Formative assessment in pathology by means of Objective Structured Practical Examination (OSPE) in MBBS II students

Abstract

Background: Objective Structured Practical Examination (OSPE) is an effective method to assess the competency, is objective and has uniformity. Recently it has been implemented in pre-clinical and para-clinical subjects for practical assessments at some places. Aims and objectives: To compare OSPE as a tool of internal assessment for practical skills in pathology, II MBBS with traditional practical examination (TPE), by comparing the students' performance and to obtain students' and faculty's feedback to evaluate their perception and feasibility of OSPE. Material and Methods: The present cross sectional study was carried out amongst the students of the II MBBS who had appeared for the II term pathology practical exam on the same course and with the same examiners after proper sensitisation. Later, feedback for the acceptability and feasibility of it was taken from both students and faculty. The Ethical committee clearance and consent of the students was also obtained. Results: Hundred students had participated in TPE, and 90 in OSPE. The score of the students increased significantly (p value-0.03) and 20% of the students achieved >75% marks as compared with only 3% in TPE. All or maximum students and faculty expressed the feasibility, objectivity and removal of examiner bias. Concern regarding the keeping of the time limit while performing by students and need of more elaborate and demanding preparation for the exam by faculty was conveyed. Conclusion: The present study finds the students view of inculcating OSPE as a part of the revision practical to hone their skills implying it to be an effective teaching/ education tool as well. It also re-emphasizes the established advantages of OSPE including uniformity, proper assessment of practical skills and knowledge, feasibility, definite increase in the chances of passing the exam and scoring higher marks.

