OSCE in Pathology
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Monika Gupta
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Email: monikagupta0703@gmail.com
Introduction
The conventional methods of clinical and practical examination do not test the clinical / psychomotor skills, attitude, and communication skills, as the skill domain is difficult to test by such methods.
To overcome these fallacies, a specific type of test, called Objective Structured Clinical Examination (OSCE) has been devised. The examination is organized in the form of several stations through which the candidates are made to rotate till a cycle is completed. Number of stations can vary depending on the type of skill being tested, each with a definite time period. Each station focuses on testing a particular skill, including history taking, general examination, systemic examination, specific elicitible clinical signs etc. Depending of their significance in a particular case / topic, weightage points are predetermined and examinees assessed by awarding them the proportionate marks. Also, teachers provide feedback to the students according to the performance of the formative assessment at the individual level.1
When a student is given a task that involves doing an experiment / practical or performing procedures in a laboratory, OSCE is labeled as Objective Structured Practical Examination (OSPE), described by Harden in detail in 1979.2 The process can be applied to paraclinical specialties like pathology or any subspecialty of pathology. Typical stations can be devised depending on the subspecialty to be tested. For example, in hematology, a questionnaire may be set for judging the procedure of making blood smears:
1. Does the candidate clean the slides properly? 2. Does he place a drop of blood on slide at the proper place? 4. Does he spread out drop quickly with a proper angle and evenly along the contact? 5. Does he make smooth tongue shaped tail end? 6. Does he correctly dry the slide? 7. Does he properly label the slide? Similarly, if we want to assess the method of examination of peripheral smears, the questionnaire may be framed as:
1. Does he choose the best area for differential counts? 2. Does he evaluate the quality of smear ? 3. Does he examine the morphology of all the cells? 4. Does he examine the back and forth,length and sidewise? A similar test can be devised for protein estimation in routine urine examination:
1. Does he take a urine sample upto the optimal level of the test tube? 2. Does he boil upper one third of the column? 3. Does he add 2 to 3 drops of 2% acetic acid? 4. Does he compare change in the top layer with the bottom layer of urine?
Likewise, for assessment of histopathology, a test may be devised to assess the accurate recognition of the organ, specific diagnosis, associated findings, clinical correlation etc.
Overall aims of application of OSPE methods in pathology include judging the choice of laboratory tests, interpretation of data, and appropriate selection of clinical responses to test results.3 The specific objectives may be: i) to assess the subject wise course content coverage in the new curriculum, ii) to assess different examination system for evaluation of students, iii) to evaluate the effectiveness of teaching and learning activities under the curriculum, iv) to explore students opinions regarding improvement of new curriculum.1
1. Hussain MM, Talukder HK, Moazzem N, Rashid A, Hanif A, Nargis T. Evaluation of existing curriculum (2002) of undergraduate medical education in Bangladesh. Mymensingh Med J 2011;20(2):226-32. 2. Harden RM, Gleeson FA. Assessment of clinical competencies using an objective structured clinical examination (OSCE) In: ASME Medical Education Booklet No. 8. Dundee: ASME;1979. 3. Benbow EW, Harrison I. Pathology and the OSCE: insights from pilot study. J Pathol 1998;184(1):110-4.
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