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clinmed/2002050006v1 (May 16, 2002)
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Title: Student feedback on the objective structured component of the practical examination in pharmacology

Running title: Objective structured exam in pharmacology

Authors:

Pathiyil Ravi Shankar

Pranaya Mishra

Corresponding author:

DR.P.Ravi Shankar

Department of Pharmacology

Manipal College of Medical Sciences

P.O.Box 155

Deep heights

Pokhara, Nepal.

E-MAIL: mcoms{at}mos.com.np

pathiyilravi@rediffmail.com

Name of author to contact for reprints:

Same as above

 

Abstract:

The study was planned to determine the attitude of undergraduate medical students towards the objective structured practical examination (OSPE) in pharmacology and to investigate any influence of sex, nationality and medium of instruction at school on these attitudes. The second year undergraduate medical students of the Manipal college of medical sciences, Pokhara, Nepal were asked to complete a questionnaire regarding the spotters and communication skills component of the practical examination. Students considered OSPE a good method of practical examination. The male students agreed more strongly that the spotters develops the ability to choose an appropriate drug while the female students were more in favour of OSPE over animal experimentation. The Sri Lankan students were less in favour of the introduction of stations testing skills as part of OSPE and also disagreed strongly with the point that communication skills should be conducted in a language other than English. Based on these observations, changes should be made in the teaching as well as evaluation methodologies to maximise learning.

 

 

 

 

Introduction:

Objective structured practical examination (OSPE) is being increasingly used not only in the developed world but also in developing countries like India and Nepal due to benefits like objectivity and reliability.1 OSPE requires the student to go through a series of stations (between 10-20), spending three minutes at each station. At the Manipal college of medical sciences, Pokhara, Nepal affiliated to the Kathmandu university OSPE stations account for 25 out of the 50 marks in the practical examination in Pharmacology. The OSPE consists of 2 parts: a spotter section of 20 marks and a communication skills section of 5 marks. At the spotter section a student identifies a drug among the choices displayed for a particular condition and then answers one or two questions related to the drug. At the communication skills station the student communicates with and prescribes a drug for a simulated patient. The student is assessed by an examiner, ticking a carefully prepared checklist. This form of examination is being used for formative evaluation in pharmacology in our institution for more than 6 years.

The Manipal college of medical sciences, Pokhara has an international student body with students from Nepal, India, Sri Lanka and also non-resident Indians. These students come from diverse social, cultural, economic and educational backgrounds.

The aims of this study are:

    1. To evaluate the attitudes of medical students towards the OSPE component of the pharmacology practical examination.
    2. To evaluate the attitude of students towards procedure stations as part of OSPE component.
    3. To investigate any gender and nationality differences in these attitudes.
    4. To investigate any influence of the medium of instruction in school on these attitudes.

 

 

Materials and methods:

A survey was undertaken of 96 undergraduates during the second half (IV th semester) of the second year of their MBBS course. Students were asked to complete a questionnaire which asked them to consider the 2 OSPE components of their practical examination in pharmacology, namely: spotters and communication skills.

The students were given a brief explanation of the aims of the study, but were not told that the results would be analysed for gender and nationality differences. The students were assessed by means of a standardised Likert type scale containing 10 items. The student was asked to grade each item using the following scoring system: 5- strongly agree, 4-agree, 3-neutral, 2-disagree, 1-strongly disagree.

Responses were received from 70 students (72.92%) of whom 41 were male (58.6%) and 29 were female (41.4%). Results were analysed using the SPSS statistical package, and Mann Whitney test was performed as the test of significance.

The questionnaire used for eliciting information is shown in table 1. The items put within the square brackets were used for further analysis of the different items with regard to differences in sex, nationality and medium of instruction.

 

 

Results:

Table 2 shows the mean attitude score of the different items on the questionnaire. Students most strongly agreed with the points that both 'the spotters and the communication skill were a learning experience' and also with the points that 'communication skills trained them to convey drug related information to the patient'. They felt that the time allotted for the station testing communication skills (3 minutes) was not enough.

The gender analysis of students' attitudes towards OSPE in pharmacology is shown in Table 3. The male students agreed more strongly with the statement that the 'spotters component of OSPE develops the ability to choose a prescribed drug' (p=0.0169). The female students preferred OSPE to animal experimentation in pharmacology (p=0.044). There was also gender differences regarding the points that 'OSPE decreases the element of luck' (p=0.037) and that 'theory questions given to the students along with the spotters are a good idea' (p=0.0049).

