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ORIGINAL ARTICLE
Year : 2022  |  Volume : 4  |  Issue : 1  |  Page : 10

Online Objective Structured Clinical Examination in Critical care Teaching: A Pilot Study


Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Date of Submission10-Dec-2021
Date of Acceptance30-Mar-2022
Date of Web Publication11-May-2022

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JTCCM-D-21-00029

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  Abstract 


Objective: To evaluate the effect of online objective structured clinical examination (OSCE) in critical care teaching. Methods: This is a self-controlled prospective study performed in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from 2020 to 2021. Consecutive students came from various surgical departments. Online tests were conducted for each student pre-and post-ICU round. There were three spots in online OSCE including clinical case, electrocardiography and chest X-ray. Results: Twenty-four students completed the tests. The median age is 27 years (24–28) in the cohort. There are 18 males and 6 females. Of twenty-four students, 7 came from department of neurologic or head-neck surgery, 3 from department of thoracic surgery, 12 from department of abdominal surgery, and 2 from others. There was significant difference in scores between pre-round and post-round ICU test in the chest X-ray spot, which was 3.33±4.81 and 6.67±4.81 respectively (P = 0.029). Scores in the postround ICU test in the electrocardiography spot was higher than that in the pre-round test (5.85±5.05 vs. 8.33±3.80)however no significance was reached (P = 0.056). There was no significant difference in the scores between pre-round and post-round ICU test in the clinical case spot (63.33±18.33 vs 71.67 ± 13.07, P = 0.116). Lastly, there were significant differences in total scores between pre-round and post-round ICU test (72.50±19.83 vs 86.67±13.40, P = 0.019). Conclusions: Online OSCE was feasible in the teaching evaluation of surgical rotation residents in ICU. Surgery rotation residents in ICU should receive more training in electrocardiography and chest X-ray.

Keywords: Objective structured clinical examination, teaching evaluation, surgical resident


How to cite this article:
Huang CL, Wang HJ, Qu SN, Zhang H, Wang H, Xing XZ. Online Objective Structured Clinical Examination in Critical care Teaching: A Pilot Study. J Transl Crit Care Med 2022;4:10

How to cite this URL:
Huang CL, Wang HJ, Qu SN, Zhang H, Wang H, Xing XZ. Online Objective Structured Clinical Examination in Critical care Teaching: A Pilot Study. J Transl Crit Care Med [serial online] 2022 [cited 2022 Dec 7];4:10. Available from: http://www.tccmjournal.com/text.asp?2022/4/1/10/345026




  Introduction Top


Objective structured clinical examination (OSCE) is an useful tool in teaching effect evaluation not only for undergraduate medical training, but also for nursing faculty and students, which enables the evaluation of situational awareness (SA) associated with clinical reasoning skills and is superior to traditional clinical examination.[1],[2] Fischer performed a systematic search pertaining to SA and OSCE and found that OSCEs can provide undergraduate medical students with supportive feedback and strengthen educational measures in diagnostic accuracy and reasoning abilities.[1] Vincent et al. conducted a systematic review and concluded that compared with traditional clinical examination, OSCE is more credible to evaluate the clinical competence of undergraduate nursing students.[2]

OSCE has also been extensively studied in intensive care unit (ICU) for medical students and nursing students. It has been used in America and Faculty of Intensive Care Medicine since 2010 as a test of competency-based training program which can be used as effective performance evaluation tools.[3],[4] In addition, the introduction of OSCE shifted studying time and students needed less studying time to prepare test.[5] In the epidemic of the coronavirus disease 2019 (COVID-19), most teaching hospitals have shifted to online education instead of traditional education to protect their teachers and students.[6]

The objective of this study is to assess the effect of online OSCE teaching mode in a tertiary cancer hospital in China in the epidemic of COVID-19. Our hypothesis is that surgical residents can also learn knowledge of oncologic critical care by online OSCE.


  Methods Top


This is a self-controlled prospective study performed in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from 2020 to 2021. The study was performed in accordance with the Declaration of Helsinki and the International Conference on Harmonization Good Clinical Practice guidelines. The protocol was approved by the Institutional Review Boards of Cancer Hospital, Chinese Academy of Medical Sciences (22/092-3293).

Consecutive students who came from various surgical departments for rotation in ICU were included. Students who do not fulfill tests were excluded. Online tests were conducted for each student pre- and post-ICU round. There were three spots in online OSCE including clinical case, electrocardiography, and chest X-ray.

Questions were random selected from the online bank of questions by scanning two-dimensional code with smartphone. There were 30 questions in clinical case spot and five questions were random selected in each test. Electrocardiography spot includes ten questions and two questions were random selected for each test. There were eight questions in chest X-ray spot and one question was random selected in each test. There are four clinical cases, one chest X-ray case and one electrocardiography in each admission or discharge test, each clinical case is worthy 20, each X-ray case and electrocardiography case is worthy 10, respectively. Scores were summed for each test and the total score is 100.

