Experience of Conducting Objective Structured Clinical Evaluation (OSCE) in Malawi
ABSTRACT
In Malawi various nursing educational institutions have increased the enrollment of nursing students in order to respond to the rampant nursing shortage prevalent in the Malawian clinical settings. With this increase in intake, nurse educators are met with so many questions as to whether the nurses being trained are competent and fit for practice. To ensure that these nurses have appropriate competences, Objective Structured Clinical Evaluation (OSCE) has been embraced as a key strategy to evaluate student’s competence. The paper describes the lessons learnt from conducting OSCE to undergraduate student nurses at Kamuzu College of Nursing in Malawi. The paper considers the background and context of the school, the preparation of students, the formulation of OSCE tasks, recruitment of examiner and simulated patients and the evaluation of the OSCE. The paper concludes that OSCE can be a worthwhile valid strategy of teaching and assessing nursing students as long as it is properly designed. Nonetheless, profound commitment of all stakeholders involved is very vital.
In Malawi various nursing educational institutions have increased the enrollment of nursing students in order to respond to the rampant nursing shortage prevalent in the Malawian clinical settings. With this increase in intake, nurse educators are met with so many questions as to whether the nurses being trained are competent and fit for practice. To ensure that these nurses have appropriate competences, Objective Structured Clinical Evaluation (OSCE) has been embraced as a key strategy to evaluate student’s competence. The paper describes the lessons learnt from conducting OSCE to undergraduate student nurses at Kamuzu College of Nursing in Malawi. The paper considers the background and context of the school, the preparation of students, the formulation of OSCE tasks, recruitment of examiner and simulated patients and the evaluation of the OSCE. The paper concludes that OSCE can be a worthwhile valid strategy of teaching and assessing nursing students as long as it is properly designed. Nonetheless, profound commitment of all stakeholders involved is very vital.
Cite this paper
Munkhondya, T. , Msiska, G. , Chilemba, E. and Majamanda, M. (2014) Experience of Conducting Objective Structured Clinical Evaluation (OSCE) in Malawi. Open Journal of Nursing, 4, 705-713. doi: 10.4236/ojn.2014.410075.
Munkhondya, T. , Msiska, G. , Chilemba, E. and Majamanda, M. (2014) Experience of Conducting Objective Structured Clinical Evaluation (OSCE) in Malawi. Open Journal of Nursing, 4, 705-713. doi: 10.4236/ojn.2014.410075.
References
[1] Wellard, S., Bethune, E. and Heggen, K. (2007) Assessment of Learning in Contemporary Nurse Education: Do We Need Standardised Examination for Nurse Registration? Nurse Education Today, 27, 68-72.
http://dx.doi.org/10.1016/j.nedt.2006.04.002 [2] Rennie, A. and Main, M. (2006) Student Midwives’ Views of the Objective Structured Clinical Examination. British Journal of Midwifery, 14, 602-607.
http://dx.doi.org/10.12968/bjom.2006.14.10.21933 [3] Anderson, M. and Stickley, T. (2002) Finding Reality: The Use of Objective Structured Clinical Examination (OSCE) in the Assessment of Mental Health Nursing Students Interpersonal Skills. Nurse Education in Practice, 2, 160-168.
http://dx.doi.org/10.1054/nepr.2002.0067 [4] Mahara, M.S. (1998) A Perspective on Clinical Evaluation. Journal of Advanced Nursing, 28, 1339-1346.
http://dx.doi.org/10.1046/j.1365-2648.1998.00837.x [5] Bradshaw, A. (1997) Defining “Competency” in Nursing (Part 1): A Policy Review. Journal of Clinical Nursing, 6, 347-354.
http://dx.doi.org/10.1111/j.1365-2702.1997.tb00327.x [6] ICN (2009) ICN Framework of Competencies for the Nurse Specialist. International Council of Nurses, Geneva. [7] Australian Nursing & Midwifery Federation (2005) Australia National Competency Standards for Nurses in General Practice.
http://anmf.org.au/documents/reports/compstandards_nursesingp.pdf retrieved 11th May 2014 [8] Cowan, D.T., Norman, I.J. and Coopamah, V.P. (2005) Competence in Nursing Practice: A Controversial Concept—A Focused Review of Literature. Nurse Education Today, 25, 355-362.
http://dx.doi.org/10.1016/j.nedt.2005.03.002 [9] While, A.E. (1991) The Problem of Clinical Evaluation—A Review. Nurse Education Today, 11, 448-455.
http://dx.doi.org/10.1016/0260-6917(91)90007-W [10] Chapman, H. (1999) Some Important Limitations of Competency Based Education with Respect to Nurse Education: An Australian Perspective. Nurse Education Today, 19, 129-135.
