|Year : 2014 | Volume
| Issue : 1 | Page : 23-27
|Introduction of objective structured clinical examination (OSCE) in dental education in India in the subject of oral medicine and radiology
Rahul Bhowate1, Arati Panchbhai2, Sunita Vagha3, Suresh Tankhiwale4
1 Prof, Dept of Oral Medicine and Radiology, M.Sc in Health Professions Education, SPD College, Sawangi-M, DMIMS(DU), Wardha, Maharastra, India
2 Assoc. Prof. Dept of oral Medicine and Radiology, M.Sc in Health Professions Education, SPD College, Sawangi-M, DMIMS (DU), Wardha, Maharastra, India
3 Incharge, Nodal Centre, Dept of Gen Pathology, JN Medical College, Sawangi-M, DMIMS (DU), Wardha, Maharastra, India
4 Director, School of Health Professions Education, Dept of Gen Medicine, JN Medical College, Sawangi-M, DMIMS (DU), Wardha, Maharastra, India
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|Date of Web Publication||17-Oct-2014|
| Abstract|| |
Objectives: The learning-assessment relationship is an integral part of educational process, its main purpose is to optimize learner`s abilities which can be achieved through the implementation of Objective Structured Clinical Examination as an assessment tool. The present study is undertaken with the aim to introduce an Objective Structured Clinical Examination in the faculty of dentistry for the subject of oral medicine and radiology and to obtain the perception of participants about it.
Materials and Methods: The study involved 65 final year dental students and faculties from Oral Medicine and Radiology. The self-administered questionnaire and feedback forms were given to the students to record their responses. Descriptive analysis and factor analysis were used to identify key factor among the different Objective Structured Clinical Examination items.
Results: The results revealed the strong consensus in favor of Objective Structured Clinical Examination. The factor analysis extracted 2 key components i.e. "I understand the aims and objectives of the Objective Structured Clinical Examination" and "it tested my diagnostic clinical skill" as significant.
Conclusion: The present article suggests that inclusion of Objective Structured Clinical Examination in the formative and summative examination would be beneficial. It is recommended that the pilot study should be carried out for the selected model of objective structured clinical examination before being implemented as an assessment tool.
Keywords: Assessment tool, competence, objective structured clinical examination
|How to cite this article:|
Bhowate R, Panchbhai A, Vagha S, Tankhiwale S. Introduction of objective structured clinical examination (OSCE) in dental education in India in the subject of oral medicine and radiology
. J Educ Ethics Dent 2014;4:23-7
|How to cite this URL:|
Bhowate R, Panchbhai A, Vagha S, Tankhiwale S. Introduction of objective structured clinical examination (OSCE) in dental education in India in the subject of oral medicine and radiology
. J Educ Ethics Dent [serial online] 2014 [cited 2020 Jun 5];4:23-7. Available from: http://www.jeed.in/text.asp?2014/4/1/23/143169
| Introduction|| |
Assessment is an essential part of the teaching-learning process, it aids in the professional development of all healthcare personnel and also in the continuous improvement of the institutions.  The learning-assessment relationship is an integral part of learning process, its main purpose is to optimize learner`s abilities, additionally it provides motivation and guidance for future learning and development. , Hence, considering assessment as a part of the training process, both the learning and assessment should focus on the competences to be attained by learner in the end. ,, This can be achieved through the implementation of Objective Structured Clinical Examination (OSCE) as an assessment tool in the formative examinations that are conducted periodically throughout the year in our university. ,,,,
The literature reveals that the OSCE is in vogue and taking good shape in the medical curriculum however, it is been relatively recently introduced in dentistry. ,,, and is yet a novel concept in most of the areas for the faculty of dentistry.
During the OSCE, students rotate around a series of stations on a timed basis; each station is associated with the direction of the task to be performed by student. At the ring of a bell, each student enters the station and performs the predefined task at predetermined time which is usually 5 min per station.  OSCE stations may be interactive or non-interactive. ,,, Non-interactive stations involve written answers to specific tasks or problems that do not require a direct observation and are usually marked after the examination.  While interactive stations assess different clinical competencies such as history taking, interpretation of clinical data, performing clinical tasks or solving a problem.  A student is observed and evaluated by a trained examiner using prepared checklist.
The number of OSCE stations may vary from 15 to 20 depending upon the number of students to be covered in each OSCE session, the increased number of the stations allows for the content variety, thereby enhances the reliability of the assessment.  OSCE brings uniformity in the examination as well as improves reliability and validity of assessment. It is one of the assessment methods which may also include feedback. 
