OSPE (OBJECTIVE STRUCTURED PRACTICAL EXAMINATION)

The traditional system of practical examination in nursing consists of either assigning a

procedure to a student or a patient for identifying the needs and problems. This depends upon
student's ability and availability of the patient for a particular procedure.
Realizing the problems related to the conventional practical exams, the department of
Physiology (Nayar et al 1986) at All India Institute of Medical Sciences, introduced a new
pattern of practical examination called OSPE, which has greater objectivity, reliability and
validity.
Objective structured practical examination (0SPE) is a new pattern of practical
examination, in which each component of clinical competence is tested uniformly and
objectively for all the students who are taking up a practical examination at a given place.
Through OSPE, one gets a reasonable idea of the extent of achievement of each student in every
practical skill related to a particular discipline. It can be used for formative and summative
evaluation.

TYPES OF STATIONS
In order to have a comprehensive appraisal of the shudder performance during OSPE,
different types of stations are planned and organized alternatively, that includes:
Procedure station: It requires a student to perform a task, e. g. monitoring of oral temperature.
When a student performs the task, simultaneously she is observed and marked against the
checklist being prepared in advance by a silent but vigilant examiner. Eventually, the student
gets a score according to the skill demonstrated by her.
The question station/the response station: The student answers the question being asked on the
answer she provided and leaves it in the place specified. Usually the question station may have a
question related to the procedure station.

SCORING STUDENTS IN OSPE

For each specific skill, a checklist is prepared by breaking the skill being tested into
essential steps and score is assigned to each step which is proportional to the importance of the
step related a particular procedure.
The objectivity in assessment is achieved by getting each component tested at one
particular station by the same examiner and has the students rotate through all the stations. The
time allowed is same for all the stations, 3 to 5 minutes is the length of time allocated to each
station.

PROCEDURE OF CONDUCTING OSPE

Examiners A, B, C stand in a place from where they can have a good view of what a
candidate is doing at a particular station. They have a checklist on which the tick as they observe.
The score of each student is entered separately and confidentially. The questions for stations 2, 4,
6 are specific, short and worded unambiguously and printed on a separate sheet. The key to the
question should be prepared in advance.
These students are given clear instructions regarding how they will rotate around the
stations and the time limit in each station and what they are supposed to do in each station
(demonstrate a skill, make observation, make calculation from the data provided or answer the
question asked).
At the end of OSPE, the checklist of examiners A, B, C pertaining to a given candidate
and her answer sheets are put together to give her a final score.
Through OSPE, one can find out at what particular step, in what specific procedure, the
student has made an error and a subsequent feedback can be given to rectify her mistake, instead
of making a general comment like “performance was good” or “most of them did well”.

ADVANTAGES OF OSPE
 It is more objective, reliable and valid than the traditional system of examination.
 All students are subjected to the same standardized test.
 Emphasis is shifted from testing factual knowledge to testing of skills, that too in a short
time.
 It helps to ensure a wide coverage of all practical skills.
 It ensures interaction of teaching and learning
 There is increased faculty-student interaction.
 A large number of students can be tested within a relatively short time.
LIMITATIONS OF OSPE
OSPE is used only in simulated situations due to non- availability of patients for the same
procedure.
 The simulated situation may not reflect the real life situation.
 Students cannot be assessed for different skills, such as IPR, communication skills and
dexterity in handling equipments.
 Empathy towards the patients cannot be evaluated.
 The skill of the student in providing holistic nursing care cannot be assessed.
 It may be time consuming to construct an OSPE cannot be used by a single person, it
needs more resources in terms of manpower, time and money.
 There is no interaction between the examiner and the student.
 There is a risk of fatigue.
 Breaking clinical skills into individual competencies may be articificial and not
meaningful.
 Careful organization is required since all stations require equal time.

A model OSPE designed for 1st year Post Basic B. Sc. Nursing
Subject: Child Health Nursing

Instructions to Students

Before the start of OSPE, following instructions are given to students:

1. Bring your own pen/pencils and must wear white lab coats
2. Electronic devices like mobile phones, tablets etc. are not allowed in the examination hall
3. Cheating in any aspect is strictly prohibited and the regulation of the university will be
applied
4. Write your name and ID on each sheet of answer books
5. Upon entering the OSPE examination hall, stand on each station with face opposite to
station
 6. Encircle the station number in your answer books. This will be your first station and then
follow the sequence
7. A bell will ring at the beginning of OSPE marking the start of examination
8. Rotate clockwise around each stations including 4 rest stations spending 90 seconds (1.5
minutes) at each station
9. Clear instructions are given at each stations as to what you should do
10. A bell will ring at the end of examination and remain at your station from where the
answer books will collected

