INTRODUCTION
Globally, radiography
education has undergone enormous changes in order to produce a more effective
teaching and clinical assessment methods (Pascual et
al., 2011). These changes are evident in the curriculum, teaching methods, and
even assessment methods (Sluming, 1996). An example
is the development of a Bachelor’s degree curriculum and transformation from
the diploma curriculum in Nigeria. Most of these changes are however not unique
to the radiography department alone, but rather, they appear as a response in
the cycle of the re-engineering process in medical teaching and even healthcare
(England, 2018). Boggis et al. (2010)
described the need for students to participate in different clinical settings
to practise radiography, and recommended that experienced radiographers should
be involved in the clinical practice as they offer an important teaching
resource. The Objective Structured Clinical Examination (OSCE) is one of those
methods which have evolved as an assessment method of the clinical skills of
the students and involve several structured clinical evaluation sessions (Almohiy and Davidson, 2011).Objective Structured Clinical
Examination (OSCE) has been widely used and increasingly being used since it
was developed. Research has shown that it is an effective evaluation tool to
assess practical skills (Sloan et al. 1995). In many instances, the OSCE
process has been adapted to test students from different healthcare related
disciplines (Guillaume,
2013).
In assessment of the
theoretical knowledge, multiple choice questions (MCQs) and written essays are
usually employed while for clinical skill assessment, long cases and short
cases are traditionally employed alongside with observation of practical
activities and viva (Agarwal et al., 2010).
Internationally, some universities, especially in the European, Asian and North
American continents, have introduced the use of Objective Structured Clinical
Examination (OSCE) in their assessment methods. Other methods of assessment
include: worksheets, written assignments, oral and poster presentations,
research exercises and self-reflective statements (Agarwal
et al., 2010). Clinical assessment methods are holistic approaches and
systematic methodologies for making inferences about the learning and
development of students, a process by which teachers judge whether the learning
outcomes of the courses are met (Agarwal et al.
2010). Generally, student’s assessment
helps in identifying the deficiencies in the students’ knowledge and the
lacunae in the training program.
Shailesh, (2011) defined Objective Structured Clinical Examination
(OSCE) as ‘an established, reliable, and effective multi-station test for the
assessment of practical professional skills in an objective and transparent
manner’. It was introduced by Harden et al. (1975) in a Scottish medical school
in order to avoid the many disadvantages of the traditional method of
assessment of clinical skills and since then, it has found increasing
acceptance in several medical disciplines chiefly because of its objectivity in
assessment. Internationally, since Harden et al. (1975) introduced OSCE,
several universities have adopted it as a form of assessment in their health –
related departments. In Nigeria, it has been formally adopted by the nursing,
medical and dental councils and is being used by several universities including
Nnamdi Azikiwe University.
Almohiy and Davidson (2011), McDougall (2017), and Shailesh, (2011), all noted that this kind of
traditional clinical assessment reduces the validity, objectivity, and
reliability of clinical assessment methods. Several other drawbacks of the
traditional method are that there may be unequal difficulty levels due to lack
of uniformity in patient characteristics; all the important skills may not be
tested; unequal time may be available to perform the procedures; and at times,
patients may exhibit unease and noncooperation.
Students too, have their grievances about this method, viz. feeling that what
they did well went unobserved while other students were getting away with
mistakes and perceiving a lack of clarity about what skill is being tested and
the level of performance expected. Several studies (Agarwal
et al. 2010; Dennehy et al,. 2008; Harden et al.
1975; Marshall and Harris 2000; Morag et al. 2001) have reported OSCE as a
better tool in assessing the competence of the students including
problem-solving ability, critical thinking, and communication skills.
Based on these, it is
believed that the OSCE method may also have a positive impact if applied in the
assessment of radiography students within Nnamdi Azikiwe University and other radiography training institutions
in Nigeria to create an enhanced student centred learning, perception and
approaches needed to maximize learning output and enhance teacher satisfaction.
