Abstract Title
Use of objective structured clinical examination for evaluation of the medical student communication skills

Authors

Vitaliy Koikov
Gulmira Derbissalina
Zhanagul Bekbergenova
Lazat Karsakbaeyeva
Zarema Gabdilashimova

Theme

Clinical Assessment and the OSCE

INSTITUTION

Republican Center of Healthcare Development
Astana Medical University

Background

Communication skills are an important professional competence for physicians. One method to evaluate the communicative competence of the student is to conduct objective structured clinical examination (OSCE) involving standardized patients (volunteers). 

The technique of using standardized patients is effective in practical training and at the stage of assessing students. This approach is a method of active learning and efficiently develop practical skills in students, while in the case of individual assignments it formes ability to work independently, in the case of collective (group) tasks - developing teamwork skills.

The learning pyramid (according to the National Training Laboratories, Bethel, Maine, 1969) and place of OSCE

Summary of Work

Analysis of the questionnaires showed that 4% of the students said about unfriendly volunteers, 27% - wrote that it was difficult to take medical history, 2% - unfortunately, have never faced such situation, 12% - said about improvement of the volunteers communication skills. Only 10% of examinees decided that OSCE doesn’t develop their communication skills, 24% said some stations that have caused them some difficulties. However, the students themselves admitted their poor communication skills.

Take-home Messages

Use of OSCE gives possibility to achieve an objective, unbiased assessment of the knowledge and skills of students, to evaluate teaching and quality of curriculum.

References
1. Zhaksylykova GA Derbisalina GA The objective structured clinical examination as a method of monitoring and evaluation skills of the students of the medical school. Astana. - 2009. 
2. Dosmagambetova RS, Kaptagaeva AK, Kemelova GS, Taizhanova DZ, Ricklefs VP Simulation technology in medical education. Karaganda. - 2010. 
......
Summary of Results

According to the State educational standards of Kazakhstan, the 5th year students (specialty "General Medicine") have to pass a two-stage exam in the end of clinical subjects study. This exam consists of integrated testing and skills evaluating by OSCE. Subject "General practice" includes four modules: "Internal Medicine", "Childhood diseases", "Obstetrics and Gynecology", "Surgical diseases". Skills evaluation was made at 10 OSCE stations. We involved "standardized patient" (volunteers, 6th year students). The analysis of these stations will allow us to analyze the level of communication skills of students. Students who have passed the exam, completed an anonymous questionnaire evaluating OSCE and their communication skills.

OSCE stations

Conclusion

OSCE with volunteers and systematic feedback from both students and the volunteers can improve and assess the communicative competence of students. Analysis of the questionnaires showed that the students self-critical attitude to their communication skills, and recognize the need for their continuous improvement.

Acknowledgement

Authors

Vitaliy Koikov

MD, Doctor of Medical Sciences,

Head of Centre for Research, Expertise and Health Innovation Development  of the Republican Centre for ?ealth Development,

vitaliy.koikov@gmail.com

Gulmira Derbissalina

MD, Candidate of Medical Sciences, Associate Professor

Head of Department of General Practice of Astana Medical University

derbissalina@gmail.com


Lazat Karsakbaeyeva

MD, Candidate of Medical Sciences

Associate Professor of Department of General Practice of Astana Medical University


lz.kars@gmail.com

 

Zarema Gabdilashimova

MD, Doctor of Medical Sciences,

Professor of Department of Obstetrics an Gynecology of Astana Medical University

gzarema@mail.ru

Zhanagul Bekbergenova

MD

Assistent of Department of General Practice of Astana Medical University

 

zhanna_bekbergen@mail.ru

 

We thank the volunteers who had played the role of standardized patients and students included in the survey.

 

Background

Communicative competence is one of the important components of professional competence, which must be developed in the course of the training of doctors. Not only students but also graduates of medical schools often have communication difficulties in their professional activities. Communication skills of physician (for any specialty) have a decisive influence on the degree of satisfaction of the patient by medical care, their evaluation of the physician professional competence, the completeness and accuracy of the diagnosis, as well as the efficiency of the health system as a whole.

This requires special attention to the training of doctors, the development of their communicative literacy at all stages of the educational program. In the present conditions medical school student should not only be professional, but also have developed communicative abilities. One of the methods to assess the communicative competence of the student is to conduct Objective Structured Clinical Examination (OSCE) with participation of volunteers - standardized-patients. Monitoring and evaluation of knowledge with the use of OSCE method can achieve an objective, unbiased assessment of the knowledge and skills of students, to give a principled assessment of the level of teaching, the quality of the educational process.

