By: Cherie Lucas, PhD, BPharm, GradCertEdStud (Higher Ed) and Gail Forrest, RN MResEd. Cert IV Training and Assessment
With the current worldwide pandemic circumstances, many educators have transitioned to work from home, developing strategies for online Objective Structured Clinical Examinations (OSCEs). These examinations are designed to assess students’ ability and competency standards by applying their skills and knowledge to identify students’ practice readiness.1 Students who undertake OSCE examinations are usually required to progress through a series of ‘stations’ in order to interview, examine, and/or treat a standardized patient (SP) who presents with a query, medical/pharmaceutical issue or problem. While online examinations are not new experiences for some educators, they do pose some challenges, especially as the majority of the current teaching and learning is being conducted at the same time across courses and schools via video-conferencing tools such as Zoom.
What are the challenges with these tools when assessing students?
There are many challenges faced by educators when assessing via video-conferencing, including considerations on how information is processed, the risk of information overload (ie “Zoom Fatigue”), what features are available for use, and the prospect of cheating when assessing students off campus.2
Furthermore, psychology research has shown that effective communication often relies on a 55/38/7 formula: 55% non-verbal (e.g. body language), 38% voice tone, and only 7% spoken word, with non-verbal communication as a key element to building rapport and trust between patient and healthcare provider.3 Most OSCEs assess both verbal and non-verbal cues, especially when assessing the communication competency standard. However, there are challenges to assessing the full range of non-verbal cues with video-conferencing platforms. For example, the screens are limited to what they can show and how the student is positioned or framed within the screen, which may not capture non-verbal cues such as hand gestures or fidgeting.2
What are some considerations when implementing Virtual OSCEs?
- Strategies for ensuring academic integrity:
- Placing invigilators within ‘breakout rooms”
- Utilizing software such as ProctorU, Respondus or Examsoft for unstaffed OSCE stations
- Allocating specific times for students to log on
- Requesting students to present their identification cards upon entry to the online forum
- Requiring students keep their cameras and microphones switched on at all times
- Only allowing students to enter their virtual examination room via accounts in which they cannot change their name
- Changing scenarios regularly throughout OSCE stations
- Preparation is the key to success:
Some of the key considerations when developing online OSCEs and schedules relate to: considering timezone differences with students undertaking OSCEs in other regions of a country or in other countries, allocating appropriate assessment tools applicable for the online space, and revising learning objectives and outcomes that are possible with the use of online interfaces.4 For example, it may be more difficult to assess a student to perform a ‘hands on” assessment on an SP without appropriate devices such as measuring a blood pressure, International Normalized Ratio (INR), cholesterol and/or glucose level via the online process. However, talking through the process to an examiner via video-conferencing and defending their decisions for the process can be achieved via this format. While there are a number of challenges, one notable advantage of conducting examinations of this nature with large cohorts, is that physical rooms are no longer required and timetabling these on campus is no longer necessary, thus freeing up valuable space for other on-campus activities such as showing students multiple vignettes and having them critique the ‘good’, ‘bad’ and the ‘ugly’. - Understanding how verbal and non-verbal cues are communicated:
Requesting students to be conscious of how they are framed within the screens during the online examination is another consideration to optimize the interaction. Informing students about the importance that non-verbal cues play in communication serves as two purposes: (i) students are more aware of this aspect of communication; (ii) they are more conscious of the limitations of displaying effective non-verbal cues via online interfaces. With ‘Telehealth’ and similar worldwide virtual, accessible online care delivery models, having future pharmacists examined and exposed to these conditions early in their careers may help them better engage with patients especially as their future profession may follow suit and move potentially towards conducting online pharmacy advice services…perhaps the next TelePharm?5
Moving Forward
With the evolving pharmacy landscape, and movement towards online medical services, sharing our challenges and successes in this rapidly changing educational environment will benefit pharmacy schools worldwide.
What has worked well at your institution?
What lessons can be learned?
References:
- Gillette C, Stanton RB, Anderson Jr HG. Student performance on a knowledge –based exam may predict student ability to communicate effectively with a standardized patient during an objective structured clinical examination. Curr Pharm Teach Learn 2017; 9(2):201-207.
- Skylar J. ‘Zoom fatigue’ is taxing the brain. Here’s why that happens. National Geographic: Science Coronavirus Coverage, 2020; April 26.
- Benbenishty JS and Hannink JR. Non-verbal communication to restore patient-provider trust. Intensive Care Med 2015; 41:1359-1360.
- Errichetti T and Smith C. Key Considerations for Taking Your OSCEs Online [Webinar] 2020; April 29.
- Quinlin L, Clark Graham M, Nikolai C and Teall AM. Development and implementation of an e-visit objective structured clinical examination to evaluate student ability to provide care by telehealth. J Am Assoc Nurse Pract [published online ahead of print] 2020; Apr 16.
Dr Cherie Lucas, Senior Lecturer (Pharmacy Practice) and Clinical Education Manager (Placements) at the University of Technology Sydney, Australia. Educational scholarship interests include reflective practice, interprofessional education and simulation. Dr Lucas enjoys reading, salsa dancing, painting; and hosting dinner parties (not necessarily in that order). She can also be reached via LinkedIn or Twitter: @LucasReflection.
Gail Forrest, Lecturer (Nursing); Director of Post Graduate Nursing Studies at the University of Technology Sydney, Australia. Research interests include patient safety and human factors within healthcare. Gail enjoys coastal treks and has done several 35km charity walks, and dragging her kids on bush walks with her and their 2 dogs. She can also be reached at LinkedIn or Twitter: @GailForrest8.
Pulses is a scholarly blog supported by a team of pharmacy education scholars
Pulses 
Dr.Lucas & Ms. Forrest,
I enjoyed reading your articulate post! As you described issues and challenges with developing and implementing a virtual OSCE, I most appreciated you mentioning about the contributions to communication from what is said, vocal tone, and non-verbal inputs. With these and other notable issues that you described, I would only like to extend your description that an OSCE is not merely “a series of stations”. It needs many stations for reliability. By “many”, I would suggest more than 10 stations (though this could vary based on the breadth or narrowness of the abilities that are trying to be assessed). As you note, we need to worry about the intra-station validity, but please do not forget the multitude of stations for it to have reliability and overall validity for an entire OSCE.
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Thank you Michael for these insightful comments.
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