The nationality analysis of studentsí attitudes towards OSPE in pharmacology is shown in table 4. The attitude of the Sri Lankan students towards the point 'theory questions related to the spotter are a good idea' was less favourable than that of the other nationalities (p=0.031). The Sri Lankans also scored less regarding the introduction of stations testing skills as part of OSPE (p=0.007). They also strongly disagreed with the point that 'communication skills should be conducted in a language other than English' (p=0.0002).

Medium of instruction: The English medium students were more favourable towards the point that 'it is confusing to switch from one problem to another within a short time period' (p=0.004). The vernacular medium students agreed more strongly with the point that 'communication skills teaches how to give non-drug information to the patient' (p=0.022). There were borderline evidence of differences between the vernacular and English medium students regarding their attitudes towards the points that 'spotters is a reliable type of examination' and 'spotters develops the ability to choose a P drug' (p=0.064, p=0.059).

 

 

Discussion:

The objective structured practical examination (OSPE) is being increasingly used as an objective instrument for the assessment of the knowledge and skills of the medical undergraduates. It has been used for formative evaluation in the pre-clinical curriculum of the Kathmandu university for more than six years. It was adapted from the objective structured clinical examination (OSCE). The OSPE appears to be a reliable device with a good capacity for discriminating between different categories of students. It is better in these respects than the conventional practical examination. Moreover, it has the scope for being structured in such a way that all the objectives of laboratory teaching can be tested.1 In the revised curriculum of the Kathmandu university stations testing skills in pharmacology are proposed to be introduced and the attitude of students towards this development was generally positive.

Attitudes have a very strong influence on the behaviour of a person.3 They form the link between knowledge and practice. The importance of studentsí attitudes towards the training program in undergraduate medical education is being increasingly recognised. The studentsí attitudes towards medical college in general and pharmacology in particular have improved after the introduction of problem-based learning (PBL).4,5 PBL also has other positive effects in terms of use of additional learning resources, interdisciplinary learning, team work and making learning fun.5

Mean attitude scores: Item wise scores indicate that the attitudes were favourable except towards the points that it is confusing to switch from topic to topic within the category spotters and item numbers 4 and 5 under the category communication skills. The spotters test a wide range of topics in pharmacology in no particular order and the students did not find this particularly confusing. The time allotted for the communication skills station is not enough and should be increased to at least 5 minutes. The students also suggested that the communication skills should be conducted after they finish the spotters component of the OSPE.

Gender analysis of attitudes: It has been observed that there are gender differences in medical studentsí assessment of their personal skill levels.6 The attitude of male students towards the point that 'communication skill develops the ability to choose a P drug' was more positive. More female students preferred OSPE over animal experimentation and this could be related to the greater empathy of females towards animals. It could also be due to the greater number of Sri Lankans among the female students and the Buddhist reverence for life is well known.

Nationality analysis of attitudes: The observed differences except the point that communication skills should be conducted in a language other than English are difficult to explain. The Sri Lankans strongly felt that if communication skills are conducted in Nepalese then they would be at a serious disadvantage. Language classes in Nepalese could be a possible solution.

Medium of instruction differences: The differences observed were contrary to expectations with the English medium students having a higher score towards the point that 'it is confusing to switch from one problem to another within a short time period'. These differences will need further studies to be elucidated.

It is proposed that in future, the ratings of individual students in OSPE be shown to them so that they are aware of the points on which they are being evaluated and also their areas of weaknesses. PBL has been shown to improve both the cognition of and motivation towards medical education7,8 and the increased emphasis on PBL, communication skills and information technology skills in the revised curriculum of Kathmandu university is a step in the right direction

 

References:

    1. Nayar U, Malik SL, Bijlani RL. Objective structured practical examination: a new concept in assessment of laboratory exercises in preclinical sciences. Med Educ 1986;20: 204-209.
    2. Natu MV, Singh T. Objective structured practical examination (OSPE) in pharmacology- Studentsí point of view. Indian J Pharmacol 1994;26:188-89.
    3. Kowlawit ZV, Hoole AJ, Sloane PS. Implementing objective structured clinical examination in a traditional medical school. Acad Med 1991;66(6):345-347.
    4. Birgegard G, Lindquist U. Change in student attitudes to medical school after the introduction of problem-based learning inspite of low ratings. Med Educ 1998;32(1):46-49.
    5. Antepohl W, Herzig S. Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study. Med Educ 1999;33(2):106-113.
    6. Clack GB, Head JO. Gender differences in medical graduatesí assessment of their personal attributes. Med Educ 1999;33:101-105.
    7. Chandra D, Sharma S, Sethi G, Dkhar S. Pharmacotherapeutic education through problem based learning and its impact on cognitive and motivational attitude of Indian students. Eur J Clin Pharmacol 1996;51(1):1-5.
    8. Dolmans D, Schmidt H. The advantages of problem-based curricula. Postgrad Med J 1996;72:535-538.