The aim of the study is to evaluate Radiography students’ perception and
preference of Objective Structured Clinical Examination (OSCE), as a clinical
assessment of method.
MATERIALS AND METHODS
A cross-sectional
survey approach was adopted and the participants completed a self-administered
questionnaire at the end of the OSCE examination. The study was conducted
within the department of Radiography and Radiological Sciences, Faculty of
Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus,
Nnewi, Anambra State.
Nigeria. The study population included all registered, eligible radiography
students in their 5th year of study during the 2018/19 academic
session, who participated in the Objective Structured Clinical Examinations of
the 2018/19 academic session and Traditional Clinical Examination of 2017/18
Session at the department of radiography and radiological sciences, Nnamdi Azikiwe University. Selected
Participants must have undergone clinical placement during the second semester
of 2018/19 academic session, had practical experience of the traditional
clinical examination during the 2017/18 Session and Objective Structured
Clinical Examination during the 2018/19 Session. After data collection, one
hundred and twenty one (124) students accurately and voluntarily completed and
returned the questionnaire.
The study instrument was
an adapted, culled and modified forty items, seven sectioned well-structured questionnaire
assessing data of demographics, students’ perception and preference of OSCE
under the following domains using a four point scale as follows: from strongly
disagree (score of 1) to strongly agree (score of 4). The sections focused on
attributes, organization and validity rate of OSCE. The study questionnaire was
revised and validity by expert’s opinion.
The questionnaire was distributed to and completed by a group of practising
radiographers who are postgraduate students at Nnamdi
Azikiwe University, Nnewi
Campus on two separate occasions. The reliability coefficient of the scale used
for this research was 0.724. A reliability coefficient greater than 0.70
confirms that the scale used in the study is reliable (Hair et al., 2006).Ethical approval was
received from the faculty of health science ethical review committee for the
research study.
The data was analysed in line with the study objectives using
the statistical package SPSS version 21 and presented in tables, figures and
charts.
RESULTS:
In total, 124
participants were recruited into this study and accurately filled this
questionnaire employed to evaluate Radiography students’ perception and
preference of Objective Structured Clinical Examination (OSCE), as a clinical
assessment of method.
There are more females, 68(54.83%)
than males, 56(45.16%). All respondents were in there final year of Bachelor’s
Degree in Radiography program at the Department of Radiography, Nnamdi Azikiwe University.
Perception of
attributes of OSCE among respondents in this study
The results in table
1 shows that more than half (60%) of the respondents agree that they are aware
of the nature of the OSCE, a little less than first percentile (22.6%) strongly
agreed, while 11.3% and 5.6% disagree and strongly disagreed of not being aware
of the nature of OSCE respectively.
Knowledge area covered by OSCE examination indicates that 29% strongly
agree there is a wide knowledge, 54% also agree while 16.1% and 0.8% does not
agree and strongly agree of the wide knowledge gap area respectively. On the
account of having more time for OSCE, about 46.8% is of the opinion that the
OSCE requires more time while 29% strongly agrees; more so 19.4% and 4.8% does
not think more time is needed with OSCE respectively.
Consequently, about 47.6% of the respondents seems
not to hold the believe that the OSCE examination compensates students in some
areas, about 25.8% strongly do not think that the OSCE examination compensates
students in some areas while a couple (25.8%) of respondents holds the opinion
the OSCE examination do compensates students in some areas. Similarly, about
46.8% are not aware of the amount of information contained in the OSCE
examination while 21% holds a strong opinion that they don’t know, and about
28.2% knows about the information contained in the OSCE examination. (See table 1 for details).
