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RESEARCH-ARTICLE
1Department of Physiology, Melaka Manipal Medical College (Manipal Campus), Manipal; and Departments of 2Physiology and 3Biostatistics, Kasturba Medical College, Manipal, Karnataka, India
Address for reprint requests and other correspondence: R. R. Abraham, Dept. of Physiology, Melaka Manipal Medical College (Manipal Campus), Manipal, Karnataka 576 104, India (e-mail: reemabraham{at}yahoo.com).
Abstract
A single examination does not fulfill all the functions of assessment. The present study was undertaken to determine the reliability and student satisfaction regarding the objective structured practical examination (OSPE) as a method of assessment of laboratory exercises in physiology before implementing it in the forthcoming university examination. The present study was undertaken in the Department of Physiology of Melaka Manipal Medical College (Manipal Campus, Manipal, Karnataka, India). During the OSPE, students were made to rotate through 11 stations, of which 8 stations were composed of questions that tested their knowledge and critical thinking and 2 stations were composed of skills that students had to perform before the examiner. One station was kept as the rest station. Performance of the students was assessed by comparing the students' scores in the traditional practical examination (TPE) and OSPE using "Bland-Altman technique." Student perspectives regarding the OSPE were obtained by asking them to respond to a questionnaire. The Bland-Altman plot showed that 
63% of the students showed a performance in the scores obtained using the OSPE and TPE within the acceptable limit of 8; 32% of the students scored much above the anticipated difference in the scores, and the rest scored below the anticipated difference in the scores on the OSPE and TPE. Feedback indicated that students were in favor of the OSPE compared with the TPE. Feedback from the students provided scope for improvement before the OSPE was administered for the first time in the forthcoming university examination.
Key words: assessment; student performance
IT IS A WELL-KNOWN FACT that assessment drives learning. A single examination does not fulfill all the functions of assessment, such as assessing knowledge, comprehension, skills, motivation, and feedback (3, 4, 9). A good test must be acceptable to those using it, feasible, valid, and reliable (11). At Melaka Manipal Medical College (MMMC; Manipal Campus) in Manipal, Karnatka, India, students are taught anatomy, physiology, and biochemistry in their first year.
Physiology departments in many medical schools have been using the objective structured practical examination (OSPE) as an assessment method for assessing students' performance in laboratory exercises (1, 7). The Department of Physiology at MMMC has been implementing a series of reforms in both teaching and assessment strategies in the process of improving the quality of teaching and assessment methods. In the university examination, there used to be frequent complaints from external examiners insisting that the existing examination pattern is tedious and time consuming. The present study was undertaken to determine student satisfaction regarding the OSPE as a method of assessment of laboratory exercises in physiology before implementing it in the forthcoming university examination.
METHODS
At MMMC, there are two admission intakes per year: one in March and another in September. The first-year curriculum is divided into four blocks. At the end of each block, students undertake two examinations, both in theory and laboratory exercises. The present study was undertaken for the March 2007 group of students (n = 125 students) at the end of the third block (in November 2007). These students had undertaken the traditional practical examination (TPE) at the end of the first and second blocks. The TPE in physiology consisted of two components: computer-assisted OSPE (COSPE) (12) and performance exercises. In COSPE, 10 PowerPoint slides focusing on the interpretation of graphs, diagnosis of clinical conditions from photographs, identification of blood cells, reading the packed cell volume (PCV)/erythrocyte sedimentation rate, problems on the calculation of clearance/forced expiratory volume in the first second, etc., were projected onto a LCD screen with an autodisplay that projected a new slide every 3 min (each slide represented an original OSPE station). Each of these stations had questions carrying four marks. After finishing the COSPE, which took 30 min, students had to undertake the performance examination. In the performance examination, students were given two tasks (for example, determination of vital capacity, blood pressure recording, etc.). Students were required to perform these tasks in the presence of the examiner followed by a viva voce on the experiments that they had performed. The OSPE was introduced at the end of the third block. During OSPE examination, the same students (March 2007) were divided into three groups, and each group was required to report at a different time. In each group, four subgroups (with each subgroup consisting of 10 students) were made. Students were made to rotate through 11 stations, which 8 stations were composed of questions that tested their knowledge and critical thinking and 2 stations that were composed of skills they had to perform before the examiner. One station was kept as the rest station. The two stations in which students had to perform a task were composed of questions such as focusing the red blood cell-counting area in a Neubauer's chamber, palpation of apex beat, determination of the systolic blood pressure, etc. Students were given 3 min at each station. The entire examination was conducted in 1 day in three sessions with each session consisting of four circuits. Questions were on topics from all three blocks. Student performance in the TPE and OSPE was compared using "Bland-Altman technique" (Fig. 1). Student perspectives regarding the OSPE were obtained by asking them (March 2007 students) to respond to a questionnaire (Table 1).
