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MEDICAL EDUCATION: REVIEW ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 3  |  Page : 135-141

Use of objective structured clinical examination and structured clinical instruction module for interprofessional education on cancer: A focused review


1 Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
2 Department of Medical Oncology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India

Date of Web Publication26-Dec-2012

Correspondence Address:
Senthil P Kumar
Department of Physiotherapy, Kasturba Medical College,Manipal University, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.105062

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  Abstract 

American association for cancer education had emphasized the role of structured educational programs for medical students and residents in primary care specialties in order to improve palliative oncology education. Dissatisfaction with the conventional methods of clinical assessment on the part of teachers and students led assessors to search for appropriate alternatives and in 1975, Harden and his colleagues introduced the objective structured clinical examination (OSCE). OSCE was introduced as a standardized tool for objectively assessing clinical competencies−including history-taking, physical examination, communication skills, data interpretation, etc. It consists of a circuit of stations connected in series, with each station devoted to the assessment of a particular competency using pre-determined guidelines or checklists. The Structured Clinical Instruction Module (SCIM) modifies the OSCE for teaching purposes. The objective of this review is to provide a focused update on the status and applicability of SCIM and OSCE in cancer for educational use in palliative care. From the 12 studies which were on OSCE and 6 studies which were on SCIM, it appears that the two competency-based evaluation methodologies used in cancer education namely the OSCE and the SCIM are well validated and reliably used across settings and samples of students, practitioners, and patients. Future studies in Indian palliative care settings are warranted prior to extrapolation of existing evidence.

Keywords: Cancer education, clinical skills, objective evaluation, structured instruction, teaching-learning


How to cite this article:
Kumar SP, Prasad K. Use of objective structured clinical examination and structured clinical instruction module for interprofessional education on cancer: A focused review. Int J Health Allied Sci 2012;1:135-41

How to cite this URL:
Kumar SP, Prasad K. Use of objective structured clinical examination and structured clinical instruction module for interprofessional education on cancer: A focused review. Int J Health Allied Sci [serial online] 2012 [cited 2024 Mar 28];1:135-41. Available from: https://www.ijhas.in/text.asp?2012/1/3/135/105062


  Introduction Top


Education is the foundation for knowledge both in theoretical and clinical skills for healthcare professionals working on cancer patients in palliative care. [1] American association for cancer education (AACE) [2] had emphasized the role of structured educational programs for medical students and residents in primary care specialties in order to improve palliative oncology education. The AACE had developed the first structured teaching module for quality of life assessment in terminally ill patients which consisted of 1-h long small-group session with four learning objectives. [3]

Kelly et al. [4] qualitatively interviewed a range of professionals (nurses, allied health professionals (AHPs), healthcare support workers, and educationalists) and also analyzed the curriculum documents of local universities, and they found that most cancer and palliative care education was directed toward nurses employed in specialist oncology settings. Some groups appeared to be poorly served (including community nurses, senior nurses, and AHPs). No evidence could be found of inter-professional cancer or palliative care education within the university sector. The curriculum content did not appear to reflect the ethnic diversity or socio-economic deprivation that characterized the local health economy.

The main aim of medical education is to foster the development of clinical competence in students at all levels. Differences in experiences, methods of instruction, and ambiguous forms of assessment are obstacles to attaining this goal. [5] Dissatisfaction with the conventional methods of clinical assessment on the part of teachers and students led assessors to search for appropriate alternatives and in 1975, Harden and his colleagues [6] introduced the objective structured clinical examination (OSCE).

The OSCE was introduced as a standardized tool for objectively assessing clinical competencies-including history-taking, physical examination, communication skills, data interpretation, etc. [7] It consists of a circuit of stations connected in series, with each station devoted to the assessment of a particular competency using pre-determined guidelines or checklists. [8],[9]

The OSCE is a versatile multipurpose evaluative tool that can be utilized to assess healthcare professionals in a clinical setting. It assesses competency, based on objective testing through direct observation. [10] It is precise, objective, and reproducible allowing uniform testing of students for a wide range of clinical skills. Unlike the traditional clinical exam, the OSCE could evaluate areas most critical to performance of healthcare professionals such as communication skills and ability to handle unpredictable patient behavior. [11]

The OSCE has become a gold standard for performance-based assessment in many health professions. [10] Originally developed for the assessment in medical schools, the OSCE has been widely adopted for teaching, assessment, and certification purposes in most health professions. [12]

Brannick et al. [13] in their recent systematic review found that OSCE appeared to be more reliable and valid than other similar methods to assess clinical skills both as general traits and as situation-specific behaviors. The six core competencies most commonly evaluated in a typical OSCE are interpersonal communication skills, patient care, professionalism, practice-based learning, medical knowledge, and systems-based practice. [14]

The Structured Clinical Instruction Module (SCIM) modifies the Objective Structured Clinical Examination (OSCE) for teaching purposes. The objective of this review is to provide a focused update on the status and the applicability of SCIM and OSCE in cancer for educational use in palliative care.


