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Year : 2016 | Volume : 4 | Issue : 4 | Page : 220 - 223  


Original Articles
Nursing Students’ Perceptions on Objective Structured Clinical Examination (OSCE)

Khin Thandar Aung1, Anis Nur Al Basirah binti Zakaria2

1:Head, Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University, Malaysia.

2:Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University, Malaysia.

Corresponding Author:

Khin Thandar Aung

Email: khin_ta@iium.edu.my

ABSTRACT:

Background: Objective Structured Clinical Examination (OSCE) has been widely used in the assessment of students’ clinical performance. One of the strategies to improve the effectiveness is through assessing feedback from students on OSCE. These data are important to ensure the learning objectives of the OSCE are achieved besides to improve the effectiveness and to ensure it will be practicable in clinical settings.

Objective: This study aims to identify nursing students’ perceptions on OSCE.

Methodology: A cross sectional study using convenience sampling was conducted among 91 nursing students who have experienced in sitting OSCE in International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia.

Results: The findings showed that the majority of respondents (85.3 percent) has the positive perception on OSCE whilst 14.7 percent of respondents have the negative perception. For the association between socio-demographic and year of study and gender, it showed both have no significant association with the nursing students’ perception.

Conclusion: The majority of respondents was identified to have positive perceptions on OSCE. However, some of them have negative perceptions on OSCE. Thus, the relevant authorities should take a step to improve the quality of OSCE exam, as well as its accuracy and reliability. It is hoped that the OSCE will be one of the main assessment in IIUM and other health care courses at the other universities.

Keywords: OSCE, nursing students, perception

INTRODUCTION:

Objective Structured Clinical Examination (OSCE) has been widely used in the assessment of students’ clinical performance. Research reported that it is an effective evaluation tool for nursing students’ clinical skills and it also increases the confidence level of students in clinical field (Harden & Gleeson, 1979).

Every university and college has different assessment tools in assessing their students. International Islamic University Malaysia (IIUM) has implemented several methods in assessing students’ clinical performance including the OSCE. The students will customarily undertake the practical examination after their clinical posting for every semester on which the assessed skills correspond to the respective syllabus. The result from OSCE will help to determine and evaluate the students’ clinical competencies. This can be seen when the students’ abilities to select the necessary elements from their own inventory of resources and apply them to respective situations which will be reflected from their performance during OSCE. Nevertheless, (McWilliam& Botwinski ,2010) argued that the evaluation became one of the major challenges in nursing education because it is a reflection of students’ abilities to select the acquired elements from their entire range of skills used of resources and apply them to the specific situations.

At the same time, although previous research has documented that nursing students normally described their experience of undertaking OSCE as a useful practical experience for them and that the majority of them verbalized that OSCE is an acceptable and useful assessment tool to determine the nursing students’ clinical skills, there has been several studies whereby the students reported that OSCE is a very stressful event for them. As a result, they feel unable to perform like they did in the actual clinical settings. This is highly evidenced in a recent study who shared the students’ concern where OSCE can lead to stressful experiences and ineffective result for them.

Notwithstanding of the benefits of OSCE, students pointed out that OSCE put them under pressure. They verbalized of inability to perform well during the practical examination like they would do in actual clinical settings because of the pressure being observed by examiners with limited times allocated. Some students perceived that the OSCE was not a holistic examination as the patients used are not real patients; instead simulated patients or mannequins were used. These feedbacks may not be conclusive, yet it is vital in warranting OSCE as one of the effective ways to support student learning needs. Therefore, this study will focus on nursing students’ perceptions on OSCE. It is anticipated that this research is necessary to further enhance OSCE as the most effective tool in assessing students’ clinical skills and knowledge.

MATERIALS & METHODS:

Ethics: The research had been approved by Kulliyyah of Nursing Research Committee (KNRC) and International Islamic University Malaysia Research Ethics Committee (IREC).

Study Design: A cross-sectional study design was conducted at International Islamic University Malaysia (IIUM), Kuantan Campus among the students of the Bachelor of Nursing. The convenient sampling was selected involving the selected group who was volunteering to be the part of this research and those who meet the inclusion criteria set out at the onset of the study. The estimated sample size is 104 involving 50 students from year 3 and 54 students from year 4. The data collection was placed between February and March 2015. Once the permission was obtained, researcher requested the students whom meet the inclusion criteria to sign the consent form.