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The Bland-Altman plot (Fig. 1) showed that 63% of the students showed a performance in the scores obtained using the OSPE and TPE within the acceptable limit of 8; 32% of the students scored much above the anticipated difference in the score, and the rest scored below the anticipated difference in the scores on the OSPE and TPE (Table 1). Table 2 shows students' perspectives regarding the OSPE. Ninety-five percent of the students felt that the questions asked were relevant and that the OSPE was comprehensive and covered a wider area of knowledge compared with the TPE (86%). Students (76.22%) felt that the OSPE should be the pattern of examination in the forthcoming block as well as university examinations, as they had to go through only one round of examination compared with the TPE, where they had to go through two separate examinations (COSPE and performance exercises). Nevertheless, 56.6% of the students felt that the time given (3 min) was too short, especially for the performance exercises. They also felt that the clinical pictures shown were not clear.
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Several studies have proved the objective structured clinical examination as a reliable assessment tool (2, 10). In the present study, the format of testing by the OSPE was similar to that of the objective structured clinical examination. Previous studies have reported that OSPE is an effective tool in discriminating between good and poor performers in physiology practical examinations (6, 8). Dissanayake et al. (1) reported a marked improvement in the mean scores for the laboratory component of final examinations in the physiology courses at King Faisal University Medical School. The block-end practical examination at MMMC used to be conducted in four sessions (1 session for COSPE and 3 performance sessions), which required 1 whole day. The university examination used to be conducted in both before-noon and afternoon sessions for 3 consecutive days. In the university examination, external examiners used to complain about the extensiveness of the examination. Students used to complain about the irrelevant questions asked by the examiners and also the subjectivity of the examination. They used to complain that the questions asked in the performance exercises varied in difficulty, giving rise to much variation in the scores. OSPE was adopted as a method of assessment with the intention of restricting the examination only in the before-noon sessions, thereby reducing the total time, to make the assessment uniform for all students and also to reduce the stress of students by making them go through only one round of examination instead of two rounds.
From the students' point of view, the OSPE was acceptable and generated wide appreciation. In a study conducted by Malik et al. (5), OSPE was rated by the students as a reliable, effective, useful, interesting, and challenging examination, although it was considered taxing, both mentally and physically. Feedback from the students (March 2007) indicated that students were in favor of the OSPE compared with the TPE (Table 1). The feedback provided scope for improvement before OSPE was administered for the first time in the forthcoming university examination. This study reveals the importance of the role of students in developing new assessment tools.
In conclusion, the present study revealed that the OSPE was well accepted by the students compared with the TPE. The study provided scope for refining the method before it was implemented for the first time in the forthcoming university examination.
Acknowledgments
We thank all the March 2007 students for participating in this study and giving valuable feedback.
Footnotes
The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Received for publication February 8, 2008. Accepted for publication November 17, 2008.
REFERENCES
This article has been cited by other articles:
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  R. Vyas, E. Tharion, and S. Sathishkumar Improving the effectiveness of physiology record books as a learning tool for first-year medical students in India Advan Physiol Educ, December 1, 2009; 33(4): 329 - 334. [Abstract] [Full Text] [PDF]
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