Dr Naresh Chauhan

Dec 08, 2021

ACME project

Introduction of objective structured clinical examination as an assessment tool for undergraduate students in Community Medicine.

Dr Naresh T Chauhan, Dr Abhay K, Dr Vipul Chaudhary

Asst Professor, Community Medicine Deptt, Govt Medical College Surat

Introduction/Background: As it is said that Indian Medical Graduate (IMG) is not competent enough to serve at the PHC of the village. The fault also lies with the present medical teaching methods where we don’t teach a basic concept of primary health care the way they are going to be applied in the field. For example preparing ORS, epidemic investigation, chlorination of water and many more taught in classroom of Community Medicine. If it being implemented in the form of the objective structured case examination (OSCE) than the teacher and students have to teach and learn in that manner and so it will overcome gaps in the essential knowledge for those skills. (1–3)

               It has been observed that traditional way of the assessing students does not includes the affective and psychomotor domain assessment most of the time, so by introduction of structure way of assessment like OSPE and OSCE in the subjects will not only assess the student for higher domain but also provide feedback to the teacher and student for scope of improvement.(1,4–6)

               Department of community medicine have been assessing students for various skill like chlorination of water ORS preparation and counselling in oral viva voce and spotting which in is not a structured way of assessment as emphasized  in Competency Based Medical education (CBME) and mostly testing the knowledge of the students. So with the idea of implementing the OSCE in community medicine this study has been undertaken with the objective of introducing OSCE as assessment tool for community medicine and to improve understanding and skills of undergraduate for various public measures.

Literature Review:

Many have documented the superiority of OSCE over traditional way of assessing in many subjects like physiology, Biochemistry Anatomy and community Medicine. (4,5,7,8)

OSCE: The objective structured clinical examination (OSCE) is a method of objectively testing the clinical and practical knowledge and skills acquired during the medical curriculum. (9)

Following are the steps which can be used for designing OSCE.(2,3)

In PSM, students are usually not asked to perform a particular practical related to public health, it is mostly covered in viva or theory which is again based on overall performance rather than the candidate’s individual practical/counselling skills. Hence, individual competencies might not be tested. Due to this, students do not bother much about exact procedures while performing a skill. They are vague in answering questions, lacking focus, and objectivity. (5)

Aim: to improve the public health related skills of the undergraduate students.

Objective/s:

1.     To introduce OSCE assessment tool for community medicine

2.     To know the perceptions of teachers and students regarding OSCE as a tool for assessment

3.     To document if the OSCE helps in improving skills of the students

Material & Methods:

Study settings: Second year MBBS students of Govt Medical College Surat.

Study Duration: from April 2022 to Sept 2022.

Study design: Mixed method study design. There will be an educational intervention study with focal group discussion (FGD) of students and teachers for the OSCE in community medicine.

Study methodology:

All the faculties and residents involved in the study will be trained for the uniformity in assessment using OSCE stations. OSCE checklist will be used for assessment and the effectiveness of OSCE will be assessed through a student’s and teacher’s feedback questionnaire that will be prepared after the literature search and validation by the faculty in Community Medicine and medical education. The questions administered will be checked for coefficient of reliability by Cronbach’s alpha. The students will be sensitized and oriented toward OSCE beforehand by explaining the OSCE pattern and discussing sample questions during their practical classes. Exact details and the timing for the station will be chalked out for the study based on piloting.

After informing student regarding their voluntary participation they will be enrolled in the study. 

Sample size: 250 students from second year (2020 admission batch ) will be enrolled after informed confirmed. There will be a posting of 40 student in each batch for four weeks. So following OSCE station will be exposed to the batch of 35 to 40 batch of students.

Sampling technique: purposive sampling method, all the students who are willing to participate will be taken from 2020 admission batch.

The following OSCE stations will be used for the study.

In the second stage of the study all the faculties and the sample of the student will be arranged for focal group discussion for getting qualitative data on the new assessment tool OSCE.

FGD: the objective of FGD for this study is to know the understanding of the students and teacher about the newer approach in learning. Following key question will be added to know about their view on OSCE.

1.      What is your view/opinion on OSCE station in CM

2.      How it is helpful in learning important concept in CM

3.      Weather we should stick to traditional approach or OSCE?

There will be 3 to 4 FGD for students and 2 for teacher which will saturate the objective of the FGD. Content analysis will be done and findings will be helpful for the improvement of teaching learning in community medicine subject.

Validation of questionnaires/checklist:  pre-validated feedback/perception scale will be used from the literature.