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How to cite this article: Vaishali B Nagose, Vipin N Todase, Neha A Mahajan, Shirish R Gondane. Formative assessment in pathology by
means of Objective Structured Practical Examination (OSPE) in MBBS II students. MedPulse International Journal of Pathology.
September 2019; 11(3): 150-153. https://www.medpulse.in/Pathology/
Original Research Article
Formative assessment in pathology by means
of Objective Structured Practical Examination
(OSPE) in MBBS II students
Vaishali B Nagose
1
, Vipin N Todase
2*
, Neha A Mahajan
3
, Shirish R Gondane
4
1,3
Associate Professor,
2,4
Assistant Professor, Department of Pathology, DUPMC, Jalgaon, Maharashtra, INDIA.
Email:vips.todase@gmail.com
Abstract
Background: Objective Structured Practical Examination (OSPE) is an effective method to assess the competency, is
objective and has uniformity. Recently it has been implemented in pre-clinical and para-clinical subjects for practical
assessments at some places. Aims and objectives: To compare OSPE as a tool of internal assessment for practical skills
in pathology, II MBBS with traditional practical examination (TPE), by comparing the students’ performance and to
obtain students’ and faculty’s feedback to evaluate their perception and feasibility of OSPE. Material and Methods: The
present cross sectional study was carried out amongst the students of the II MBBS who had appeared for the II term
pathology practical exam on the same course and with the same examiners after proper sensitisation. Later, feedback for
the acceptability and feasibility of it was taken from both students and faculty. The Ethical committee clearance and
consent of the students was also obtained. Results: Hundred students had participated in TPE, and 90 in OSPE. The score
of the students increased significantly (p value – 0.03) and 20% of the students achieved >75% marks as compared with
only 3% in TPE. All or maximum students and faculty expressed the feasibility, objectivity and removal of examiner
bias. Concern regarding the keeping of the time limit while performing by students and need of more elaborate and
demanding preparation for the exam by faculty was conveyed. Conclusion: The present study finds the students view of
inculcating OSPE as a part of the revision practical to hone their skills implying it to be an effective teaching/ education
tool as well. It also re-emphasizes the established advantages of OSPE including uniformity, proper assessment of
practical skills and knowledge, feasibility, definite increase in the chances of passing the exam and scoring higher marks.
Keywords: Assessment, Feedback, Objective Structured Practical Examination, Traditional practical examination.
*
Address for Correspondence:
Dr.Vipin N. Todase, B block, Quarter B-12, Doctor’s residential quarters, Dr. Ullhas Patil Medical College, Jalgaon (kh.), 425309,
Email:vips.todase@gmail.com
Received Date: 27/07/2019 Revised Date: 13/08/2019 Accepted Date: 01/09/2019
DOI: https://doi.org/10.26611/10151137
INTRODUCTION
Till date learning is driven by need to be prepared for
assessment, which evaluates the knowledge of the
learners and acquired new skills.
1
The traditional practical
examination (TPE) suffers the drawback of being more
subjective; less depend on student variability and
reflecting overall performance only and being
monotonous. In contrast, newer methods in particular
Objective Structured Practical Examination (OSPE)
assess the competency, are objective and have uniformity
in the evaluation of students. Time and again OSPE has
been proven as a valid and reliable assessment tool and is
known to decrease the examiner bias. In 1975 the
Objective Structured Clinical Examination (OSCE) was
initiated. From it the Objective Structured Practical
Examination (OSPE) is derived.
2,3
It is a tool for
evaluating practical skills in pre and para-clinical
subjects. It is based on objective testing through direct
observation. Thus the major advantage of it is objectivity
and uniformity in questioning and evaluation of students.
The procedure consists of a battery of stations -
“procedure stations” and "response stations". Each of
them is designed to test a competency. On “procedure
stations” the students have to perform tasks under
observation. On "response stations" they have to write the
answers of the objective type questions or interpret data.
Thus, it evaluates the areas which are most critical to be
performed by students, including performing certain
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MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 11, Issue 3, September 2019 pp 150-153
Copyright © 2019, Medpulse Publishing Corporation, MedPulse International Journal of Pathology, V olume 11, Issue 3 September 2019
practical exercises, the ability to obtain or interpret data
or solve a problem. It has been proved by previous
research works as well that OSPE is a valid and reliable
assessment tool which decreases examiner bias.
4,5,6
In
recent times it has been implemented in pre – clinical and
para-clinical subjects for practical assessments at some
places. As, in this institute we are following traditional
practical exam pattern, comparison of OSPE with the
traditional practical exams was attempted along with the
analysis of feedback from the students regarding OSPE
experience in this study.
MATERIAL AND METHODS
The present cross sectional study was carried out amongst
the students of the II MBBS who had appeared for the II
term pathology practical exam. This study was conducted
on the same course and with the same examiners during
the week following the tradition practical examination
over a span of four days. First the students and the faculty
were sensitized regarding OSPE, how it was planned to
be performed in our department along with explaining the
blueprint of it to all; especially emphasizing the
performing exercise within specific time period. After
this session the consent of the students was sought. There
were six stations in all, response and procedural stations,
three each. Each of the procedural station (urine
examination, Hb estimation/ Blood grouping/ Total
Leukocyte Count and Peripheral smear examination) was
observed by a faculty with the help of a checklist. The
response stations were evaluated by short questions or
objective questions on a slide, gross specimen, instrument
or chart. The marks distribution and the exercises were
kept the same as TPE. After finishing the test, the
feedback regarding the OSPE as compared to the TPE
was taken from the students as well as the faculty with the
help of structured questionnaire (Figure 1 and Table 1).
Additional comments were also noted. The responses
were assessed in form of percentage of students choosing
the given options. The comments were analyzed for the
required or possible changes in the exam pattern. After
evaluating the answer sheets, and final result calculation,
the scores of the students of both the exams – TPE and
OSPE were compared by unpaired t test.
RESULTS
The total number of students appearing for TPE was 100.
The number of students appearing for OSPE was 90; four
students could not attend due to ill health and six students
did not give consent. The performance of the examinees
improved with OSPE, as evident from increased number
of students scoring higher marks (> 75% marks – 20%
students in OSPE vs 3% in TPE). (Figure 2) The mean
score also significantly increase in OSPE than TPE (p
value – 0.0331). (Table 2)
The overall response of the students and faculty to the
OSPE was positive (Figure 1and Table 1)
Figure 1: Feedback from the students regarding OSPE