TYPES OF STATIONS

Sl No. Stations Question Method of scoring

1. Procedure station Check and record the Observed and scored by the
length and weight of a examiner A using checklist
newborn baby
2. Question station What is the normal length Answer on a sheet provided
and weight of a newborn
baby?
3. Procedure station Measure the head, chest Observed and scored by the
and Mid Upper Arm examiner B
circumference of the baby
4. Question station At what age does the head Answer on a sheet provided
and chest circumference
becomes equal?
5. Procedure station Plot the above findings in Observed and scored by
the growth chart of the examiner C
newborn baby
6. Question station List down the uses of a Answer on a sheet provided
Road to health chart or
growth chart
Checklist for measuring weight and length of baby
SL. NO. STEP YES NO
1. Explain to mother/attendant about the procedure and the
purpose of it.
2. Bring the child to the room or area where measurement
will be taken.
3. Place the weighing machine on firm surface.
4. Before checking the weight, balance the scale by setting it
at zero
5. Remove the baby’s clothes and place the baby slowly on it.
Weigh with minimum clothing.
6. Keep one hand over the abdomen (4-6 cm away from the
skin) to prevent from falling.
7. Note the reading on the scale meter and record.
8. Clean the infantometer with cotton swab. Place a clean
baby sheet or paper on the measuring board or
infantometer.
9. Hold head in midline, place the baby on infantometer, head
of infant should be at head side(header) and feet should be
at footer.
10. Grasp the knee together.
11. Push down the knees till fully extended and flat against the
infantometer or measuring board.
12. Adjust the length of the infantometer to the length of the
baby by bringing the end to the feet of the baby.
13. Note the length of the baby from the readings on the
infantometer and clean the infantometer.
14. Note the reading on the scale and record

HOW TO SCORE STUDENTS IN OSPE?

1. For each specific skill, a checklist is prepared by breaking the skill being tested into
essential steps and scores is assigned to each step which is proportional to the importance
of the steps related to a particular procedure.
 2. The objectivity in assessment is achieved by getting each component tested at one
particular station by the same examiner and have the students rotate through all the
students.
3. The time allowed is same for all the stations 3-5 minutes is the length of time allocated to
each station.

OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE)

According to Harden (1988), OSCE is an approach to assess the clinical competence, in

which the components of competence are assessed in a planned or structured way with attention
being paid to the objectivity of the examination.

The student is assessed at a series of stations with one or two aspects of competence
being tested at each station. The examination can be described as a focused examination with
each station focusing on one or two aspects of competence.

OSCE includes series of 12 to 20 stations, each testing one or two components of clinical
competencies for 3 to 5 minutes. Students are rotated to all stations with pre determined time
interval, thus through the series of 12 to 20 stations to accommodate 12 to 20 students, who will
be examined simultaneously. The process is repeated till all students are examined. Taking
clinical history, physical examination, critical thinking in patient management, problem-solving
and communication and interpersonal relationship are some of the competencies examined in
these stations. In OSCE, the process as well as product is examined.

The examples of competencies assessed in OSCE are:

 History taking from a patient who presets with a problem, e.g. abdominal pain
 Educating a patient about management, e.g. self injection for diabetes mellitus
 General advice to a patient, e.g. on discharge from hospital with a myocardial infarction
 Communication with other members of health care team and relatives
 Physical examination interpretation of findings
 Management by appropriate nursing intervention
 Problem-solving
 In the examination, it is what the examinee does, when confronted with a patient or a
situation, that is assessed not what he knows and he answers, he writes to a theoretical question
on the subject. Simulate patients, videotape and simulators have also been used.

The following contribute to the objectivity of the examination:

 Candidates see a number of examiners in the course of the examination, usually eight or
more.
 What is to be assessed at each station is agreed in advance and a marking schedule is
produced which lists what is expected of the candidate at each station.
 Examiners use a checklist, which reflects what is to be tested at the station. This is agreed
in advance by the examiners.
 The aim of the examination is to produce a profile for each candidate rather than a single
composite mark.
 A candidate for example, may be competent in physical examination techniques, but have
an unsatisfactory attitude and may be lacking in interpersonal skills.
 The standard or criteria for pass, distinction, fail and dangerous fail can be agreed.
 Examiners can be trained for the task expected of them and their performance can be
assessed in advance on practice videotapes.
 The examination tests a wide range of skills which greatly reduces the sampling error.
This verysignificantly improves the reliability of the examination.
 All students face the same tasks.
 Simulated patients help to ensure that all students are presented with a similar challenge.

The objectivity of an OSCE is attained and bias is minimized by:

 Using trained examiners

 Scheduling activities
 Using checklists
 Following a standardized system
 Uniformity in evaluations as all students perform the same tasks.
PROBLEMS IN CONDUCTING OSCE

 Nonavailability of many faculty members

 Lack of enthusiasm of the teachers to try out new methods
 Students apprehension for having to learn even the smallest detail of the subject
 Lack of physical facilities and cooperation in the clinical settings
 Controversies over the evaluation criteria.

STRATEGIES TO OVERCOME

 Training the faculty members in using OSCE

 Preparation of the students from the beginning of the course for this type of examination.
 Proper communication with the administrators of the clinical areas regarding OSCE.
 Ensuring the reliability and validity of the evaluation criteria.
 Adequate planning and organization of the whole exercise.

Example of a model OSCE

Objective Structured Clinical Examination (OSCE)

Student’s name _____________________ Date _____________

Procedure station I:
Assess the patient X, identify the three priority nursing needs
1. _________________
2. _________________
3. _________________
Procedure station II
Perform a neurological assessment of patient B with meningitis and record the findings
Procedure station III:
Conduct anthropometric measurement of patient A and write the findings
Procedure station IV
Carry out nursing care of patient Y under phototherapy and record the procedure
Procedure station V
Calculate the drug dosage for administration to a 4 years old child with 125mg of ampicillin
where stock available is 500mg in 2ml.
Procedure station VI
Patient has a prescription of 1200ml fluid for 12 hours. How many drops per minute the nurse
will administrate through macro drip set?
1. 27
2. 30
3. 32
4. 40
Procedure station VII
As per the immunization schedule, write the time, dose, route and site of the following vaccines
1. Vaccine 1
Time_______
Dose_______
Route_______
Site________
2. Vaccine 2
Time_______
Dose_______
Route_______
Site________
Procedure station VIII
Provide health education on breastfeeding to a mother who delivered a preterm baby