A questionnaire was adopted from previous study by Small L.F,et.al(2013) with minor modifications. Reliability of the questionnaire was checked and Chronbach’s alpha value was found to be satisfactory (0.9). The questionnaire consists of four parts: Part A (socio-demographic data), Part B (nursing students’ perceptions on before OSCE), Part C (nursing students’ perceptions during OSCE) and Part D (nursing students’ perceptions after OSCE).

The collected data were analysed by using IBM SPSS version 19.0 for Windows. Descriptive statistics and inferential statics were used. The data were categorized using four (4) Likert scales; 1: strongly disagree, 2: disagree, 3: agree, 4: strongly agree. The rating then was grouped together. There were two groups with ratings of 1 and 2 as negative perceptions, 3 and 4 as positive perceptions. 28 marks and below was categorized as negative while 28 to 56 marks was categorized as positive perceptions.

RESULTS:

The total number of respondents that willingly to participate in this study was 91 out of 104 among year 3 and year 4 nursing students which the response rate was 87.5 %. All respondents were categorized according to the year of study, year of OSCE and gender.

The socio-demographic data of the respondents is presented in Table I. Respondents from year 3 were 48 respondents (52.75%) and respondents from year 4 were 43 respondents (47.25%). For gender categories, female respondents were higher than male respondents. Female respondents were 73 (80.22%) while male respondents were 18 (19.78%).

Table I: Socio-demographic data for respondents (n=91)

Variable

Frequency (n)

Percentage (%)

Year of Study

Year 3

Year 4

 

 

48

52.75

43

47.25

Gender

Male

Female

   

18

19.78

73

80.22

Table II: Perception based on gender

 

Perception

Total

Negative

Positive

Gender

Female

Count

3

70

73

% within Gender

4.1%

95.9%

100.0%

Male

Count

0

18

18

% within Gender

.0%

100.0%

100.0%

Total

Count

3

88

91

 

Table III: Perception based on year of study

 

Perception

Total

Negative

Positive

Year of Study

3

Count

0

48

48

% within YOStudy

.0%

100.0%

100.0%

4

Count

3

40

43

% within YOStudy

7.0%

93.0%

100.0%

Total

Count

3

88

91

% within YOStudy

3.3%

96.7%

100.0%

The perception of nursing students on OSCE was shown in table II and III. It was analyzed according to the gender and year of study. For gender, there were 3 (4.1%) female respondents being labeled as negative perceptions category, while 70 (95.9%) female respondents as the positive perceptions category. For male respondents, there was none of them being labeled as negative perceptions category, while 18 (100.00%) male respondents as the positive perceptions

category. Overall, there were 3 (3.3%) has negative perceptions and 88 (96.7%) has positive perceptions. The data analysis for nursing students’ perceptions according to year of study (year 3 and year 4) found out that 100% from year 3 have positive perceptions and 93% of year 4 has positive perception and 7% has a negative perception on OSCE. The nursing students’ perception was divided into 3 parts; pre OSCE, during OSCE and post OSCE and shown in Table IV, V and VI.

Table IV: Nursing Students’ Perceptions: Pre OSCE

Variable

Frequency (n)

Percentage (%)

Information and preparation provided by the lecturer are enough

   

Negative

13

14.3

Positive

78

85.7

Individual preparedness is well

 

 

Negative

34

37.4

Positive

57

62.6

Perceived level of stress experience

   

Negative

16

17.6

Positive

75

82.4

Table V: Nursing Students’ Perceptions: During OSCE

Variable

Frequency (n)

Percentage (%)

The perceived atmosphere at the OSCE stations is good

   

Negative

27

29.7

Positive

64

70.3

The extent and quality of information received at the OSCE are good

   

Negative

17

18.7

Positive

74

81.3

Time allowed for reading instructions is enough

   

Negative

36

39.6

Positive

55

60.4

Time allowed for the completion of the procedures is enough

   

Negative

54

59.3

Positive

37

40.7

The equipment and scenarios given are realistic, relevant and logistic

   

Negative

9

9.9

Positive

82

90.1

Examiners are courteous, friendly and cooperative

   

Negative

28

30.8

Positive

63

69.2

DISCUSSION:

There were more than half of the nursing students in IIUM had a positive perception on OSCE. Concerning the perception of pre OSCE, the majority of students felt satisfied with the information and preparation provided by the lecturers prior to the examination so that they can plan well. They also mentioned that briefing about the topic and objectives of the OSCE are needed. A previous study also showed the participants had a positive perception on individual preparedness before sit for OSCE (Nulty, et al, 2011).This indicates that most of the students will have their own preparation before to sit for

