Influences of OSCE design on students’ diagnostic reasoning

Abstract

In comparison with 'traditional' part-task OSCEs, whole-task OSCEs like the HDPE increase students' use of diagnostic reasoning during study time.

Clinical Skill Evaluation of Undergraduate Nursing Students Using Objective Structured Clinical Examination (OSCE)

“…Nevertheless, respondents performed better in cognitive aspect than in psychomotor aspect. This study in line with a research done by Lafleur, Cote & Leppink (2015) who did a randomized, controlled, mixed-methods study on forty medical students found that by studying for a whole-task OSCE stations, students tend to achieve a better use of diagnostic reasoning.…”

Clinical examination in the OSCE era: are we maintaining the balance between OS and CE?

“…Whereas in part-task assessments CE is fragmented, whole-task assessments remain meaningful and coherent, reflecting how CE is performed in the workplace. We demonstrated that this perception of the task demands influences the use of diagnostic reasoning and study strategies when learning how to conduct a physical examination 6 7. In other words, if assessors notice that students are rehearsing a routine, OSCEs can be redesigned to assess a meaningful whole task.…”

“…Worryingly, what students refer to as ‘practicing for OSCEs’ could really mean discussing a structured routine outside of the clinical environment rather than engaging in deliberate practice 4 6. Depending on the type of OSCE, it is therefore not uncommon for a student to perform well in the technique of CE but be unable to explain his diagnostic reasoning to the observer, since the OS was the focus of his preparation 4 6 7…”

“…Students will observe the task demands of an OSCE and whether the emphasis is on the structure (eg, conducting a normal shoulder exam; a part task) or achieving a genuine global performance (eg, examining a painful shoulder to justify their diagnosis; a whole task) 6 7. Whereas in part-task assessments CE is fragmented, whole-task assessments remain meaningful and coherent, reflecting how CE is performed in the workplace.…”

“…For instance, mini-clinical evaluation exercises (Mini-CEX), Entrustable Professional Activities (EPA) and video recordings of actual practice are valid methods currently used in the workplace. Awaiting clarification studies, we can expect students to redirect their focus on CE rather than OS in those whole-task assessments 1 6 7. Consequently, a combination of assessments, where trainees are actually performing a clinical examination instead of only ‘showing how’, will help maintain the balance between OS and CE 10…”