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Authors: Ukadike, Okugbo Stanley
Agbonrofo, Peter
Omorodion, Irowa
Issue Date: 2011
Publisher: Department of Surgery, School of Medicine, University of Benin, Benin City.
Abstract: The objective structured clinical examination is the most common way of assessing the clinical skill and proficiency of medical students. From its humble beginnings in 1974 by Harden et al, it has gained traction worldwide in medical students’ assessment and clinical competency training. It has undergone various modifications and alterations and has been domesticated in medical schools worldwide. Where it was first introduced it has slowly gained ground to become the main method of clinical assessment of medical students. Its main attraction has been its objectivity and versatility in testing clinical competency whilst retaining excellent reliability. However, it is tedious to plan, design and effect. Logistics involved are extensive and test the intellectual, pedagogical, commitment, versatility and physical energies of the examiners. It also enjoys the use of various objects, devices and software in creating clinical scenarios to enhance the clinical experience whilst enabling the extinguishing of harm to patients or subjects in the controlled environment that it provides. In the University of Medical School, the department of surgery was the first to use it as a means for final examination. This followed its introduction in 2011 to the end of clinical surgical clerkship of the 400Level students in that year. It has since come to supplant the traditional examination model of the long case and short case. This year marks the fifth year of its introduction and thus this study was designed to evaluate it using a student based assessment. Materials and Methods This is a cross sectional survey of final year medical students undergoing the part V examinations in Surgery. The study population is the 600level medical students who were undergoing the final MBBS Surgery examination using the OSCE. There was no attempt made at stratification nor at randomization. The research instrument used was a questionnaire which was designed by the authors to assess the medical students’ assessment of the OSCE Examination and its processes. The questionnaire had face and content validation by examiners in the department of surgery. There were 102 medical students in the class, and all of them were approached by the authors and given the questionnaire to fill. All students who presented themselves during the period of the examination were asked to fill the questionnaire which was self-administered. The questionnaires were immediately collected by the authors and collated into excel spreadsheets. The data was then analysed using the SPSS version 21 and the results presented in tables, charts. Results A total of 79 completed questionnaires were retrieved. This had a return rate of 78%. All the students agreed that they knew about OSCE and had participated in one previously, however only 94.9% accorded the OSCE a fair examination. In terms of desirability of the OSCE, 76(93.2%) wanted the examination as the main method of clinical assessment though only 38() accepted to have had adequate preparation for the examination. Concerning the comprehensiveness of the scope of the OSCE, 41 students agreed and 23 strongly agreed. In terms of the OSCE stations not mirroring real clinical scenarios, 38 disagreed, and 26 strongly disagreed. Most of the students 32 agreed that the timing of each OSCE station was too short whereas 26 students disagreed. The logistics for the examination was highly rated with 34 disagreeing that the logistics was poor but 20 were unsure. The students rating of the OSCE gave a mean score of >8 for spread of the OSCE stations, detail of the questions and objectivity of the examination. However, clarity of the questions had a mean score of 6.99 and difficulty of the question was 6.86. The ease of answering the question was rated with a mean score of 5.54 The nearness to clinical reality was rated as 7.52 with artificiality of the stations rated as 4.12. The duration of the station had a mean score of 6.23 whilst the ease of guessing the right answers had a mean score of 3.93. Most of the students 53, could not proffer any station that should be added to the OSCE. Most of the students 48 had no station they wished removed with the oral examination and history stations being the station that 8 students wished removed. The main suggestions were More exposure of the students to OSCE preparation 10; improvement in the objectivity 9; improvement in the logistics 8; longer duration of the stations and clarity of the pictures had 7 each; 4 students suggested more training of the simulators and 2 suggested improvement in the station design. Conclusion Five years after commencement of the OSCE as the main means of the final MBBS Surgery examination, the medical students have given a fairly favourable assessment of its use with the main challenge being students’ preparation for the OSCE mode of examination and changes being suggested in improvement in logistics.
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