The distinct advantages of OSCE encouraged us to introduce Objective evaluation system in the subject of Oral Medicine and Radiology.
The present interventional study is undertaken with the aim to introduce Objective Structured Clinical Examination in the Department of Oral Medicine and Radiology in line with traditional curriculum followed by obtaining participants' view in regards to OSCE.
The various objectives of the study were as follows:
- To assess the perception of final year dental students about the OSCE component of formative examination in Oral Medicine & Radiology.
- To assess the perception of students about procedure stations of OSCE.
- To assess overall response about conduction of OSCE.
| Materials and Methods|| |
The ethical committee approved non-randomized interventional study was carried out in the Department of Oral Medicine and Radiology.
The study involved 65 final year dental students and faculties from Oral Medicine and Radiology. Students who volunteered their participation were included in the study. At the outset, the consent was obtained from the study participants and they were explained the goals and objectives of the study. Students were given briefing sessions before the OSCE, associated concerns and queries were addressed.
The self-administered questionnaire consisting of 7 items were given to the students to record their response. The students were also asked to rate their responses on a standardized 5-point Likert type scale. The students were supposed to grade each item using following scoring system. (5-SA = strongly agree, 4-A= agree, 3-N = neutral, 2-D= disagree, 1-SD= strongly disagree). They were also asked to rate the conduction of OSCE on 10-point scale. P. A. Mossey (2001) OSCE evaluation questionnaire was adopted in this study with addition of few items.
Training of faculty and students
All the staff received training on OSCE before the actual conduction of OSCE by the Department of Medical Health Professions Education. The training package was prepared for students before going through the OSCE. In the beginning of the training session, students received an orientation about the nature of the OSCE and the process of conduction of the examination.
Preparation and administration of OSCE
Total 07 OSCE stations were prepared by the faculty of Oral medicine and Radiology. These include 3 Procedural stations, 2 Question stations and 2 Analytical/Clinical Reasoning stations. One rest station was built into the schedule of OSCE, all OSCE stations were standardized and each was of 5 min duration. For each station, separate OSCE sheet was prepared with appropriate instructions. Observation checklists were prepared for clinical procedures. The OSCE was prepared to cover the items included in the response questionnaires. The OSCE was carried out in three consecutive days because of the limited number of patients trained to perform a role for procedural stations. Before starting the OSCE, one of the examiners read the instruction to the students. The students were informed to demonstrate clinical knowledge, psychomotor and communication skills for procedural stations.
A standardized marking system using a Rubric test was used for marking all OSCE answer booklet.
Collecting participants feedback
Immediately after the OSCE, all participants were handed over the questionnaire to obtain the feedback about OSCE.
Data were analyzed using the SPSS-version17.0, the obtained results were tabulated. Descriptive analysis was performed in this study including frequencies and percentage, and the factor analysis was used to identify key factor among the different OSCEs items. The validity of factor analysis was tested by Kaiser-Meyer-Olkin (KMO) test and Bartlett's test. Chi-square and P-value were also calculated for statistical significance.
| Results|| |
[Table 1] outlines the results of the questionnaires in response to questions 1 to 7. This reveals strong consensus in favor of OSCE evaluation method. Moreover 36.9% (24) rated the conduction of OSCE at 8 on 10-point scale. Coefficient of variance [Table 2] showed consistently low variation of 13.22 in relation to, 'I understand the aim and objective of OSCE' whereas 21.27 coefficient of variance noted in relation to the 'OSCE covered the wide range of skills' in dental discipline. Sampling adequacy was tested and found to be significant (P < 0.000). Factor analysis extracted the two key components, i.e. "I understand the aims and objectives of the OSCE" and "the OSCE tested my diagnostic clinical skill." [Table 3] The identified 2 key components ranked the `diagnostic clinical skill, operative clinical skill and I need to learn more along with communication skill` at higher level, thus showing greater loading or weightage for these factors. This finding showed its stronger association of OSCE with clinical component [Table 3].
|Table 2: Descriptive analysis showing median percentile and average score on the basis of total score of perception|
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|Table 3: Association between determinants of OSCE with extracted component|
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| Discussion|| |
The observations in the present study were quite rewarding and were in favor of implementation of OSCE in dental curriculum. The higher loading of the extracted 2 key components, i.e. "I understand the aims and objectives of the OSCE" and "the OSCE tested my diagnostic clinical skill." to `diagnostic clinical skill, operative clinical skill, I need to learn more and communication skill` suggested that greater the understanding of aims and objectives better would be the learning gain in terms of achieving the clinical competencies and the communication skill. It also pointed out that the OSCE leads to learning as well as assessment of various clinical skills.
