Download Darowan Akajagbor, PharmD , BCPS, Nicole E. Eckard, PharmD

Students’perceptions of a redesigned objective structured clinical
examination for assessment of core competency domains
1
PharmD ,
Darowan Akajagbor,
BCPS, Nicole E. Eckard, PharmD,
1D’Youville College School of Pharmacy, Buffalo, New York
Figure 1: Students’ perception on OSCE preparedness and their
current knowledge/skills
The use of OSCEs in pharmacy education is growing. A study published in 2010 designed
to describe current OSCE practices in pharmacy programs in the United States found that
of the 88 programs included in the analysis, only 32 (36%) used OSCEs in their
curriculum. The study also observed that few programs conduct OSCEs in an optimal
manner and most do not adhere to best practices in OSCE construction and
administration.3
•
In 2013, our school of pharmacy redesigned our OSCE content and format to include
objectives derived from core competency domains outlined in Appendix D from the 2007
accreditation council for pharmacy education (ACPE) standards (Table 1)
•
Appendix D provides the pre-pre-advanced pharmacy practice experiences performance
domains and abilities as guidance for assessment of student capabilities before entering
APPEs.4
77.0
•
To assess students’perceptions of a restructured objective structured clinical
examination (OSCE) using competency domains derived from the pharmacy
education (ACPE) standards.
METHODS





We created a blueprint for a 5-station OSCE and piloted it in the Spring of 2013 with full
implementation in the Fall of the 2013-2014 academic year for second (P2) and third (P3)
professional year pharmacy students.
The OSCE was comprised of a preparatory station and a series of four interactive and noninteractive stations. The students were expected to perform specific functions in each
station within a seven minute time block with one minute between stations.
Competency domains assessed were derived from APPE performance domains and
abilities from Appendix D. Each exam was created to include at least 75% of the 11-core
competency domains.
After the Spring 2014 OSCE, students completed an anonymous survey regarding their
perception of the exam structure, content, exam preparedness, knowledge, skills, and
APPE preparedness (P3’s).
The survey was granted exempt status by the D’Youville College Internal Review Board.
60.7
42.6
37.7
I was well
prepared for the
OSCE
My level of
anxiety for the
OSCE is high
The OSCE
The OSCE
highlighted areas highlighted areas
of strengths in my of weaknesses in
skills and
my skills and
knowledge
knowledge
Positive Response (P2's)
Students’ Responses (%)
90.2
65.2
63.8
71.0
Preparing for and
taking the OSCE
allowed me to feel
more prepared for
the APPEs (P3's
Only)
82.0
86.9
78.7
23.2
P2 Students
P3 Students
39
Station 2
Station 4
P3 Average
P3’s
Order fulfillment
Identification and assessment of drug related
problems
Basic patient assessment
Ethical, professional and legal
Medication information (pharmacology,)
Pharmaceutical calculations
Drug information analysis & literature research
Communication
Patient counseling
Medication information (medicinal chemistry &
pharmacology)
100
100
100
100
75
100
75
100
75
50
50
25
0
#2
#3
#4
#5
#6
#7
#8
#9
#10
#11
Appendix D Domains (See table 1 for domain descriptions)
IMPLICATIONS
•
Recommendations for Future Exams:
One thing you would absolutely CHANGE
Additional time per station
Kinetics/calculations
Journal club station
More preparatory activities during the semester
Case complexity
Additional time per station
Additional instructions on how to use the prep station
Blood pressure station
Making more clinical recommendations
Feedback after, reflection of last semester’s OSCE
Journal club station
Station 3
150
#1
Positive Response (P3's)
Table 2: Students’ Free Text Response
74
0
•
Recommendations for Future Exams: One
thing you would absolutely KEEP
Device counseling
Drug related problems
Case-based exam
Cases provided ahead of time
Prescription checking
Cases provided ahead of time
Prep station
Counseling station
“Hands on” station
Station 1
91
Figure 4: Combined Appendix D core domains covered during the
2013- 2014 academic year
The OSCE was Enough time
The OSCE
The OSCE
The tasks in
The tasks in
well structured was allocated to
covered
covered a
each station
each station
complete most comprehensive comprehensive
reflected
reflected
tasks
variety of
amount of
clinical skills
knowledge
pharmacy
pharmacy
learned during gained during
related skills
practice
the semester
the P2 and/or
knowledge
P3 coursework
Positive Response (P2's)
48
Station 2 Medical information (clinical
pharmacokinetics)
Pharmaceutical calculations
Station 3 Drug information analysis and
literature research
Station 4 Order fulfillment
Communication
Patient device counseling
37.7
14.5
65
Station 1 Identification and assessment of
drug related problems
Communication
Positive Response (P3's)
86.9
77
P2’s
Figure 2: Students’ perception on OSCE and course structure
93.4
84
Table 3: Station Descriptions (Spring 2014 Only)
24.6
1
2
3
4
5
OBJECTIVE
72.5
67.2
54.1
Table 1: 2007 ACPE Standards Appendix D Core Domains
Patient Safety/Accurately Dispense Medications (Order fulfillment)
Basic Patient Assessment
Medication Information
Identification and Assessment of Drug Related Problems
Mathematics applied to pharmaceutical calculations, compounded medications, dose
calculations, and applications of pharmacokinetic calculations
6 Ethical, Professional, & Legal Behavior
7 General Communication Abilities
8 Counseling Patients
9 Drug Information Analysis and Literature Research
10 Health and Wellness – Public Health
11 Insurance/Prescription Drug Coverage
76.8
80
P2 Average
% Covered
•
Students’ Responses (%)
An OSCE is usually comprised of a series of stations throughout which candidates rotate
on a timed basis and are required to perform specific functions to complete the task or
address a problem.
Figure 3: Station Performance (Spring 2014)
Average Score (%)
The survey had a response rate of 96% in the second professional year (P2) class and a 98% rate in the third
professional year (P3) class.
Objective structured clinical examinations (OSCEs) have been extensively described in the
literature and are used to evaluate clinical competency in health professions education
around the world. 1,2
•
RESULTS (OUTCOME)
RESULTS (SURVEY)
BACKGROUND
•
1
BCPS
Based on the overall results, the majority of the students surveyed had positive
perceptions regarding the restructured OSCE but the P2’s had a less positive perception.
Many P3 students did not feel prepared for APPE’s after the exam which may imply
curriculum deficiencies.
Using the Appendix D core domains to formulate OSCE content will enable
identification of areas for early intervention and to improve students’competency before
starting APPEs. Steps will be taken to address domains that are not covered or only
covered once during the OSCEs. Future OSCEs will be updated to be consistent with the
2016 ACPE standards.
REFERENCES
1.
2.
3.
4.
Awasiu A, Rahman N, Mohamed M, Bux S, Nazar N. Malaysian pharmacy students assessment of an objective structured clinical
examination. American Journal of Pharamceutical Education. 2010;74(2):34.
Austin Z, O’Byrne C, Pugsley J, Munoz LQ. Development and validation process of an objective structured clinical examination
(OSCE) for entry-to-practice certification in pharmacy: the Canadian experience. American Journal of Pharamceutical Education.
2003;67(3):76.
Sturpe DA. Objective Structured Clinical Examinations in Doctor of Pharmacy Programs in the United States. American Journal of
Pharmaceutical Education. 2010;74(8):148.
Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree:
(“Standards 2007”) Approved January 2006
Corresponding Authors: Darowan Akajagbor, Nicole Eckard
[email protected]. [email protected]
No financial disclosures or conflicts of interest apply to authors