Indian J Physiol Pharmacol 1999; 43 (2) : 242-246

OBJECTIVE STRUCTURED PRACTICAL EXAMINATION INPHARMACOLOGY FOR MEDICAL LABORATORY TECHNICIANS

GITANJALI BATMANABANE, RAMASAMY RAVEENDRAN ANDCHANOLEAN SHASHINDRAN

Department of Pharmacology,Jawaharlal Institute of Postgraduate MedicalEducation & Research (JIPMER),

Pondicherry - 605 006

(Received on March 27, 1997)

Abstract: The objective structured practical examination (OSPE) is auseful evaluation method for testing psychomotor skills. Students for thedegree in medical laboratory technology require to learn certain skillswhich will make them useful in any research or teaching laboratory inexperimental pharmacology. We outline an OSPE which can be used forevaluating students in experimental pharmacology.

Key words: OSPE evaluation methods

INTRODUCTION

The degree course for medical laboratorytechnicians [B.Sc (MLT)) requires thatstudents attain a certain degree ofproficiency in psychomotor skills such ashandling animals, putting up isolatedtissues, administering drugs to animals bythe various routes independently andmaking necessary arrangements for theconduct of practical classes or experiments.Skills such as handling of animals andmounting of tissues are very relevant (1) tothe tasks expected of these trainees in theircareer and hence assume great importance.A great deal of curricular time and effort isspent on these areas.

At the present time evaluation duringthe practical examination has been by a seatviva at the end of the practical. It is a form

*Corresponding Author

of global assessment at the end of thepractical task. Since the process is notevaluated, this method lacks contentvalidity (2). In order to overcome thisproblem we decided to identify certainimportant psychomotor skills related toexperimental pharmacology (Table 1) whichcould be tested in an objective manner andconvert the examination pattern to objectivestructured practical examination (OSPE).

METHODS

A station is the place designated fortesting a particular skill. Stations testingpsychomotor and communication skills arecalled procedural stations (3) and thosetesting cognitive skills such asinterpretation, analysis, synthesis andproblem solving skills are known asresponse stations. Approximately two thirds

Indian J Physiol Pharmacol 1999; 43(2)

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Indian J Physiol Pharmacol 1999; 43(2) OSPE in Pharmacology 243

TABLE I: Some important skills in experimental pharmacology for medical laboratory technicians.

1. Correct use of the physical balance to weigh a substance.

2. Loading the exact volume of a drug into a hypodermic syringe from a vial.

3. Injecting subcutaneously

4. Handling of mice and injecting a given drug through the intraperitoneal route single handedly

5. Mounting the isolated rat ileum preparation

6. Obtaining a response with Frog rectus isolated muscle preparation

7. Smoking a kymograph drum

8. Attaching the isolated frog heart to the lever and recording a reponse with a drug

9. Handling a frog and counting respiratory movements in frog

10. Measuring tail-flick response of rat using the analgesiometer

of the stations are procedural stations andthe remaining one third are responsestations. This can vary according to thecontent area being evaluated. The exactnumber of stations can be decided based onthe infrastructure, time and manpoweravailable for conducting the examination.The test is conducted with ten minutesbeing allotted to each station.

Each procedural station is manned byone observer who may be a faculty memberor a technician or a resident while theresponse stations are unmanned. Each ofthe observers is given prevalidatedchecklists which are used to rate theperformance of the students. At the end ofthe exam the scores of individual studentsare tabulated. We describe below twoexamples each of the procedural andresponse stations.

Materials to be provided : Hypodermicsyringe of 1 ml capacity, hypodermicneedles (with caps) of 18 to 24 gauge, anorange with a site marked on it, salinesolution, spirit, cotton, sharps disposalcontainer.

Check-list

1. Wipes area with spirit from centre toperiphery.

2. Waits for the spirit to dry.

3. Positions needle with bevel facingupwards.

4. Holds syringe. in correct manner(without touching needle).

5. Inserts needle at 45° degree angle.

6. Withdraws to check that the needle IS

not in a vein.

8. Withdraws and wipes area with cotton.

Procedural station 1 :

Skill to be tested: Injecting subcuta­neously.

7. Pushes plungercompletely.

smoothly and

T ASK I nj e cto. 1 m I 0 f s a lin esubcutaneously and dispose the needle.

9. Disposes needle (without recapping) andsyringe.

244 Batmanabane et al

Procedural station 2

Skill to be tested: Using the physicalbalance fot)~~eighing a substance.

TASK: Weigh 1.029 g of sodium chlorideusing the physical balance. The sensitivityof the balance is 1 mg.

Materials to be provided: Physical balance,weights, butter paper, sodium chloride.