DISCUSSION
OSCE is gradually being recognized and adapted
by medical faculties all over the world.(Pierre PB, 2004, Rasoulian M, 2007. Barman. A. 2005).Since
its inception in the 1970s, its use is spreading to other continents including
Africa and particularly Nigeria. Dissatisfaction with previous methods of
clinical assessment by both teachers and students led to a search for a more
appropriate method and the creation of OSCE by Harden and colleagues in 1975.(Barman. A, 2005)
The students felt the OSCE
covers a wider range of topics than the TCE and allows them to make up for any
areas they may have performed poorly. This is true to the extent that the student
does not mix up the answers with the wrong questions. This is important as some
complained of feeling stressed by the OSCE and not having enough time at the
stations. This is similar to other studies where a few students made similar
complaints, but most students did not perceive these as a problem. The pitfall
is that unlike in the TCE where a student can be safely guided out of trouble,
in the OSCE the examiners do not communicate with the students and so cannot
correct an erring student.
A technique of student
assessment has a huge impact on their study strategies, their performance and
general attitude towards a subject. Faulty methods of assessment can lead to
wrong decisions on the part of the examiners on the one hand and to the future activity
of students including the welfare of the community whom they will serve in the future
on the other hand. The students in this report, as in other reports, felt that
OSCE was easier to pass and less difficult than TCE. Whether this implies that
an easier and less difficult method of examination leads to the promotion of
weak students who would have otherwise failed if a more difficult and
challenging method of assessment was used is yet tobe
ascertained. This is also important because in real life, patients are not
usually standardized, valid, reliable or objective but vary in all these areas
from one patient to another and depend on the ethnicity (language barriers),
gender and even religion of the doctors attending to them.
A study described OSCE as
making students to manage patients in bits rather than as a whole individual
and that study felt that OSCE is less holistic and is a shortcut of the real scenario
of clinical practice, unlike TCE. The OSCE type employed in our institution is
highly modified and standardized because it consists of various examination
methods packaged into one. It will also be useful if the teaching methods can
be re-assessed with the intent to prepare students to sit for the OSCE.
The
study findings indicate that more than half (60%) of the respondents agree that
they are aware of the nature of the OSCE, a little less than first percentile
(22.6%) strongly agreed, Studies by Entwistle et al
and Ramsden in 1983 and 2001 respectively shows that
over time student’s have desired to achieve the
highest possible grades by using well-organized and conscientious study methods
and effective time management (Entwistle & Ramsden, 1983; Entwistle et al.,
2001). Knowledge area covered by OSCE
examination indicates that 29% strongly agree there is a wide knowledge, 54%
also agree. According to study results, knowledge acquisition cannot be over
emphasized, Ohagwu and colleagues have opined that
Clinical skill acquisition begins during the third year of study Radiography
programme and this training involves formal tutoring and practices (Ohagwu et al., 2016). The results show that 46.8% is of the
respondent’s opinion that the OSCE requires more time while 29% strongly agrees
to the same opinion. Instruction given for OSCE examination was seen by more
than half (62.1%) of the respondents to be clear, 19.4% strongly agrees that
the OSCE examination is clear. A study by Agarwal and
colleagues (2010) reflects our results that the OSCE examination is clear and
the clinical assessment methods are holistic in its approaches, inferences are
made from systematic methodologies and the learning outcomes achieved.
Similarly, radiography education has undergone enormous changes to become a
globally effective training and clinical assessment tool (Pascual
et al., 2011). Many (54%) of the respondent have opined that the OSCE
examination have the chance of failing, 29.8% strongly holds the opinion that
the OSCE examination is a failure while 15.3% do not hold such opinion that the
OSCE examination increase the chance of failing.
We
observed that perception of organization among respondents indicates that 41.9%
and 45.2% agree and strongly agrees that OSCE have good orientation before
examination respectively. According to the study by Abir. H and
Mona Al-Sheikh (2017), they also found that the OSCE was fair examination tool
compared to the traditional method among study respondents, more so, another
set of study participants opined that OSCE provides a true measure of clinical
skills (Lawrence and Selvan, 2019). However a study conducted three years earlier holds
a similar opinion among student as over 91% of the respondents felt the OSCE
examination was easier to pass compared to TCE (Ameh
et al. 2014).Similarly 46% of the study participants believe that there was
maximum revision of clinical procedures before OSCE while 43.5% holds a
stronger opinion and 21.8%of the respondents disagrees that there are good
revision of clinical procedures before OSCE.
