Malaysian Pharmacy Students' Assessment of an Objective Structured Clinical Examination (OSCE)
To implement and determine the effectiveness of an objective structured clinical examination (OSCE) to assess fourth-year pharmacy students' skills in a clinical pharmacy course.
A 13-station OSCE was designed and implemented in the 2007-2008 academic year as part of the assessment methods for a clinical pharmacy course. The broad competencies tested in the OSCE included: patient counseling and communication, clinical pharmacokinetics (CPK), identification and resolution of drug-related problems (DRPs), and literature evaluation/drug information provision.
Immediately after all students completed the OSCE, a questionnaire containing items on the clarity of written instructions, difficulty of the tasks, perceived degree of learning gained and needed, and the suitability of the references or literature resources provided was administered. More than 70% of the students felt that a higher degree of learning was needed to accomplish the tasks at the 2 DRP stations and 2 CPK stations and the majority felt the written instructions provided at the phenytoin CPK station were difficult to understand. Although about 60% of the students rated OSCE as a difficult form of assessment, 75% said it should be used more and 81% perceived they learned a lot from it.
Although most students felt that the OSCE accurately assessed their skills, a majority felt the tasks required in some stations required a higher degree of learning than they had achieved. This may indicate deficiencies in the students' learning abilities, the course curriculum, or the OSCE station design. Future efforts should include providing clearer instructions at OSCE stations and balancing the complexity of the competencies assessed.
Keywords: clinical competencies, objective structured clinical examination, bachelor of pharmacy, Malaysia
Colleges and schools of pharmacy traditionally have assessed students' performance using multiple-choice and essay questions. However, these methods of assessment may not adequately evaluate mastery of essential skills and measure cognitive learning in clinical settings.1,2 Furthermore, clinical faculty members often see a disparity between performance of high achievers in the classroom and in clinical settings.3 This inconsistency may stem from differences in testing for memorization of information and clinical application of knowledge. Therefore, the use of performance-based assessment methods, such as the objective structured clinical examination (OSCE), in undergraduate pharmacy education is of fundamental importance.1,4-7 OSCE has been used in evaluating clinical competence in health professions education around the world. Since the role of pharmacists has expanded beyond compounding and dispensing drugs, strategies for teaching and evaluation in pharmacy education must change as well.1,8-10 This is also in tandem with the philosophy and practice of pharmaceutical care, with more emphasis on experiential training than didactic learning. Because more emphasis is being placed on the experiential aspect of training, more emphasis must be placed on effective and accurate evaluation of students' performance in practice settings.1,11 OSCE has been an instrumental part of clinical competence assessment in the Faculty of Pharmacy at the International Islamic University Malaysia (IIUM) since 2006.4 The complexities of competencies tested at different OSCE stations may vary significantly. Further, the clarity of instructions given to examinees, as well as the perceived degree of learning needed to achieve the competency being tested/evaluated, may also differ from one OSCE station to another. Such wide variations may influence the validity and reliability of the overall examination. Thus, the current study focused on examinees' perceptions of the OSCE stations' effectiveness in accurately evaluating competencies. We believe that examinees perceived that the clarity of instructions and level of complexity of tasks varied from one OSCE station to the next and that affected their performance. In this paper, we describe the pharmacy students' perceptions regarding the assessment of different competencies at OSCE stations and how OSCEs compare with other assessment methods.