Check-list

1. Follows counterpoising procedure.

2. Places paper of same size in both pans.

3. Places weights in left pan.

4. Does not spill outside the pan.

5. Releases the lever before removingladding salt.

6. Removes weights and returns them tothe box.

7. Cleans up.

Response station 1:

Skill to be tested : Calculation of thedose of a drug and the procedure for dilutionto obtain the correct volume that can beaccurately measured in a syringe.

TASK: The dose of drug "A" is 0.5 mglkg. The concentration of the solution of "A"provided is 1 percent.

(a) Calulate the volume that is requiredfor injecting drug "A" into a mouse weighing25 g.

Indian J Physial Pharmacal 1999; 43(2)

(b) Write down the steps of theprocedure so that the correct amount of thedrug can be accurately loaded in atuberculin syringe.

Response station 2:

Skill to be tested: Recognition of symbolsdisplayed on labels denoting inflammable,corrosive, radioactive and poisonous.

TASK: You are given lebels for fourboxes containing the following chemicals:

1. Ether

2. Concen tra ted nitric acid

3. Sodium cyanide

4. RIA Kit for assay of insulin

(a) Draw the most appropriate symbol whichcharacterises the property of each chemicalagainst its name.

(b) Give two examples of chemicals for each

symbol you have drawn.

DISCUSSION

The present practical 'examinationsystem in pharmacology for the medicallaboratory technicians lacks validity,objectivity and reliability. Since studentsare asked to carry out individualexperiments, there is a lack of uniformityas some experiments are much easier toperform. Hence luck plays a major role in'the outcome. There is also high inter­examiner variability. OSPE successfullyreduces most of these problems.

Indian J Physiol Pharmacol 1999; 43(2)

The advantages of OSPE are that thereis uniformity since all students perform allthe tasks, it is very objective and a largenumber of students can be effectivelyexamined in a relatively short time. Themain drawback of OSPE seems to bethe fact that there is an artificialcompartmentalization of tasks which doesnot truly reflect the real life situation. Theother problems are observer fatigue, whichcan be avoided by getting observers tochange stations after some time. Theadvantages far out-weigh the disadvantagesof this method. Prior discussion with allteachers and meticulous planning isrequired to conduct OSPE effectively.However, once started, its advantagesbecome obvious to students and teachersalike.

Lack of confidentiality is probably theonly reason why OSPE cannot be conductedduring the university examinations.Therefore, we recommend the use of OSPEfor formative examinations only (we conductfour such examinations).

OSPE in Pharmacology 245

The success of OSPE depends a greatdeal on the checklists which are used. Indesigning these checklists care should betaken that the task and its components areobservable, measurable and can becompleted comfortably within the allottedtime. Discussions with the faculty andstudents will ensure that unrealistic andirrelevant tasks are not set. Responsestations can be set to test problem solvingskills which are complementary to thE: skillstested in the procedural stations. In the firstexample described in this paper theresponse station tests the ability of thestudent to calculate the dose to be injectedwhile the procedural station tests the skillof injecting the drug.

A candidate's individual score afterOSPE is indicative of the expertise gainedby the student for that particularpsychomotor skill whereas the group scoreserves as a feedback to the teacher. In theworked out example given in Table II onlycandidates No. 2 & 4 have received veryhigh scores. All the students have performed

TABLE II : OSPE Code SheetCheck List for injecting subcutaneously.

1. Wipes area with spirit from centre to periphery2. Waits for spirit to dry3. Positions needle with level f~.cing upwards4. Holds syringe correctly (without touching needle)5. Inserts needle at 45° angle for 1 cm6. Withdraws to check that the needle is not in a vein7. Pushes plunger smoothly and completely8. Withdraws and wipes area with cotton9. Disposes of needle (without recapping) and syringe

Individual Score

SI.No ItemCandidate's number

1 2 3 4 5

" " x " x

x " x " x

" " x " x

" " " " "" " " " ...J

x x x x x

x " x " x

" " x " x

x x x x x

5 7 2 7 2

Group

6 Score

,I 4

" 3x 3

" 6

" 6x 0

" 3

" 4x 0

6

Instructions to observer: Mark (,f), if yes/doneMark (x), if no/not done

Name of observer: Signature

246 Batmanabane et al

correctly at the fourth and fifth subtaskswhereas none of them have got the sixthand ninth subtasks correct. When themajority of the students in a class is notable to do a task properly the teacher shouldtake this as a feedback implying inadequate

Indian J Physiol Pharmacol 1999; 43(2)

or faulty coverage during the teaching­learning session (4). This will help theteacher in devising better teaching-learningactivities so that students are able to attainproficiency in the skills practised.

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