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Shamsunnisa Sadia, MCPS, FCPS^*, Saadia Sultana, MCPS, FCPS ^*,

Fareesa Waqar, FCPS^**.

*Assistant Professor, **Professor and Head of Department

Department of Obstetrics & Gynecology, Islamic International Medical College-Trust, Railway Hospital, Rawalpindi (Pakistan).

Correspondence: Dr. Shamsunnisa Sadia,Assistant Professor, Department of Obstetrics & Gynecology, Islamic International Medical College –Trust, Pakistan Railway Hospital, Rawalpindi (Pakistan). E-mail: naadeems@yahoo.com

ABSTRACT

Objective: To describe the perceptions of undergraduate medical students regarding Objective Structured Clinical Examination (OSCE) and its comparison to Multiple Choice Questions (MCQ), essay questions and viva voce.

Methods: This cross-sectional survey was carried out at Islamic International Medical College Rawalpindi (Pakistan), from 3 December 2008 to 2 January 2009. We used a questionnaire comprising of a total of 12 items, out of which 8 items were regarding the quality of exam (Likert scale), 3 regarding the difficulty, being educative and fairness of OSCE relative to other methods of assessment and last one regarding its acceptability as a method to assess clinical skills for undergraduate medical students. The questionnaire was distributed to students of 4^th and 5^th year medical students to be filled and returned for assessment of the responses.

Results:   One twenty seven students completed the questionnaire. The results of the study showed that the exam was stressful for 51% of the respondents. About 81% thought that performance of tasks during OSCE was interesting and educative. OSCE, essay type, MCQ and oral viva examination were perceived easy by 44, 33, 18 and 5% students, educative by 32, 16, 23 and 30% and fair by 43, 13, 32 and 11% respectively.

Conclusion: OSCE is well-received and acceptable to undergraduate medical students of Pakistan as a method to assess clinical skills.

Keywords: OSCE; Medical students; Clinical skills; Examination; Assessment.

Citation: Sadia S, Sultana S, Fareesa Waqar F. OSCE as an Assessment Tool: Perceptions of Undergraduate Medical Students. Anaesth Pain & Intensive Care 2009;13(2):65-67

INTRODUCTION

Residency programs are increasingly required to provide performance based assessments to document clinical skills, and OSCE are one of the best methods to assess these skills. An OSCE is a timed, multistation examination in which learners perform tasks such as interviews, physical exams, clinical/ resuscitative procedures and counseling in realistic settings. At each station learner performance is evaluated with specific checklists or global rating scales, completed by faculty members and/or standardized patients. OSCE’s enable the same clinical scenarios to be presented to many trainees and have become the gold standard for performance-based assessment. The College of Physicians and Surgeons Pakistan (CPSP) has already inculcated objective structured assessments in its medical post graduate diploma awarding examinations. In due course of time the Pakistan Medical & Dental Council is expected to ask all examining bodies to incorporate such structured assessment methods into undergraduate medical examinations as well. Medical students are assessed by OSCE both at the end of clinical rotation and final professional examinations by the Department of Obstetrics and Gynecology, Islamic International Medical College Rawalpindi. A lot has been said about the pros and cons of OSCE as an assessment tool[1]^–[2]. But information regarding the perceptions of the medical students in this context is lacking. We conducted this survey to ascertain the perceptions of undergraduate medical students regarding OSCE and its comparison to MCQ’s, essay type questions and viva voce.

METHODOLOGY

In this cross-sectional survey we used a questionnaire, which was distributed among 4th and 5th year medical students of Islamic International Medical College Rawalpindi, to be filled and returned back. The questionnaire had three parts; Part one contained 8 questions regarding the quality of exam which answered on a four point Likert scale (1=strongly agree, 2=agree, 3=disagree, 4=strongly disagree). Part two consisted of 3 items regarding the difficulty, being educative and fairness of OSCE relative to other methods of assessment (MCQ, essay type questions and oral viva). Finally, part three had one item regarding the acceptability of OSCE as a method to assess clinical skills for undergraduate medical students (Table 1). Analysis was done by descriptive statistics using SPSS version 15.