http://dx.doi.org/10.1054/nedt.1999.0620 [11] Dolan, G. (2003) Assessing Student Nurse Clinical Competence: Will We Ever Get It Right? Journal of Clinical Nursing, 12, 132-141.
http://dx.doi.org/10.1046/j.1365-2702.2003.00665.x [12] Harden, R.M. (1988) What Is an OSCE? Medical Teacher, 10, 19-22.
http://dx.doi.org/10.3109/01421598809019321 [13] Roberts, C., Newble, D., Jolly, B., Reed, M. and Hampton, K. (2006) Assuring the Quality of High-Stakes Undergraduate Assessments of Clinical Competence. Medical Teacher, 28, 535-543.
http://dx.doi.org/10.1080/01421590600711187 [14] Walsh, M., Bailey, P.H. and Koren, I. (2009) Objective Structured Clinical Evaluation of Clinical Competence: An Integrative Review. Journal of Advanced Nursing, 65, 1584-1595.
http://dx.doi.org/10.1111/j.1365-2648.2009.05054.x [15] Bartfay, W.J., Rombough, R., Howse, E. and LeBlanc, R. (2004) The OSCE Approach in Nursing Education: Objective Structured Clinical Examinations Can Be Effective Vehicles for Nursing Education and Practice by Promoting the Mastery of Clinical Skills and Decision-Making in Controlled and Safe Learning Environments. The Canadian Nurse, 100, 18-25. [16] Mitchell, M.L., Henderson, A., Groves, M., Dalton, M. and Nulty, D.D. (2009) The Objective Structures Clinical Examination (OSCE): Optimising Its Value in the Undergraduate Nursing Curriculum. Nurse Education Today, 29, 398-404.
http://dx.doi.org/10.1016/j.nedt.2008.10.007 [17] Marshall, G. and Harris, P. (2000) A Study of the Role of an Objective Structured Clinical Examination in Assessing Clinical Competence in Third Year Student Radiographers. Radiography, 6, 117-122.
http://dx.doi.org/10.1053/radi.1999.0229 [18] Bujack, L., McMillan, M., Dwyer, J. and Hazelton, M. (1991) Assessing Comprehensive Nursing Performance: The OSCA, Part 2—Report of the Evaluation Project. Nurse Education Today, 11, 248-255.
http://dx.doi.org/10.1016/0260-6917(91)90086-P [19] Bramble, K. (1994) Nurse Practitioners Education: Enhancing Performance through the Use of the OSCE. Journal of Nursing Education, 33, 59-65. [20] Alinier, G. (2003) Nursing Students’ and Lecturers’ Perspectives of Objective Structured Clinical Examination Incorporating Simulation. Nurse Education Today, 23, 419-426.
http://dx.doi.org/10.1016/S0260-6917(03)00044-3 [21] Major, D. (2005) OSCEs—Seven Years on the Bandwagon: The Progress of an Objective Structured Clinical Evaluation Programme. Nurse Education Today, 25, 442-454.
http://dx.doi.org/10.1016/j.nedt.2005.03.010 [22] Nulty, D.D., Mitchell, M.L., Jeffrey, C.A., Henderson, A. and Groves, M. (2011) Best Practice Guidelines for Use of OSCEs: Maximising Value for Student Learning. Nurse Education Today, 31, 145-151.
http://dx.doi.org/10.1016/j.nedt.2010.05.006 [23] Wessel, J., Williams, R., Finch, E. and Gemus, M. (2003) Reliability and Validity of an Objective Structured Clinical Examination for Physical Therapy Students. Journal of Allied Health, 32, 266-269. [24] Rushforth, H.E. (2007) Objective Structured Clinical Examination (OSCE): Review of the Literature and Implications for Nursing Education. Nurse Education Today, 27, 481-490.
http://dx.doi.org/10.1016/j.nedt.2006.08.009 [25] Joy, R. and Nickless, L. (2008) Revolutionising Assessment in a Clinical Skills Environment—A Global Approach: The Recorded Assessment. Nurse Education in Practice, 8, 352-358.
http://dx.doi.org/10.1016/j.nepr.2007.11.001 [26] Jones, A., Pegram, A. and Fordham-Clarke, C. (2010) Developing and Examining an Objective Structured Clinical Examination. Nurse Education Today, 30, 137-141.
