A telehealth-based training model for an ambulatory care pharmacy skills course

Description: Increasingly, pharmacy services are provided using telehealth-based modalities. This paper describes a pharmacy skills course that utilised telehealth principles to train students on the technical and communications skills necessary for the ambulatory care setting. Zoom breakout rooms, electronic health records, YouTube video vignettes, and teaching assistants portraying patients/physicians simulated a telehealth-based ambulatory care setting. Evaluation: Five quizzes and six written assignments were utilised to measure student’s knowledge and skills. At the end of the course, students were evaluated through a three-station objective structured clinical exam (OSCE). Students also completed a pre/post attitudes survey. Result: Overall, students performed well on various assessments including quizzes and written assignments. The majority of the students performed well on the OSCE. Significant improvement was noted on all items in the attitudes survey. Conclusion: This study suggests that a telehealth training model can be effective in teaching pharmacy students both the technical and communication skills necessary for practice in the ambulatory care setting.

Hands-on training on inhaled devices to boost pharmacy students’ performance during inhaler counselling

Objective: The effective use of inhalers depends on completeness of information from healthcare providers. As pharmacists acquire foundational skills on inhalers from their undergraduate curriculum, the experience and performance of pharmacy students regarding inhaler counselling should be explored. Methods: Pharmacy students who completed their final year of study answered an online questionnaire on their experience with teaching-learning activities on inhalers. Students also underwent an objective structured clinical exam that included Turbuhaler device counselling. Results: 84 students who completed the online questionnaire strongly agreed that the curriculum increased their awareness of different types of inhalers (65.5%) and specific techniques for use (64.3%). Students reported being able to counsel on metered-dose inhaler (98.8%) and dry-powder inhaler (92.8%) techniques. Students performed well (mean=9.4, SD=2.7) at Turbuhaler counselling from a full score of 14. Conclusions: The current training on inhaler devices was useful for the pharmacy students. Future training should emphasise supplementary advice on inhaler taste and gargling.

Faculty Perceptions on Objective Structured Clinical Exam in Dental Education

Structured Clinical Exam (OSCE) uses standardized content and procedures to assess students across multiple domains of learning. The study is aimed to assess knowledge, attitudes, practices and observations of dental faculty on OSCE. The survey was distributed into dental faculty members in randomly selected government and private institutions in Saudi Arabia. The questionnaire was pre-tested and consisted of 4 categories including general characteristics of respondents, knowledge on utility of OSCE in curriculum and it’s reliability, attitudes regarding OSCE on a 5 point Likert scale, practices and observations on OSCE on Multiple choice questions (both single answer and multiple answer) and responses on a 5 point Likert scale. The sample size was determined to be 93 and the survey was sent electronically to 10 institutes. 101 complete responses from 7 institutions were considered from the 122 received. Faculty participation in OSCE was high within evaluators 94% (n=94) and administrators 61% (n=61). Majority of respondents (62%) believed that OSCE is most suited for competency based education, to assess cognitive skills (73%) and diagnostic interpretation (79%). Reliability of OSCE can be increased by standardization of evaluators (77%) with highest number believing that 6-8 stations (42%) are the minimum required in an OSCE. Institution guidelines (49%) coupled with workshops (47%) was the preferred method of preparation for OSCE. Majority felt that OSCE is most suitable for high stakes exams (mean=3.37) and it is an indispensable part of dental assessment (mean=3.78). Minimum number of stations for adequate reliability was reported to be lesser that in reported literature, specially so for high stakes assessments. Logistics required for arranging an OSCE and difficulty in standardized patients, may suggest that OSCE should be used in select situations.