Summary of Work
Analysis of the questionnaires showed that 4% said that volunteers were unfriendly with them, 27% wrote that it was difficult to communicate with volunteers (2% - have a question when you can use two solutions of the situation, and 2% - not encountered ever with this situation , 23% - no friendly volunteers), 12% have commented to the volunteers (to speak up loudly, do not ask too many and not the right questions, do not ask theory), 10% responded that OSCE doesn't develop communication skills, 24% said that the stations are complex (8% - Therapeutic station, due to heavy contact with the volunteers themselves ill-prepared examinees, 8% - Station childhood diseases due to poor preparedness, 2% - obstetrics and gynecology, as the station they do not understand, 4% - surgical disease, unspecified) , 24% want to make suggestions to improve the OSCE stations (8% offer to attract volunteers on the station of palpation of the thyroid gland, and 4% did not ask further questions to teachers, 4% of teachers do not look at students examinees), 4% of students believe that the examiners were not objective. 
In the comments students offer to show their evaluation sheets for objectification, to implement mini-OSCE in the class, volunteers have to forget about the theory and the fact that they are students of the Medical University.
 
Take-home Messages
References
1. Zhaksylykova GA Derbisalina GA The objective structured clinical examination as a method of monitoring and evaluation skills of the students of the medical school. Astana. - 2009. 
2. Dosmagambetova RS, Kaptagaeva AK, Kemelova GS, Taizhanova DZ, Ricklefs VP Simulation technology in medical education. Karaganda. - 2010. 
3. Footage of OSCE 2012. 
4. Mo'minov TA, MI Dauletbakova Innovative technologies in the educational process of medical schools. Almaty. - 2003. 
5. Mo'minov TA, MI Dauletbakova The objective structured clinical examination in assessing the skills of graduates. Almaty. - 2008. 
6. Nazarbayev RK, LM Zhamalieva Development and implementation of an objective structured clinical examination for subordinators - general practitioners. Aktobe. - 2006. 
7. Carrol J.G., Munroe J. Teaching medical interviewing: a critique of educational research and practice. J. med. Education 54, 498-500, 1979.
8. Pendleton D. A. Doctor-patient communication. Doctoral dissertation, University of Oxford. 1981.
9. Pendleton D. A., Schfield N., Tate P. et al, The consultation. An approach to learning and teaching. Oxford medical publications, 1987..
Summary of Results
In medical schools of Kazakhstan OS?E on the subject "General practice" is held four times per year at the end of each rotation. There are 10 stations OSCE - 5 stations of the block "Practice of Internal Medicine for GP" - "Community-acquired pneumonia: diagnosis and determine the indications for hospitalization", "Peptic ulcer: diagnosis of complications and indications for referral to a specialist", "Chronic pyelonephritis: diagnosis of acute and justification of additional types of surveys", " Billing certificate of incapacity"," Methods of palpation of the thyroid gland ", 1 station of the block" Surgical diseases at the GP practice" - removal of stitches, 3 stations of the block "Childhood diseases at the GP practice" - clinical decision situational problems (newborn examination, the examination of children, issues of immunization), 1 station OSCE of the block "Obstetrics and Gynecology at the GP practice" - advice on contraception and family planning.
In the course of our examination on the four stations of the ten volunteers were involved - students of the 6 course, which was conducted prior training as a "standardized patient" according to the station where they would be.
At the end of the examination examinees students filled out a questionnaire to assess their communication skills (feedback). We have analyzed 51 questionnaires.

Feedback (questionnaire for the 5th year students)

1. Did you have any comments on the organization OS?E?

2. Do you have comments on the teachers?

3. Were you friendly with volunteers?

4. Was it easy to get in touch with the volunteers? At what station more difficult? Why?

5. Do you have comments to the volunteers?

6. Does OSCE systematize your knowledge and skills? (Step by step instructions)?

7. Is OSCE the objective tests of knowledge in your opinion?

8. Does OSCE develop your communication skills? Yes No

9. What OSCE station were difficult for you and why?

10. Your suggestions for the OSCE improvement at the individual stations

11. Were examiners objective in assessing your knowledge and skills?

etc. 

Conclusion
Acknowledgement
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