http://dx.doi.org/10.1016/j.nedt.2009.06.014 [27] Malawi Ministry of Health Annual Report (2011-2012). [28] Harrison, S. (2004) Overcrowded Placements Hinder Student Learning. Nursing Standard, 18, 7. [29] Tanner, C.A. (2006) The Next Transformation: Clinical Education. Journal of Nursing Education, 45, 99-100. [30] Watson, R., Stimpson, A., Topping, A. and Porock, D. (2002) Clinical Competence Assessment in Nursing: A Systematic Review of the Literature. Journal of Advanced Nursing, 39, 421-431.
http://dx.doi.org/10.1046/j.1365-2648.2002.02307.x [31] Boursicot, K. and Roberts, T. (2005) How to Set up an OSCE. The Clinical Teacher, 2, 16-20.
http://dx.doi.org/10.1111/j.1743-498X.2005.00053.x [32] Pender, F.T. and de Looy, A.E. (2004) The Testing of Clinical Skills in Dietetic Students Prior to Entering Clinical Placement. Journal of Human Nutrition and Dietetics, 17, 17-24.
http://dx.doi.org/10.1046/j.1365-277X.2003.00474.x [33] Byrne, E. and Smyth, S. (2008) Lecturers’ Experiences and Perspectives of Using an Objective Structured Clinical Examination. Nurse Education in Practice, 8, 283-289.
http://dx.doi.org/10.1016/j.nepr.2007.10.001 [34] Walters, J. and Adams, J. (2002) A Child Health Nursing Objective Structured Clinical Examination (OSCE). Nurse Education in Practice, 2, 224-229.
http://dx.doi.org/10.1016/S1471-5953(02)00024-0 [35] Khattab, A. and Rawlings, B. (2001) Assessing Nurse Practitioner Students Using a Modified Objective Structured Clinical Examination (OSCE). Nurse Education Today, 21, 541-550. [36] Barry, M., Noonan, M., Bradshaw, C. and Murphy, S.T. (2011) An Exploration of Student Midwives’ Experiences of the Objective Structured Clinical Examination Assessment Process. Nurse Education Today, 26, 115-122. [37] Furlong, E., Fox, P., Lavin, M. and Collins, R. (2005) Oncology Nursing Students’ Views of a Modified OSCE. European Journal of Oncology Nursing, 9, 351-359.
http://dx.doi.org/10.1016/j.ejon.2005.03.001 [38] Brosnan, M., Evans, W., Brosnan, E. and Brown, G. (2006) Implementing Objective Structured Skills Evaluation (OSCE) in Nurse Registration Programmes in a Centre in Ireland: A Utilization Focused Evaluation. Nurse Education Today, 26, 115-122.
http://dx.doi.org/10.1016/j.nedt.2005.08.003 [39] Zabar, S., Kachur, E., Kalet, A. and Hanley, K. (2012) Objective Structured Clinical Examinations: 10 Steps to Planning and Implementing OSCEs and Other Standardized Patient Exercises. Springer, Berlin. [40] Wass, V., Van der Vleuten, C., Shatzer, J. and Jones, R. (2001) Assessment of Clinical Competence. The Lancet, 357, 945-949.
http://dx.doi.org/10.1016/S0140-6736(00)04221-5 [41] Newble, D. (2004) Techniques for Measuring Clinical Competence: Objective Structured Clinical Examinations. Medical Education, 38, 199-203.
http://dx.doi.org/10.1111/j.1365-2923.2004.01755.x [42] Alinier, G., Hunt, B., Gordon, R. and Harwood, C. (2006) Effectiveness of Intermediate-Fidelity Simulation Training Technology in Undergraduate Education. Journal of Advanced Nursing, 54, 359-369.
http://dx.doi.org/10.1111/j.1365-2648.2006.03810.x
[1] Wellard, S., Bethune, E. and Heggen, K. (2007) Assessment of Learning in Contemporary Nurse Education: Do We Need Standardised Examination for Nurse Registration? Nurse Education Today, 27, 68-72.
http://dx.doi.org/10.1016/j.nedt.2006.04.002 [2] Rennie, A. and Main, M. (2006) Student Midwives’ Views of the Objective Structured Clinical Examination. British Journal of Midwifery, 14, 602-607.
http://dx.doi.org/10.12968/bjom.2006.14.10.21933 [3] Anderson, M. and Stickley, T. (2002) Finding Reality: The Use of Objective Structured Clinical Examination (OSCE) in the Assessment of Mental Health Nursing Students Interpersonal Skills. Nurse Education in Practice, 2, 160-168.
http://dx.doi.org/10.1054/nepr.2002.0067 [4] Mahara, M.S. (1998) A Perspective on Clinical Evaluation. Journal of Advanced Nursing, 28, 1339-1346.
