Clinical skills evaluation in a resource‐constrained environment

Context and setting Our medical school, located in Benin City, Nigeria, runs a 6-year undergraduate medical programme with a disciplined-based curriculum. Clinical exposure commences in Year 4, with an assessment using long- and short-case formats, which takes 4 days to complete. Why the idea was necessary Over the past 20 years, student intake has increased from about 50 to the current 250 per year, without commensurate increase in the size of the faculty. In addition, the patient population has not significantly increased. The increased student to faculty and patient ratios, and the resultant stress of a 4-day examination period, prompted us to look for alternative methods of teaching and assessing clinical skills. The current system of oral examinations was felt to be unreliable and limited in scope. The objective of the study, therefore, was to evaluate an objective structured clinical examination (OSCE) as an alternative tool for assessing students’ clinical skills, with regard to level of objectivity, reliability and time-efficiency. What was done We developed a 15-station OSCE to evaluate clinical skills in Year 4 students. Stations included interpretation of laboratory results, history taking and physical examination of standardised patients (SPs), and counselling. Interns were recruited to serve as SPs and were taught to play a role in 10 stations during 2, 4-hour sessions. Three stations used real patients. Six stations required history taking only, and 6 required physical examination. Prior to the OSCE, faculty staff were exposed to 2 mini-workshops on assessment that described historical perspectives, the limitations of the current methods, the process of conducting an OSCE and methods of item analysis. A random sample of 45 of 120 Year 4 students from 1 of the internal medicine rotations was chosen to take the OSCE to test the process for both students and faculty. Students were asked to complete both pre- and post-OSCE survey questionnaires about their perceptions of the assessment process. Scoring was performed by faculty and senior residents who had been trained to use a checklist or global rating scale. The standard for passing was set at 50%, according to university rules. Evaluation of results and impact A total of 23 of 45 students achieved a score > 50% in the OSCE, resulting in a pass rate of 51%. Scores ranged from 34.8% to 70.5%. Overall, 80% of students considered the OSCE to be a more objective clinical assessment tool, most appreciated the time-efficiency of the process, and all respondents were in favour of adopting the OSCE as a permanent tool. Future plans in the Department of Internal Medicine include the adoption of the OSCE in Years 4 and 6. In addition, the Departments of Psychiatry and Preventive Dentistry are investigating possible uses of the OSCE model.