OSCEs: Feared Assessment, but Much Needed (and Appreciated!)

By: Katherine B Lowe, Student Pharmacist

The OSCE assessment is an expensive and resource-intensive process for pharmacy faculty to undertake. However, its value for students cannot be underestimated. 

How do we [students] feel about OSCEs?

Objective Structured Clinical Examinations (OSCEs) bring up mixed emotions in many student pharmacists.  Each OSCE brings about a cycle of anxiety, followed by suppressing the memory until assessed again next. Our stations are split between hospital and community contexts, with a 7-minute time limit to complete each station. These may be the most dreaded assessments that we undertake, but we recognize that they are vital for our learning. This sentiment has been reflected in previously published studies, in which surveyed students welcomed an early initiation of OSCE assessments in their degree programs as it allowed them to gain confidence and learn from mistakes.^1,2 

Why is it important to us as students?

• Practicing in a safe space: OSCEs allow us to make mistakes in a safe environment where the biggest consequence is merely failure and the opportunity to redo the assessment. A very different outcome would occur if we were to make these mistakes in practice.
• Improving self-reflective skills: OSCEs allow students to reflect on our errors and resolve them before we are met with long-lasting consequences. Failing an OSCE is a highly disappointing and stressful experience, but one that makes students re-evaluate their preparation and performance, and identify where it may have led to a poor outcome, a critical element of reflective practice. Studies have demonstrated that reflective practice can assist in the reduction of diagnostic errors, especially in complex and unique cases.^3,4 
• Managing Stress: OSCEs teach us to manage situations in a high-pressure environment. It forces us to not only study our content and questioning techniques, but to develop the abilities to think on our feet, manage the nervousness and anxiety, and  perform at a high standard. If we had unlimited time in the OSCE, we would be totally overwhelmed and underprepared when entering the workforce where we will be faced with multiple patients presenting with multiple problems at the same time.
• Showing the Grey: OSCEs also give us the opportunity to see the grey in pharmacy, as a typical grading scale ranges from “most optimal treatment option” resulting in high marks, to “unsafe or inadequate treatment leading to harm” resulting in failure. Such an approach demonstrates that in pharmacy practice there can often be multiple solutions to one problem, and many of them may not necessarily be unsafe. Seeing this grey challenges us as students to try and achieve the most optimal outcome.

As students continue to undertake OSCEs, the following elements are important for faculty to consider:

Focus on skills:

•  Faculty and students should focus on the skills that students gain from this assessment rather than on what grade they receive. In many cases, students focus more on what marks they received, and having faculty help remind us about the bigger picture can help us connect the dots better. 
• Another suggestion to shift student perspectives would be for faculty to mark cases with grades such as “optimal” and “consistent with pharmacy practice”, instead of giving a number grade. This way we, as students, are forced to acknowledge what skills we need to improve on and what lessons we have learned, rather than just on the numerical score . 

Introduce more room for reflective practice:

• Students may benefit from receiving real-time feedback on what worked and did not work both during their preparation and/or shortly after their assessment. This may be achieved through small facilitated focus groups held immediately after an OSCE or through surveys given after the assessment is complete.^1,2 
• By introducing such feedback, the OSCE  becomes a link for future development rather than just a grade to be achieved. Doing this on OSCE day means that preparation for the stations and performance are fresh in the student’s minds, so they can more accurately reflect.⁴
• These debrief sessions should be kept confidential between the students and assessors, so as to maintain the integrity of the case bank whilst ensuring that students are given the most comprehensive feedback possible.

Make cases real-world applicable:

• OSCE cases can be developed from incorporating relevant references (e.g. WHO) concerning medication errors and other frequently encountered scenarios in clinical practice in cases to reflect elements of real-life practice and create evidence-based OSCE stations. Students are then enabled to link these OSCEs to scenarios which are likely to occur in their careers, creating a more worthwhile experience holistically, and again creating more of an emphasis on overall understanding rather than grades. 

In practice this may be hard to achieve due to time and resource constraints, so how do we make sure OSCE assessments have built in aspects of these elements to enhance student learning?

Acknowledgements: Dr. Vivienne Mak of the Faculty of Pharmacy and Pharmaceutical Sciences of Monash University, Australia. 

References:

1. Awaisu A, Mohamed MH, Al-Efan QA. Perception of pharmacy students in Malaysia on the use of objective structured clinical examinations to evaluate competence. Am J Pharm Educ. 2007;71(6):Article 118. 

2. Rutter PM. The introduction of observed structured clinical examinations (OSCEs) to the MPharm degree pathway. Pharm Educ. 2001;1(3):173-180.

3. Mamede S, Schmidt H, Rikers R. Diagnostic errors and reflective practice in medicine. J Eval Clin Pract. 2006;13(5):138-145. 

4. Mamede S, Schmidt H, Penaforte JC.  Effects of reflective practice on the accuracy of medical diagnoses. Med Educ. 2008;42(5):468-475.

5. World Health Organisation. Medication Errors: Technical Series on Safer Primary Care. 2016.

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Pulses is a scholarly blog supported by a team of pharmacy education scholars