http://dx.doi.org/10.1046/j.1365-2648.1998.00837.x [5] Bradshaw, A. (1997) Defining “Competency” in Nursing (Part 1): A Policy Review. Journal of Clinical Nursing, 6, 347-354.
http://dx.doi.org/10.1111/j.1365-2702.1997.tb00327.x [6] ICN (2009) ICN Framework of Competencies for the Nurse Specialist. International Council of Nurses, Geneva. [7] Australian Nursing & Midwifery Federation (2005) Australia National Competency Standards for Nurses in General Practice.
http://anmf.org.au/documents/reports/compstandards_nursesingp.pdf retrieved 11th May 2014 [8] Cowan, D.T., Norman, I.J. and Coopamah, V.P. (2005) Competence in Nursing Practice: A Controversial Concept—A Focused Review of Literature. Nurse Education Today, 25, 355-362.
http://dx.doi.org/10.1016/j.nedt.2005.03.002 [9] While, A.E. (1991) The Problem of Clinical Evaluation—A Review. Nurse Education Today, 11, 448-455.
http://dx.doi.org/10.1016/0260-6917(91)90007-W [10] Chapman, H. (1999) Some Important Limitations of Competency Based Education with Respect to Nurse Education: An Australian Perspective. Nurse Education Today, 19, 129-135.
http://dx.doi.org/10.1054/nedt.1999.0620 [11] Dolan, G. (2003) Assessing Student Nurse Clinical Competence: Will We Ever Get It Right? Journal of Clinical Nursing, 12, 132-141.
http://dx.doi.org/10.1046/j.1365-2702.2003.00665.x [12] Harden, R.M. (1988) What Is an OSCE? Medical Teacher, 10, 19-22.
http://dx.doi.org/10.3109/01421598809019321 [13] Roberts, C., Newble, D., Jolly, B., Reed, M. and Hampton, K. (2006) Assuring the Quality of High-Stakes Undergraduate Assessments of Clinical Competence. Medical Teacher, 28, 535-543.
http://dx.doi.org/10.1080/01421590600711187 [14] Walsh, M., Bailey, P.H. and Koren, I. (2009) Objective Structured Clinical Evaluation of Clinical Competence: An Integrative Review. Journal of Advanced Nursing, 65, 1584-1595.
http://dx.doi.org/10.1111/j.1365-2648.2009.05054.x [15] Bartfay, W.J., Rombough, R., Howse, E. and LeBlanc, R. (2004) The OSCE Approach in Nursing Education: Objective Structured Clinical Examinations Can Be Effective Vehicles for Nursing Education and Practice by Promoting the Mastery of Clinical Skills and Decision-Making in Controlled and Safe Learning Environments. The Canadian Nurse, 100, 18-25. [16] Mitchell, M.L., Henderson, A., Groves, M., Dalton, M. and Nulty, D.D. (2009) The Objective Structures Clinical Examination (OSCE): Optimising Its Value in the Undergraduate Nursing Curriculum. Nurse Education Today, 29, 398-404.
http://dx.doi.org/10.1016/j.nedt.2008.10.007 [17] Marshall, G. and Harris, P. (2000) A Study of the Role of an Objective Structured Clinical Examination in Assessing Clinical Competence in Third Year Student Radiographers. Radiography, 6, 117-122.
http://dx.doi.org/10.1053/radi.1999.0229 [18] Bujack, L., McMillan, M., Dwyer, J. and Hazelton, M. (1991) Assessing Comprehensive Nursing Performance: The OSCA, Part 2—Report of the Evaluation Project. Nurse Education Today, 11, 248-255.
http://dx.doi.org/10.1016/0260-6917(91)90086-P [19] Bramble, K. (1994) Nurse Practitioners Education: Enhancing Performance through the Use of the OSCE. Journal of Nursing Education, 33, 59-65. [20] Alinier, G. (2003) Nursing Students’ and Lecturers’ Perspectives of Objective Structured Clinical Examination Incorporating Simulation. Nurse Education Today, 23, 419-426.
http://dx.doi.org/10.1016/S0260-6917(03)00044-3 [21] Major, D. (2005) OSCEs—Seven Years on the Bandwagon: The Progress of an Objective Structured Clinical Evaluation Programme. Nurse Education Today, 25, 442-454.
http://dx.doi.org/10.1016/j.nedt.2005.03.010 [22] Nulty, D.D., Mitchell, M.L., Jeffrey, C.A., Henderson, A. and Groves, M. (2011) Best Practice Guidelines for Use of OSCEs: Maximising Value for Student Learning. Nurse Education Today, 31, 145-151.