The critical role of direct observation in entrustment decisions

Background: Entrustment decisions may be retrospective (based on past experiences with a trainee) or real-time (based on direct observation). We investigated judgments of entrustment based on assessor prior knowledge of candidates and based on systematic direct observation, conducted in an objective structured clinical exam (OSCE). Methods: Sixteen faculty examiners provided 287 retrospective and real-time entrustment ratings of 16 cardiology trainees during OSCE stations in 2019 and 2020. Reliability and validity of these ratings were assessed by comparing correlations across stations as a measure of reliability, differences across postgraduate years as an index of construct validity, correlation to standardized in-training exam (ITE) as a measure of criterion validity, and reclassification of entrustment as a measure of consequential validity. Results: Both retrospective and real-time assessments were highly reliable (all intra-class correlations >0.86). Both increased with year of postgraduate training. Real-time entrustment ratings were significantly correlated with standardized ITE scores; retrospective ratings were not. Real-time ratings explained 37% (2019) and 46% (2020) of variance in examination scores vs. 21% (2019) and 7% (2020) for retrospective ratings. Direct observation resulted in a different level of entrustment compared with retrospective ratings in 44% of cases (p = <0.001). Conclusions: Ratings based on direct observation made unique contributions to entrustment decisions.

Feedback after OSCE: A comparison of face to face versus an enhanced written feedback

Background The Objective Structured Clinical Exam (OSCE) is a useful means of generating meaningful feedback. OSCE feedback may be in various forms (written, face to face and audio or video recordings). Studies on OSCE feedback are uncommon, especially involving Asian medical students. Methods We compared two methods of OSCE feedback delivered to fourth year medical students in Malaysia: (i) Face to face (FTF) immediate feedback (semester one) (ii) Individualised enhanced written (EW) feedback containing detailed scores in each domain, examiners’ free text comments and the marking rubric (semester two). Both methods were evaluated by students and staff examiners, and students’ responses were compared against their OSCE performance. Results Of the 116 students who sat for both formative OSCEs, 82.8% (n=96) and 86.2% (n=100) responded to the first and second survey respectively. Most students were comfortable to receive feedback (91.3% in FTF, 96% in EW) with EW feedback associated with higher comfort levels (p=0.022). Distress affected a small number with no differences between either method (13.5% in FTF, 10% in EW, p=0.316). Most students perceived both types of feedback improved their performance (89.6% in FTF, 95% in EW); this perception was significantly stronger for EW feedback (p=0.008). Students who preferred EW feedback had lower OSCE scores compared to those preferring FTF feedback (mean scores ± SD: 43.8 ± 5.3 in EW, 47.2 ± 6.5 in FTF, p=0.049). Students ranked the “marking rubric” to be the most valuable aspect of the EW feedback. Tutors felt both methods of feedback were equally beneficial. Few examiners felt they needed training (21.4% in FTF, 15% in EW) but students perceived this need for tutors’ training differently (53.1% in FTF, 46% in EW) Conclusion Whilst both methods of OSCE feedback were highly valued, students preferred to receive EW feedback and felt it was more beneficial. Learning cultures of Malaysian students may have influenced this view. Information provided in EW feedback should be tailored accordingly to provide meaningful feedback in OSCE exams.

An Objective Structured Clinical Exam As a Tool for Assessing the Communicative Skills of Residents in Simulated Conditions

The relevance of the research problem is due to the need to update theoretical views and practical actions to create new methods for an objective and structured assessment of the communication skills of students at a medical university. The purpose of the article is to prove the suitability, reliability, feasibility of an objective structured clinical examination (OSKE) as a tool for assessing the communication skills of residents in simulated conditions during the intermediate certification of students. The leading research method was an experiment on the development and implementation of three stations within the framework of the OSKE to assess the communication skills of 77 residents who completed the training course in the discipline "Communication skills" necessary information and resistance to doctor's recommendations. The article shows that experts highly assess the level of formation of general communication skills and skills of explaining information to the patient among the majority of examinees. It was revealed that communication skills associated with persuading the patient to follow the doctor's recommendations require improvement. Based on the methods of oral questioning and questioning, as well as psychometric analysis of the exam results, it has been proven that the developed OSKE is a reliable and valid tool for assessing the communication skills of residents in simulated conditions. The materials presented in the article can be used for intermediate and final certification of students in residency, as well as in the process of teaching future doctors the skills of communicating with patients at clinical departments. The technology of the exam, developed by the authors, will make it possible to fairly objectively assess communication skills, to cause the examinees to experience a sense of fairness in assessment, which is one of the factors in the emergence of a positive attitude towards improving the activity of professional communication.