Table 1: The questionnaire

PART I – OSCE vs VIVA (Regarding OSCE answer as: A- Strongly agree; B- Agree; C- Disagree; D- Strongly disagree)
No.	ITEM			A		B		C			D
	Exam designed fairly
	Exam organized properly
	Exam was so stressful
	Exam was easier than oral
	I received adequate information before appearing in the exam
	The instruction of each station were as expected
	The time was enough for each station
	Performing of tasks at each station was interesting and educative
PART II (Tick ONE option)
No.	ITEM	OSCE	Viva		Essay Questions				MCQ
	Easy
	Educative
	Fair
PART III (Tick ONE option)
No.	ITEM						Yes			No.
1.	OSCE is an acceptable method to assess practical clinical skills for undergraduate medical students

RESULTS

One twenty seven (4th and 5th year) undergraduate medical students completed the questionnaire. The results of the study showed that 88% respondents thought that the exam was designed fairly, 80% thought that it was organized properly and 76% opined that it was easier than oral viva. According to 72% of the respondents adequate information was given prior to the examination. Instructions for each station were found to be as expected by 67%. About 81% thought that performance of tasks during OSCE was interesting and educative. However, OSCE was stressful for 51% of the students (Table 2). The 5 minute allocated time for each station was found to be insufficient by 57% of students. OSCE, Essay, MCQ and oral viva examination was perceived easy by 44 %( n=56), 33 %( n=42), 18 %( n=23) and 5 %( n=6) students respectively. OSCE, Essay, MCQ and viva examination were considered educative by 32(n=40), 16(n=20), 23(n=29) and 30 %( n=38) respectively, and fair by 43(n=55), 13(n=17), 32(n=41) and 11 %( n=14) respectively (Table 3). Eighty four percent (n=107) of the students were sure that OSCE was an acceptable method to assess practical clinical skills for undergraduate medical students. However, OSCE was unacceptable to 15% (n=19) of the respondents. One student left this item unanswered.

Table 2: Quality of performance testing

Item no.	Strongly Agree N (%)	Agree  N (%)	Disagree N (%)		Strongly Disagree N (%)
1	47(37)	65(51.2)	11(8.7)		4(3.1)
2	29(22.8)	73(57.5)	18(14.2)	7(5.5)
3	24(18.9)	67(52.8)	27(21.3)	9(7.1)
4	22(17.3)	63(49.6)	27(21.3)	15(11.8)
5	28(22)	37(29.1)	55(43.3)	7(5.5)
6	20(15.7)	34(26.8)	52(40.9)	21(16.5)
7	41(32.3)	55(43.3)	25(19.7)	6(4.7)
8	23(18.1)	80(63)	18(14.2)	6(4.7)

Table 3: OSCE relative to other methods of assessment

Item	OSCE N(%)	Essay question  N(%)	MCQ’s N(%)	Viva voce N(%)
Easy	56(44)	42(33)	23(18)	6(5)
Educative	42(33)	20(16)	29(23)	36(28)
Fair	55(43.3)	17(13.4)	41(32.3)	14(11)

 

DISCUSSION

Medical students perceived OSCE as an acceptable method and fair examination in comparison to MCQ, essay questions and oral examination. The results of this study showed that our medical students had a positive attitude towards OSCE as an alternative to assess clinical skills. Similar level of acceptance has been described in other studies as well ^[3]-6.

Although 51% of the students found OSCE to be stressful, more than 80% felt that it was educative, interesting and fair tool of assessment. Other studies⁷  also reveal that the OSCE is one of the most anxiety-provoking assessment method and students prepared more for the OSCE than for the other examinations^[4]. However, in spite of being elevated in nearly all forms of assessment methods, anxiety is not predictive of performance outcome in the OSCE.  Almost half of the respondents stated that the allocated time of 5 minutes per station was not enough however, more than 70% perceived that the examination was properly organized with adequate instructions both prior to and during examinations.

In our study, the students rated OSCE to be better than MCQ, essay type questions and viva voce in terms of being educative and fair. Interestingly, the largest number of students felt that OSCE was easier than the other three methods of assessment. These findings are supported by other surveys too[5].

CONCLUSION

The results of this study support the perception that OSCE is acceptable to undergraduate medical students of Pakistan as an alternative method to assess clinical skills.