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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