OSCEs were first developed for medical students in 1975.  The OSCE is defined as an approach to the assessment of clinical competence in which the components of competence are assessed in a well planned or structured manner with attention being paid to objectivity. 
The ultimate educational objective to be achieved is to yield a competent performer, which needs the assessment of cognitive, psychomotor and affective skills of the learner.  This warrants the incorporation of a range of procedures and skills available to obtain information about students learning and to develop value judgments on their progress.  Generally, traditional lecture-centered curricula promote a reproductive way of learning and the assessments are oriented to these, which are usually summative written or practical/clinical examinations that primarily assess the reproductive or superficial knowledge. , While the aim should be to promote the reflective thinking among dental students. This aspect will be taken care by incorporating OSCE as an assessment tool on regular basis and the assessment methods should be selected accordingly. 
Interactive stations may use "a standardized patient" that can reduce students' as well as patients` stress and promote a more comfortable environment for learning and evaluation. ,, In OSCE, each student has to perform or solve the same specific tasks thereby it reduces bias and thus offers the greater degree of objectivity and uniformity than traditional clinical examinations. The assessment and valuation of the performance is based on specific predetermined criteria agreed upon by the participating examiners thereby inter-examiner and inter-case variability is decreased and the reliability of examination is further enhanced. 
The strength of OSCE lies in its ability to evaluate a wide range of knowledge and skills which improves the reliability of the examination.  The various skills for which students are evaluated include interpersonal communication skills, problem-solving abilities, teaching and assessment skills and decision making skills. ,,,, Within OSCE, reliability is also based upon the interaction among students, standardized patients and assessors.  Another advantage of OSCE is related to the flexibility of the individual component of the stations which can take the form of small scenarios, simulations, case studies, multiple choice questionnaires or short theoretical questions.  Thus it provides an innovative learning experience for students.  It offers a valid means to evaluate students' clinical performance in a holistic manner. 
In addition, OSCE can be linked to feedback practices, it is very well suited as a mean to give feedback to the students thereby enabling learners to reflect upon and improve their abilities. ,, A key element in developing reflective thinking is learning to assess the quality of a performance in a clinical as well as in a theoretical context. Students should be competent enough to do self-assessment of their own abilities in order to identify possible ways of improving their performance.  In consequence, it will provide stimulus for the lifelong self-directed learning. ,,
The existing flaws in the conventional examinations such as variability in the assessment questions and tasks among the students, difference in marking, bias and lack of uniformity, objectivity and content validity can be overcome by adopting OSCE. A good assessment of learner should include both clinical skills and factual knowledge; therefore an OSCE should be complemented by other methods of evaluation. 
OSCE is introduced relatively late in dentistry as compared to that being widely used in the medical profession to assess the clinical competence. This article suggests that inclusion of OSCE in the formative and summative examination would be beneficial; it will lead to better achievement of the learning goals. The efforts should be made to continue the development of the OSCE for evaluation in dental education.
| Conclusion|| |
The students' evaluation of OSCE was encouraging in the present study. The factor analysis identified the key items which rank the remaining items as closely associated with assessment of clinical competence and communication skill at higher level. Because of multifaceted set-up of OSCE stations and immediate feedback, the OSCE is considered as a suitable tool to promote reflective thinking in student. We recommend the incorporation of OSCE as part of the overall evaluation scheme in other clinical departments, but with caution where invasive operative clinical procedures are involved. Continuing staff development programs in the form of short-term training on planning, conduction and evaluation techniques could greatly help to refine the process of evaluation using OSCE.
However, there cannot be a uniform model of OSCE; it is needed to be planned as per the objectives to be achieved. In view of this, the nature and number of the stations will have to be devised accordingly. It is believed that usefulness of assessment methods is closely related with its acceptance by evaluators and students, the resources available, investment needed and their reliability and validity of assessment tool. , It is recommended that the selected model be piloted before being implemented as an assessment tool.
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Prof, M Sc in Health Professions Education, SPD College, Dept of Oral Medicine & Radiology, Sawangi-M, Wardha - 442 001, Maharastra
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]
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