Vaishali B Nagose, Vipin N Todase, Neha A Mahajan, Shirish R Gondane
MedPulse International Journal of Pathology , Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 11, Issue 3, September 2019 Page 152
Table 1: Feedback from Faculty regarding OSPE
Questionnaire
Agree
Disagree
Not Sure
1.
Structure of OSPE is better than conventional
examination 100%
2.
It is successful in removing the examiners bias
or subjective evaluation 100%
3.
Time taken by
exam is less than conventional
exam
100%
4.
Examines the practical knowledge of student
better
100%
5.
Time given at each station should be increased 90% 10%
6. Exam is unbiased for all students 100%
7.
OSPE should be included as a
method of
assessment in future exams
100%
8.
Evaluation (questionnaire ) system is easy and
uniform for all
100%
Table 2: Mean scores, p value and scores of TPE and OSPE
Figure 2: Comparison of Scores in TPE and OSPE
All students as well as teachers agreed that:
1. Exam is conducted in step wise manner and
well structured, which is better than TPE.
2. Exam process is uniform for all students.
The entire faculty also felt that the time taken by OSPE is
less than conventional exam and examiners bias is
successfully removed. Almost all the undergraduates
were convinced for the later point (90%). The majority of
them felt that:
1. Practical skills and knowledge assessed
properly.
2. Time given at each station is sufficient.
3. Evaluation (questionnaire) system is easy
and uniform for all.
4. It is better than previous routine exams.
5. Increases the chances of passing in exam.
6. OSPE should be included as a method of
assessment in future exams.
Only some students were not sure regarding the above
points. They mentioned in their comments that with
revision sessions the time limit may no longer be a
constraint. The comments reflected a positive receptive
response to this relatively new assessment tool. Faculty
expressed the difficulty in arranging the OSPE and felt it
to be more tedious.
DISCUSSION
Of the different types of examination patterns for
practical in medical education; OSPE is a well structured
one. With the evolution of the OSPE with time, it is not
only used for evaluation, but also as a teaching method so
that students can prepare for exam better. OSPE can help
both examiner and student with their syllabus teaching
and learning so that maximum output can be achieved.
The conventional practical examinations have many
shortcomings which are not present in OSPE. Among the
many well known qualities of OSPE, the prominent are
reliable assessment of the practical skills of the medical
students and elimination of the examiner bias.
7,8,9
The
same have been the observations of this work. The other
qualities which make it an efficient assessment and
educational tool include objectiveness, feasibility and
acceptability, proven again by this study. The feedback
from the students showed that they perceived OSPE as
being conducted in step wise manner, well structured,
uniform and being better than TPE. The findings are
consistent with the other works.
4,5,10
Most of the students
and all the faculty perceived the removal of observer bias
and agreed that it gives better discrimination index on
merit, similar to previous researches.
5,11
Again, students
thought that this exam is good way to access the basic and
necessary knowledge required for practical examination
which is independent of the student’s personality. Major
concern of some of the students was insufficiency of time

MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 11, Issue 3, September 2019 pp 150-153
Copyright © 2019, Medpulse Publishing Corporation, MedPulse International Journal of Pathology, V olume 11, Issue 3 September 2019
at each station, a concordant finding documented as
well.4,5,6,10,12 This opinion of students may be due to the
fact that the students were experiencing OSPE for the first
time in their curriculum. However, they were hopeful that
with repeated practise, this could be overcome, making
OSPE even a better teaching learning tool. For same
reason they asked it to be included in the revision classes.
Likewise they felt that the direct observation will
definitely improve their practical skill. Many students
also accept the fact that, the exam helps them to form a
proper attitude towards learning and study. Only few
expressed that performing under supervision in time
constraints created excessive stress which could hamper
their performance. Also a few were not sure that it would
improve the chances of passing. However the passing
percentage and the scoring both were higher than TPE,
startling them. Significant increase in scores has been
observed earlier as well.4,6,13 Of the feedbacks, which
were positive in general, a common opinion was
welcoming OSPE as a future exam pattern if
implemented. The feedbacks form important foundation
for improving the medical education tools by modifying
them. In the current work they indicated that OSPE is not
just an excellent assessment tool but also a teaching
learning method which can be effectively used in revision
practical to refine the skills of performing the
competencies. The feedback from the faculty also
conveyed the same consensus. The addition points were
need of the structuring of OSPE properly requiring huge
amount of detailing and planning due to its time
limitation; need of more number of examiners and
increased time required to take the exam. They also felt
that it might be confusing for students if students are not
sensitised properly. Few suggested a shortcoming that
observer fatigue may occur if he has to assess several
candidates on a lengthy check list. An examiner also
opined that concurrent viva may be added to test more
elaborate areas of knowledge.
CONCLUSION
The present study re-emphasizes the established
advantages of OSPE including uniformity, proper
assessment of practical skills and knowledge and
feasibility. The students accepted it as an assessment tool
and recommended it to be included as a means of revision
practical to hone their practical skills, implying the
effectiveness of the method as a teaching/ educational
tool. Though the preparation of this exam is more
demanding, but there is definite increase in the chances of
passing the exam and scoring higher marks. Thus it
should be included in revision practical to begin.
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Source of Support: None Declared
Conflict of Interest: None Declared