in a dramatic improvement (from 30% to 70%) in the knowledge and clinical skills of PGs and the standard of OSCE.
Conclusion
The OSCE can be used as a learning tool for young assessors who are receptive to novel tools. The involvement of PGs in the OSCE improved their communication skills and helped overcome human resource limitations while manning various OSCE stations.

Keyword

Assessment; Competency; Near-peer assessors; Simulated patients; Standardized patients

Figure

• 

  Fig. 1. (A) Fish bone analysis in the pre-COVID-19 period. (B) Fish bone analysis during the COVID-19 pandemic. PG, postgraduate; OSCE, objective structured clinical examination; COVID-19, coronavirus disease-2019.

• 

  Fig. 2. Conducting the OSCE in the pre-COVID-19 era. OSCE, objective structured clinical examination; COVID-19, coronavirus disease-2019.

• 

  Fig. 3. (A) Conducting the OSCE during the COVID-19 pandemic; (b) hospital staff trained as a simulated patient during the COVID- 19 pandemic. OSCE, objective structured clinical examination; COVID-19, coronavirus disease-2019.

Reference

References

1. Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J. 1975; 1:447–51.

2. Majumder MAA, Kumar A, Krishnamurthy K, Ojeh N, Adams OP, Sa B. An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives. Adv Med Educ Pract. 2019; 10:387–97.

3. Bhuiyan P, Supe A, Rege N. The art of teaching medical students-e-book. 3rd ed. New Delhi: Elsevier Health Sciences;2015.

4. Schwill S, Fahrbach-Veeser J, Moeltner A, Eicher C, Kurczyk S, Pfisterer D, et al. Peers as OSCE assessors for junior medical students - a review of routine use: a mixed methods study. BMC Med Educ. 2020; 20:17.

5. Khan FA. Objective structured clinical examinations (OSCEs) as assessment tools for medical student examination. Telangana J psychiatry. 2016; 2:17–21.

6. Alkhateeb NE, Al-Dabbagh A, Ibrahim M, Al-Tawil NG. Effect of a formative objective structured clinical examination on the clinical performance of undergraduate medical students in a summative examination: a randomized controlled trial. Indian Pediatr. 2019; 56:745–8.

7. Gilson GJ, George KE, Qualls CM, Sarto GE, Obenshain SS, Boulet J. Assessing clinical competence of medical students in women’s health care: use of the objective structured clinical examination. Obstet Gynecol. 1998; 92:1038–43.

8. Beigzadeh A, Bahmanbijri B, Sharifpoor E, Rahimi M. Standardized patients versus simulated patients in medical education: are they the same or different. J Emerg Pract Trauma. 2016; 2:25–8.

9. Ware J, Mardi AE, Abdulghani H, Siddiqui I. Objective structured clinical examination (OSCE manual 2014) [Internet]. Riyadh: Saudi Commission for Health Specialities;c2014. [cited 2023 Apr 27]. Available from: https://pdf4pro.com/amp/view/objective-structured-clinicalexamination-scfhs-52868d.html.

10. Khan KZ, Ramachandran S, Gaunt K, Pushkar P. The objective structured clinical examination (OSCE): AMEE guide no. 81. Part I: an historical and theoretical perspective. Med Teach. 2013; 35:1437–46.

11. Ghalavandi S, Heidarnia A, Zarei F, Beiranvand R. Knowledge, attitude, practice, and self-efficacy of women regarding cervical cancer screening. Obstet Gynecol Sci. 2021; 64:216–25.

12. Lee KH, Han YJ, Chung JH, Kim MY, Ryu HM, Kim JH, et al. Treatment of gestational diabetes diagnosed by the IADPSG criteria decreases excessive fetal growth. Obstet Gynecol Sci. 2020; 63:19–26.

13. Kim HY, Lee D, Kim J, Noh E, Ahn KH, Hong SC, et al. Secular trends in cesarean sections and risk factors in South Korea (2006-2015). Obstet Gynecol Sci. 2020; 63:440–7.

14. Kim KJ, Kim G. The efficacy of peer assessment in objective structured clinical examinations for formative feedback: a preliminary study. Korean J Med Educ. 2020; 32:59–65.

15. Hope D, Cameron H. Examiners are most lenient at the start of a two-day OSCE. Med Teach. 2015; 37:81–5.

16. Stroud L, Herold J, Tomlinson G, Cavalcanti RB. Who you know or what you know? Effect of examiner familiarity with residents on OSCE scores. Acad Med. 2011; 86:S8–11.

17. Pell G, Homer MS, Roberts TE. Assessor training: its effects on criterion‐based assessment in a medical context. Int J Res Method Educ. 2008; 31:143–54.

18. Iramaneerat C, Yudkowsky R. Rater errors in a clinical skills assessment of medical students. Eval Health Prof. 2007; 30:266–83.

19. Saroja C, Sathyasree C, Santa Kumari A, Padmini O. Student perception of OSCE as a learning tool in osmania medical. Applied Physiology and Anatomy Digest. 2018; 3:24–8.

20. Müller S, Koch I, Settmacher U, Dahmen U. How the introduction of OSCEs has affected the time students spend studying: results of a nationwide study. BMC Med Educ. 2019; 19:146.

21. Brazeau C, Boyd L, Crosson J. Changing an existing OSCE to a teaching tool: the making of a teaching OSCE. Acad Med. 2002; 77:932.

22. Chong L, Taylor S, Haywood M, Adelstein BA, Shulruf B. The sights and insights of examiners in objective structured clinical examinations. J Educ Eval Health Prof. 2017; 14:34.

23. World Health Organization (WHO). Coronavirus disease (COVID-19) pandemic [Internet]. Geneva: WHO;c2023. [cited 2023 Apr 26]. Available from: https://www.who.int/europe/emergencies/situations/covid-19.

24. Blythe J, Patel NSA, Spiring W, Easton G, Evans D, Meskevicius-Sadler E, et al. Undertaking a high stakes virtual OSCE (“VOSCE”) during Covid-19. BMC Med Educ. 2021; 21:221.