  Search Methods Top


Search terms of "(structured) and (clinical or practical) in title" were used to identify studies with search limits activated for cancer, published and abstracted in MEDLINE. The identified studies were scrutinized for their relevance and appropriateness and included studies were compared for their professional specialty, type of cancer, sample characteristics, OSCE method, core competencies evaluated, and their main findings.


  Main Findings of The Review Top


A total of 30 articles were obtained and upon further scrutiny, a final list of 18 studies was included for consideration. 12 studies were on the OSCE [Table 1] and 6 studies were on the SCIM [Table 2].
Table 1: Comparison of studies on objective structured clinical instruction in cancer education

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Table 2: Comparison of studies on structured clinical instruction module in cancer education

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  Discussion Top


The present review highlighted the applicability and feasibility of OSCE and SCIM for different cancer types, in different professional categories under different methodologies. Overall, the educational methods utilizing the SCIM and OSCE were effective and were well received by participants and patients in a wide variety of academic and clinical settings. Very few studies examined the measurement properties of such educational modules and though the studies' findings in breast cancer are encouraging, there is still scope for further research on other types of cancer in palliative care educational settings. This review included studies from MEDLINE since it was the most authentic and widely searched database available for free access throughout the globe. Also MEDLINE was considered as a component of OSCE and was also evaluated for its curricular integration. [33]

A meta-analysis would have been ideal for quantitatively summarizing the existing literature and to determine "how much" it is effective in terms of effect size and other interferential statistics. The meta-analysis is possible in studies which are homogenous in their population characteristics, interventions (and parameters), comparisons, and standardized outcome measures. Unfortunately, the effect of education using the explained model was assessed qualitatively in all the studies, hence necessitating a qualitative pooling of studies, as was done in this review.

The OSCE has been used as a tool for both formative and summative evaluation of medical graduate and postgraduate students across the globe. The use of OSCE for formative assessment has great potential as the learners can gain insights into the elements making up clinical competencies as well as feedback on personal strengths and weaknesses. [8] There are however numerous challenges to developing, examining, implementing, and establishing an OSCE in general, [34],[35] as well as specifically in cancer and palliative care educational settings.

The success of OSCE is dependent on adequacy of resources, including the number of stations, construction of stations, method of scoring (checklists and or global scoring), the number of students assessed, and adequate time and money. [5] It is perceived that OSCEs test the students' knowledge and skills in a compartmentalized fashion, rather than looking at the patient as a whole. [8]

The OSCE can test the practical aspects of therapeutics, [36] has the ability to predict future performance of post-graduate residents, [37] can be structured to teach real-life situations like patient safety, [38] can be a useful tool to measure profession-related constructs such as professionalism, [39] has positive experiences and perspectives of lecturers [40] and students, [41] and thus can be used as an audit for teacher-student performance by detecting and correcting teaching-learning errors in education. [42],[43] Incorporating OSCE into an interprofessional learning framework [44] is essentially the need of the hour in a multidisciplinary setting which demands interpersonal relationships and communication such as palliative care. Such an OSCE-based interprofessional education would facilitate shared learning [45] and ongoing collaborative teamwork in practice, research, and education. [46]

Examples of such studies on palliative care were reported by Auret and Starmer [19] and Hall et al., [47] primarily targeting undergraduate medical students. Although the former was a monodisciplinary study, it was unique and was the only study that applied the SCIM on palliative care. The latter study was an interprofessional multidisciplinary one, which evaluated observed structured clinical encounter using three palliative care stations.

National guidance is of utmost requirement to standardize the OSCE procedures across the country, and when it is used carefully, it can make a helpful and meaningful contribution to health professional education [48] in the direction of competency-based evaluation. [49]


  Conclusion Top


The two competency-based evaluation methodologies used in cancer education namely the OSCE and SCIM, both appear to be well validated and reliably used across settings and samples of students, practitioners, and patients. Future studies in Indian palliative care settings are warranted prior to extrapolation of existing evidence.

 
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