Our study indicates that one half (50%) of the
respondents believes the OSCE scores provide true measure of essential clinical
skills in radiology while 33.1% also holds a stronger believes. Similarly,
a study by Lawrence and Selvan indicates that the
OSCE examination provides a true measure of clinical skills (Lawrence and Selvan, 2019). On the account of OSCE scores a reflection of
performance level at exam 59.7% of the respondents agree to this school of
taught while 22.6% holds a stronger opinion According to the study by Abir.H and Mona Al-Sheikh (2017) the OSCE was a fair
examination tool compared to TCE among study respondents.
Our
findings show that 46% agreed and 30.6% strongly agrees that OSCE examination
is fair than TCE. Other studies show a similarity; the OSCE was a fair examination tool compared to TCE among study
respondents (Abir. H and Mona
Al-Sheikh, 2017). On the account that there is a wide knowledge
area covered in OSCE than TCE indicates that more than half (59.7%) of
respondents agrees to this school of thought, 25% holds strongly to this idea.
The
study results shows that respondents have the opinion that orientation exercise
of OSCE is preferable to TCE before examination, about 50% of the study
respondents have preference for the revision of clinical procedures before OSCE
than the TCE, another 29% holds a stronger opinion to this view. According to Agarwal and colleagues (2010) OSCE examination is clear and
the clinical assessment methods are holistic in its approaches. Similarly, OSCE
has gained global recognition through effective training (Pascual
et al., 2011).
More
than half (54%) of the respondents seem to love the idea that the use of
simulators were in use in OSCE to TCE, Studies done by Hatry
in 199 and Poister in 2003 indicates that the number
and type of assessment tool used depend on the organization’s ability to
collect data, the information’s usefulness to decision-makers, and the
indicators’ relevance to the mission of the program (Hatry,
1999; Poister, 2003).more so, to track every activity
becomes paramount (Thiel & Leeuw,
2002), and that together the indicators support the management process of the
individual organization using them (Poister, 2003).
As
observed the study participants had favourably (46%) preference over OSCE
scores as they provide true measure of essential clinical skills in radiography
and another 27.4% holds stronger opinion. Similarly, more than half (54%) of
the respondents believes that the OSCE scores are better standardized than TCE
and 29% of the study respondents holds stronger view. Almohiy
and Davidson (2011) in their study in Australia opined that (82%) of the
respondents indicated that the OSCE was an effective test of their radiography
skills and knowledge, and believed that they were able to evaluate and care for
a patient during the OSCE. Similarly, a study in India observed OSCE
examination tool to be fairly valid and reliable tool for formative assessment
(Lele, 2011). More so, more than half (57.3%) of the
study participants strongly suggest that the examiner bias will not affect OSCE
scores than TCE and with 26.6% holding a stronger view towards this thoughts. A
study by Ameh and colleagues indicates that quite a
good number of respondents (86.5%) felt students’ personality, ethnicity and
gender will not affect OSCE scores (Ameh et al.
2014).
CONCLUSION
The OSCE had adequate student support. It provided a
pleasant learning experience for the students and it enhanced their practical
skills. The participants believed that it tested appropriate skills; the OSCE scores
provide a true measure of essential clinical skills in radiography and opted for it to remain as an examination method in thedepartment. Students’ feedback on perception and preference suggest that the OSCE
was a valuable tool and served to encourage its use in the undergraduate
curriculum.
Recommendations
1.
There
is need to extend this assessment to other end users especially the teachers.
2.
To
ascertain the effectiveness of the OSCE assessment tool, there is need for more
visibility and scope of use among other disciplines
3.
The
sample population used may not be a true reflection of the entire students
perception, hence there is need to increase the sample population in future studies.
Conflict of Interest:
There was no conflict
of interest
Funding:
There was no grant
for the research
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