Table VI: Nursing Students’ Perceptions: Post OSCE

Variable

Frequency (n)

Percentage (%)

Procedures given in OSCE are applicable during clinical posting

   

Negative

9

9.9

Positive

82

90.1

Confidence to conduct a similar procedure on a real patient is high

   

Negative

22

24.2

Positive

69

75.8

Student perceptions on OSCE results

   

Negative

14

15.4

Positive

77

84.6

Continue the way OSCE was conducted as a practical examination in the future

   

Negative

14

15.4

Positive

77

84.6

OSCE helped students to identify their deficiencies in clinical skills

   

Negative

8

8.8

Positive

83

91.2

examination. The term well prepared also can be differ for each student. However, if they expressed well, then it means they were ready to sit for examination. Regarding the feeling of stress during OSCE exam, most of the students felt OSCE was stressful. There are few factors lead to stressful among the students including inadequate prior guidelines, inadequate time allocation forstations and the newness of the assessment format (El-nemer, et.al 2009). OSCE is a live examination when students need to perform what they had been doing in the wards. The fact that they feel stressed before OSCE is supported because they did not know which procedures will be tested and who will be their examiners (Selim, et.al 2012). After OSCE, most of the students are expected to have confidence or increase their level of confidence to perform similar procedures on a real patient. In the clinical setting, ward, and clinic or outside field, there are a lot of procedures that cannot be performed by students. Sometimes, they cannot perform because of their lack of competency, high risk of procedures or there are even no chances for them to perform because there is no such case. OSCE helps them by providing some of cannot-do procedures in a clinical setting to be assessed in the OSCE. Students should be gratitude to practice such procedures. Besides that, there are some procedures in clinical setting always did by them, but with wrong or short cut ways. OSCE helps them to practice the common procedures in a correct practice. Last but not least, a majority of participants agreed that OSCE has helped them to identify their deficiencies in clinical skills and corrected because they are times they unable to perform in the way they are learned. In OSCE, they have to perform, by hook or by crook, exactly to what they all learned, not they practiced in a clinical setting. Thus, this gives their chances and gold opportunities to identify their incompetency, they are lacking in skills in order to improve later. Limitations for the study were: This study was conducted with small sample size and convenience sampling method. Hence, the results cannot be generalized to all students who are studying in health care professionals. It is recommended that there is needed to conduct on large sample and different sampling method.

CONCLUSION:

In nursing education, most of the universities and college used OSCE exam to prepare the students with confidence before clinical posting and also get ready to produce qualified nurses who are skillful and knowledgeable. According to this study, it is highlighted that further enhancement of the OSCE is needed as it is the most essential tool in assessing students’ clinical skills and knowledge.

REFERENCES:

  1. Alinier, G. (2003). Nursing Students’ And Lecturers’ Perspectives Of Objective Structured Clinical Examination Incorporating Stimulation. Nursing Education Today, 23, 419-426.
  2. El-nemer, A., Kandeel, N., Care, C., & Departments, N. (2009). Using OSCE as an Assessment Tool for Clinical Skills: Nursing Students’ Feedback. 3(3), 2465–2472.
  3. Harden, R & Gleeson, F (1979), Assessment of Medical Competence using an Objective Structured Clinical Examination, Medical Education, 13(1), 41-54.
  4. McWilliam, P., & Botwinski, C. (2010). Developing A Successful Nursing Objective Structured Clinical Examination. The Journal of Nursing Education, 49(1), 36–41.
  5. Nulty, D. et al (2011) Best Practice Guidelines For Use Of Osces: Maximising Value For Student Learning. Nurse Education Today; 31: 2, 145-151.
  6. Selim, A.A., Ramadan, F.H., El-Gueneidy, M.M., Gaafer, M.M., (2012). Using Objective Structured Clinical Examination (OSCE) in Undergraduate Psychiatric Nursing Education: Is it Reliable and Valid? Nurse Education in Practice. 32(2), 283-288.
  7. Small, L.F., Pretorius, L., Walters, A., Ackerman, M. & Tshifugula, P., (2013),Students’Perceptions Regarding the Objective, Structured, Clinical Evaluation as an Assessment Approach’, Health SA Gesondheid 18(1): 629,8.




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