http://dx.doi.org/10.1016/j.nedt.2010.05.006 [23] Wessel, J., Williams, R., Finch, E. and Gemus, M. (2003) Reliability and Validity of an Objective Structured Clinical Examination for Physical Therapy Students. Journal of Allied Health, 32, 266-269. [24] Rushforth, H.E. (2007) Objective Structured Clinical Examination (OSCE): Review of the Literature and Implications for Nursing Education. Nurse Education Today, 27, 481-490.
http://dx.doi.org/10.1016/j.nedt.2006.08.009 [25] Joy, R. and Nickless, L. (2008) Revolutionising Assessment in a Clinical Skills Environment—A Global Approach: The Recorded Assessment. Nurse Education in Practice, 8, 352-358.
http://dx.doi.org/10.1016/j.nepr.2007.11.001 [26] Jones, A., Pegram, A. and Fordham-Clarke, C. (2010) Developing and Examining an Objective Structured Clinical Examination. Nurse Education Today, 30, 137-141.
http://dx.doi.org/10.1016/j.nedt.2009.06.014 [27] Malawi Ministry of Health Annual Report (2011-2012). [28] Harrison, S. (2004) Overcrowded Placements Hinder Student Learning. Nursing Standard, 18, 7. [29] Tanner, C.A. (2006) The Next Transformation: Clinical Education. Journal of Nursing Education, 45, 99-100. [30] Watson, R., Stimpson, A., Topping, A. and Porock, D. (2002) Clinical Competence Assessment in Nursing: A Systematic Review of the Literature. Journal of Advanced Nursing, 39, 421-431.
http://dx.doi.org/10.1046/j.1365-2648.2002.02307.x [31] Boursicot, K. and Roberts, T. (2005) How to Set up an OSCE. The Clinical Teacher, 2, 16-20.
http://dx.doi.org/10.1111/j.1743-498X.2005.00053.x [32] Pender, F.T. and de Looy, A.E. (2004) The Testing of Clinical Skills in Dietetic Students Prior to Entering Clinical Placement. Journal of Human Nutrition and Dietetics, 17, 17-24.
http://dx.doi.org/10.1046/j.1365-277X.2003.00474.x [33] Byrne, E. and Smyth, S. (2008) Lecturers’ Experiences and Perspectives of Using an Objective Structured Clinical Examination. Nurse Education in Practice, 8, 283-289.
http://dx.doi.org/10.1016/j.nepr.2007.10.001 [34] Walters, J. and Adams, J. (2002) A Child Health Nursing Objective Structured Clinical Examination (OSCE). Nurse Education in Practice, 2, 224-229.
http://dx.doi.org/10.1016/S1471-5953(02)00024-0 [35] Khattab, A. and Rawlings, B. (2001) Assessing Nurse Practitioner Students Using a Modified Objective Structured Clinical Examination (OSCE). Nurse Education Today, 21, 541-550. [36] Barry, M., Noonan, M., Bradshaw, C. and Murphy, S.T. (2011) An Exploration of Student Midwives’ Experiences of the Objective Structured Clinical Examination Assessment Process. Nurse Education Today, 26, 115-122. [37] Furlong, E., Fox, P., Lavin, M. and Collins, R. (2005) Oncology Nursing Students’ Views of a Modified OSCE. European Journal of Oncology Nursing, 9, 351-359.
http://dx.doi.org/10.1016/j.ejon.2005.03.001 [38] Brosnan, M., Evans, W., Brosnan, E. and Brown, G. (2006) Implementing Objective Structured Skills Evaluation (OSCE) in Nurse Registration Programmes in a Centre in Ireland: A Utilization Focused Evaluation. Nurse Education Today, 26, 115-122.
http://dx.doi.org/10.1016/j.nedt.2005.08.003 [39] Zabar, S., Kachur, E., Kalet, A. and Hanley, K. (2012) Objective Structured Clinical Examinations: 10 Steps to Planning and Implementing OSCEs and Other Standardized Patient Exercises. Springer, Berlin. [40] Wass, V., Van der Vleuten, C., Shatzer, J. and Jones, R. (2001) Assessment of Clinical Competence. The Lancet, 357, 945-949.
http://dx.doi.org/10.1016/S0140-6736(00)04221-5 [41] Newble, D. (2004) Techniques for Measuring Clinical Competence: Objective Structured Clinical Examinations. Medical Education, 38, 199-203.
http://dx.doi.org/10.1111/j.1365-2923.2004.01755.x [42] Alinier, G., Hunt, B., Gordon, R. and Harwood, C. (2006) Effectiveness of Intermediate-Fidelity Simulation Training Technology in Undergraduate Education. Journal of Advanced Nursing, 54, 359-369.
http://dx.doi.org/10.1111/j.1365-2648.2006.03810.x