This is a pilot study; therefore, the sample is set as twenty. Statistical analyses were carried out using SPSS software for Windows, Version 16.0 (SPSS Inc., Chicago, IL, USA). Continuous variables were analyzed using paired samples t-test. The statistically significant level was set as a P < 0.05.


  Results Top


During the study, 24 consecutive students completed the tests and were enrolled into the final analysis. Each student spent 2 months in ICU ward. The median age is 27 years (24–28) in the cohort. There are 18 males and 6 females. Of 20 students, 7 came from the department of neurologic or head-neck surgery, 3 from the department of thoracic surgery, 12 from the department of abdominal surgery, and 2 from others. Moreover, 19 students are studying for a master degree and 5 students for a doctor degree. There was significant difference in scores between preround and postround ICU test in the chest X-ray spot, which was 3.33 ± 4.81 and 6.67 ± 4.81, respectively. Scores in the postround ICU test in the electrocardiography spot was higher than that in the preround test (5.85 ± 5.05 vs. 8.33 ± 3.80), however, no significance was reached (P = 0.056). There was no significant difference in the scores between preround and postround ICU test in the clinical case spot. Finally, there were significant differences in total scores between preround and postround ICU test [Table 1].
Table 1: Scores of students who take pre- and post-intensive care unit round using online test

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  Conclusions Top


In this study, we found that online OSCE was feasible in the teaching evaluation of surgical rotation residents in ICU.

In European OSCE test, OSCE covers four themes of professionalism, resuscitation, data interpretation, and equipment, which focused on basic knowledge of ICU in the question and answer style.[5] In our study, there are three spots in the test in online test. Rogers et al. found that compared with OSCE, written examinations measure failed to predict students' competence, that is the ability of applying knowledge to problem solving.[3] In our opinion, the question and answer style is basic and suitable for juniors residents in ICU, and OSCE with multiple-choice examination is suitable for seniors for senior residents in ICU.

In this study, students scored higher after ICU rotation. However, there is only significant differences in scores in chest X-ray spot after ICU rotation but not in clinical case and electrocardiograph spots, although there is trend of scored higher after ICU rotation. Indeed, we designed the tests as a pilot study, which included clinical common critically ill scenarios. For example, in clinical case station, we designed shock, infection, and respiratory failure diagnosis and treatment problems which were encountered in daily clinical practice. In electrocardiograph station, we designed premature ventricular contraction, atrial fibrillation, which were also need to be managed for each critically ill patents. Difficulty was increased in chest X-ray station which included pneumothorax and acute cardiogenic pulmonary edema, which were not encountered in surgical wards or even in ICU wards. Owning to the reasons above, there was significant difference in scores in chest X-ray station but not in clinical case or electrography stations.

There were several limitations in our study. First, the OSCE test included clinical professional problems only, other important capacity such as communication skills were not assessed. We will add communication skill station in the next study. Second, in addition to multiple choice questions, essay questions were not included in our OSCE. However, it is also necessary for surgery rotation residents. Finally, this is a single-center study which the results may not generalize to other medical education center.

In conclusion, online OSCE was feasible in the teaching evaluation of surgical rotation residents in ICU. Surgery rotation residents in ICU should receive more training in electrocardiography and chest X-ray.

Ethical approval

This study was approved by the Institutional Review Boards of Cancer Hospital, Chinese Academy of Medical Sciences (22/092-3293).

Financial support and sponsorship

The study was supported by Teaching Research Fund of Cancer Hospital of Chinese Academy of Medical Sciences (E2020009).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fischer MA, Kennedy KM, Durning S, Schijven MP, Ker J, O'Connor P, et al. Situational awareness within objective structured clinical examination stations in undergraduate medical training – A literature search. BMC Med Educ 2017;17:262.  Back to cited text no. 1
    
2.
Vincent SC, Arulappan J, Amirtharaj A, Matua GA, Al Hashmi I. Objective structured clinical examination vs. traditional clinical examination to evaluate students' clinical competence: A systematic review of nursing faculty and students' perceptions and experiences. Nurse Educ Today 2022;108:105170.  Back to cited text no. 2
    
3.
Rogers PL, Jacob H, Rashwan AS, Pinsky MR. Quantifying learning in medical students during a critical care medicine elective: A comparison of three evaluation instruments. Crit Care Med 2001;29:1268-73.  Back to cited text no. 3
    
4.
Available from: https://www.ficm.ac.uk/documents/fficm-examiners-report-march-2019/the-fficm-oscesoe. [Last accessed on 2022 Apr 19].  Back to cited text no. 4
    
5.
Müller S, Koch I, Settmacher U, Dahmen U. How the introduction of OSCEs has affected the time students spend studying: Results of a nationwide study. BMC Med Educ 2019;19:146.  Back to cited text no. 5
    
6.
Nimavat N, Singh S, Fichadiya N, Sharma P, Patel N, Kumar M, et al. Online medical education in India – Different challenges and probable solutions in the age of COVID-19. Adv Med Educ Pract 2021;12:237-43.  Back to cited text no. 6
    



 
 
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