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Item type Presentation
Format Text-based Document
Title Use of Objective Structured Clinical Examination in aSenior Baccalaureate Nursing Course for Assessment ofEnd-of-Program Outcomes
Authors Marcyjanik, Diane Lynett; Johnson, Nita L.
Downloaded 11-Apr-2018 10:31:04
Link to item http://hdl.handle.net/10755/603125
Use of Objective Structured Clinical
Examination in a Senior
Baccalaureate Nursing Course for
Assessment of End of Program
Outcomes
Diane Marcyjanik, MSN, EdS, RN
Nita Johnson, MSN, RN
Presentation Objectives
1. Apply the use of OSCE
in an undergraduate
curriculum.
2. Identify the potential
use of OSCE for end
of program outcome
assessment.
Definition of OSCE
An observed examination of clinical skills
in a controlled simulated environment,
with the utilization of structured
checklists, simulators and standardized
patients.
(Jones, Pegram & Fordham, 2010; Meechan,
Jones, & Valler, 2011; Paul, 2010)
Basic Principles• Objective structured
assessment of clinical
skills
• A series of stations
• Predefined competencies
• Use of simulators or
standardized patients
• Students move between
stations at timed
intervals
Role of the ExaminerOSCE examiner (faculty) is an observer.
• Examiner does not ask questions
• Only observe performance behaviors and mark
the standardized checklist accordingly
• Some stations may require students to answer
written questions without observer present
Why OSCE?
• Healthcare industry acknowledged
students not ready for clinical practice (Kardong-Edgren, 2013)
• Highly adaptable to a variety of
competencies (Bartfay, 2004)
• Needed objective method to assess
clinical skills prior to graduation
• Clinical skills not objectively assessed
after first semester junior year
SPRING ‘13 FALL 2013 SPRING 2014 FALL 2014 SPRING 2015 FALL 2015Proposal to UGCC
Determine station numbertypes & timing
Pilot 1 held Pilot 2 held Pilot 3 cancelled
OSCE added to curriculum
Determine assessment areas
Prepare rubrics & debriefing
Debriefparticipants
Debriefparticipants
Begin logistical implementation
Debriefparticipants
Determine related clinical skills
Prepare directions for participants
Revise stations Decision to cancel Pilot 3
Select models & examiners
IRB Approval
Begin logistical implementation
Revise directions & debriefing
Revise stations
Select cohort, models & examiners
Develop electronic rubric
Revise rubrics,debriefing &
Logistical implementation
Revise directions forparticipants
Select cohort, models & examiners
Pilot 1
Pilot 2
Pilot 3
Final OSCE
Pilot Study
• Purpose: Two pilot studies were
conducted to implement OSCE in second
semester senior year.
• Methodology: Qualitative descriptive
• Framework: Experiential Learning Theory
(Kolb,1984)
• Scenario: Holistic and cultural diversity
Description• Orientation
• Station 1- Knowledge: Ten point quiz on wound healing
• Station 2- Psychomotor skill: Perform dressing change
– (mannequin- with voice over- standard set of responses)
• Station 3- Patient teaching: Homecare instructions for dressing change (standardized patient)
• Debriefing
Criteria For Passing OSCE
• Station 1 = 10 % of Total score
• Station 2 = 70 % of Total score
• Station 3 = 20 % of Total score
Must meet all Critical Behaviors
& achieve > 85 % of total points
Implementation of OSCE
• Rubrics developed for stations
– Adapted from previous courses
– Expert review
– Pilot 1: paper rubrics
– Pilot 2: electronic rubrics
• Faculty orientation
• Student preparation
– Pilot 1 & 2: list of content areas for OSCE
– Pilot 2: added orientation power point
Data Collection
• Student Scores
– Individual stations and overall score
• Survey
– Faculty and students completed online evaluation survey immediately following the OSCE
• Focus groups
– Faculty and students participated in discussion around OSCE
Combined Pilot Results
Station 1-passed writen
exam
Station 2-passed perf.
skills
Station 3-passed pt.teaching
Passed OSCE
Points 9 6 7 0
Critical Points 2 12
0
2
4
6
8
10
12
14
16
(N=17)
na
Survey Results: Students
Did you prepare for the OSCE?N = 16 YES NO A LITTLE
3 8 5
How did you feel before starting
the OSCE?N = 16 NERVOUS CALM & CONFIDENT
12 4
Survey Results: Students
How do you feel now that the OSCE is over?