 

Table 1: OSPE in pharmacology questionnaire

SPOTTERS

1) It covers the entire [course] of study

2) [Reliable] type of examination

3) Develops the ability to [choose] a P drug

4) [Time] allotted for the stations are enough

5) I [prefer] OSPE to animal experimentation

6) It decreases the element of [luck]

7) It is confusing to [switch] from one problem to another within the given time period

8) [Theory] questions related to the spotters are a good idea.

9) Stations testing [skills] should be included

10) It is a [learning] experience

COMMUNICATION SKILLS

1) Teaches how to elicit information from the [patient]

2) Teaches how to deliver [drug]-related information to the patient

3) Teaches how to deliver [non-drug] information to the patient

4) [Time] allotted for the station is enough

5) It should be conducted in a [language] other than English

6) [Reliable] type of examination

7) Students should be allowed to use [checklists]

8) It should be conducted in an [integrated] manner with the clinical sciences

9) [Real life] patients should be used instead of simulated patients

10) It is a [learning] experience

 

 

Table 2: Mean of the attitudes of medical students towards OSPE in pharmacology

Points

Mean

Spotters

Course

3.2

Reliable

3.471

Choose

3.986

Time

3.843

Prefer

3.343

Luck

3.071

Switch

2.743

Theory

3.971

Skills

3.557

Learning

4.343

Patient

3.857

Drug

4.329

Non drug

4.00

Time 01

2.7

Language

2.486

Reliable 01

3.7

Check lists

3.286

Integrated

4.1

Real life

3.7

Learning 01

4.285

Overall score

3.525

Table 3: Gender analysis of studentsí attitudes towards OSPE in pharmacology

Points

Male

female

Spotters

Course

3.098

3.345

Reliable

3.488

3.448

Choose

4.195*

3.69

Time

3.854

3.828

Prefer

3.073* *

3.724

Luck

2.8545

3.379

Switch

2.537

3.034

Theory

4.2685 5

3.552

Skills

3.756

3.276

Learning

4.39

4.276

Communication skills

Patient

3.976

3.68

Drug

4.317

4.345

Non drug

3.902

4.138

Time 01

2.585

2.862

Language

2.732

2.138

Reliable 01

3.829

3.517

Check lists

3.269

3.31

Integrated

4.29+

3.82

Real life

3.85

3.48

Learning 01

3.26

3.43

Overall score

3.46

3.57++

* p=0.0169, * * p=0.044, 5 p=0.037, 5 5 p=0.0049, + p=0.049, + +p=0.036

 

Table 4: Nationality analysis of studentsí attitudes towards OSPE in Pharmacology

Points

Nepalese

Indian

Sri Lankan

British(NRI)

Spotters

Course

3.091

3.33

3.33

2

Reliable

3.667

3.37

3.25

2

Choose

4.091

4.08

3.58

3

Time

4.212

3.54

3.42

4

Prefer

3.061

3.29

4.08

5

Luck

3.061

2.79

3.67

3

Switch

2.636

2.79

2.92

3

Theory

4.121

4.25

3*

4

Skills

4.00

3.42

2.5* *

5

Learning

4.394

4.46

4

4

Communication skills

Patient

3.788

3.92

3.92

4

Drug

4.36

4.33

4.25

4

Non drug

3.97

3.87

4.33

4

Time 01

3

2.5

2.33

2

Language

3.152

2.21

1.085

4

Reliable 01

3.758

3.75

3.67

2

Check lists

2.885 5

3.87

3.25

3

Integrated

4.24

4.21

3.5

4

Real life

3.88

3.62

3.42

3

Learning 01

3.46

3.34

3.66

3

Overall score

3.6

3.54

3.3+

3.35

 

* p=0.031, * * p=0.007, 5 p=0.0002, 5 5 p=0.019, + p=0.021




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Ravi P Shankar
ClinMed NetPrints, 27 Jan 2003 [Full text]

This Article
Right arrow Abstract Freely available
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Right arrow Similar articles in this netprints
Right arrow Download to citation manager
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Right arrow Citing Articles via Google Scholar
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Right arrow Articles by Shankar, R. P
Right arrow Articles by Mishra, P.
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PubMed
Right arrow Articles by Shankar, R. P
Right arrow Articles by Mishra, P.
Related Collections
Right arrow Medical Education:
Undergraduate

Right arrow Drugs:
Pharmacology and toxicology

Right arrow CLINICAL:
Medicine in Developing Countries


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