N = 16 BETTER WORSE NERVOUS SAME
11 3 1 1
Do you feel that an OSCE would be a
beneficial method of testing skills
competency in the undergraduate nursing
program?
N = 16 YES MIXED FEELINGS
13 3
Survey Results: Faculty OSCE Support• “I am in full support of adding an OSCE to
every semester of the nursing program.”
• “I approve of beginning with an end-of-program OSCE and moving down through Senior 1 and Junior 2 semesters.”
• “…identify the best course in which to situate the OSCE each semester.”
Survey Results: Faculty Faculty Concerns regarding OSCE• “I'm not sure we have the resources to give
students opportunity to re-take OSCE's until they pass them.”
Electronic OSCE Rubrics• Easy to use
• Liked ability to write comments
• Reset automatically
Recommendations
• OSCE in week 1-2 of second semester senior year
• Conduct OSCE over 1-2 days (maximum)
• Student orientation
• Faculty orientation
• Use of electronic directions, rubrics, and evaluation tools
• Score 15 % of course grade
• Remediation plan
Remediation Plan
• Develop individualized remediation plan with OSCE team
Level 1
1 missed Critical Behavior and > 80 % of total points
• Practice and review specific content
• Retake station within 1 week
Level 2
>1 missed Critical Behavior and/or < 80 % of total points
• Practice and review entire content
• Retake entire OSCE within 6 weeks
ReferencesAdamson, K. A., & Kardong-Edgren, S. (2012). A method and resources for assessing the reliability of simulation evaluation instruments.
Nursing Education Perspectives, 33(5), 334-339.
Bartfay, W. J., Rombough, R., Howse, E., Leblanc, R. (2004). The OSCE approach in nursing education. Canadian Nurse, 100 (3), 18-23.
Bensfield, L. A.,Olech, M. J., & Horsley, T. L. (2012). Simulation for high-stakes evaluation in nursing. Nurse Educator, 37(2), 71-74.
doi: 10.1097/NNE.0b013e3182461b8c
Bultas, M. W., Hassler, M., Ercole, P. M., & Rea, G. (2014). Effectiveness of high-fidelity simulation for pediatric staff nurse education. Pediatric Nursing, 40(1), 27-42.
Jones, A., Pegram, A., & Fordham-Clark, C. (2010). Developing and examining and objective structured clinical examination. Nurse Education Today, 30, 137-141. doi:10.1016/j.nedt.2009.06.014
Kardong-Edgren, S. (2013). A wake up call…with an objective structured clinical examination. Clinical Simulation in Nursing,
9 (1), e3-e4. Retrieved from www.nursingsimulation.org/article/S1876-1399 (12)00356-8
Kirkman, T. R. (2013). High fidelity simulation effectiveness in nursing students' transfer of learning. International Journal of Nursing Education Scholarship, 10(1), 1-6. doi:10.1515/ijnes-2012-0009
Kirton, S., & Kravitz, L. (2011). Objective structured clinical examinations (OSCEs) compared with traditional assessment methods. American Journal of Pharmaceutical Education, 75(6), 1-7.
Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall.
McWilliam, P. L., & Botwinski, C. A. (2012). Identifying strengths and weaknesses in the utilization of objective structured clinical examination (OSCE) in a nursing program. Nursing Education Perspectives, 33(1), 35-39. doi:10.5480/1536-5026-33.1.35
Meechan, R., Jones, H., & Valler-Jones, T. (2011). Students' perspectives on their skills acquisition and confidence. British Journal of Nursing, 20(7), 445-450.
Paul, F. (2010). An exploration of student nurses’ thoughts and experiences of using a video-recording to assess their performance of cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination (OSCE). Nurse Education in Practice, 10, 285-290. doi:10.1016/j.nepr.2010.01.004
Diane Marcyjanik, MSN, EdS, RN
Clinical Assistant Professor
715-836-4012
Nita Johnson, MSN, RN
Skills/Simulation Lab Coordinator, Clinical Instructor
johnsnit @uwec.edu
715-836-5714