Adv Physiol Educ 33: 21–23, 2009;
doi:10.1152/advan.90108.2008.
How We Teach
A trial of the objective structured practical examination in physiology at
Melaka Manipal Medical College, India
Reem Rachel Abraham,1 Rao Raghavendra,2 Kamath Surekha,1 and Kamath Asha3
1
Department of Physiology, Melaka Manipal Medical College (Manipal Campus), Manipal; and Departments of 2Physiology
and 3Biostatistics, Kasturba Medical College, Manipal, Karnataka, India
Submitted 8 February 2008; accepted in final form 17 November 2008
tern 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
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 pat-
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. Eight stations
were composed of questions that tested students’ knowledge and
critical thinking, and two stations were composed of skills that
students 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).
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@yahoo.com).
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.
assessment; student performance
1043-4046/09 $8.00 Copyright © 2009 The American Physiological Society
21
Downloaded from http://advan.physiology.org/ by 10.220.33.4 on September 29, 2016
Abraham RR, Raghavendra R, Surekha K, Asha K. A trial of
the objective structured practical examination in physiology at Melaka
Manipal Medical College, India. Adv Physiol Educ 33: 21–23, 2009;
doi:10.1152/advan.90108.2008.—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, 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.
How We Teach
22
OBJECTIVE STRUCTURED PRACTICAL EXAMINATION
Table 2. Student perspectives regarding the OSPE
Yes
Questions
RESULTS
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.
DISCUSSION
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
Table 1. Comparison of the performance of students in the
OSPE and TPE
Within the anticipated difference
Below the anticipated difference
Above the anticipated difference
Total
Frequency
Percentage
77
7
39
123
62.6
5.7
31.7
100.0
The anticipated limit was 8. OSPE, objective structured practical examination; TPE, traditional practical examination.
Percentage
Number
Percentage
116
95.08
6
53
43.08
69
56.6
109
89.3
13
10.7
12
9.8
110
90.2
105
86.06
17
13.9
52
42.6
70
57.4
96
78.68
26
21.3
45
36.88
77
63.1
93
76.22
29
23.8
4.91
n ⫽ 122 students total that responded to the questionnaire.
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 beforenoon 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.
Advances in Physiology Education • VOL
33 • MARCH 2009
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Fig. 1. Bland-Altman plot of the marks using the objective structured practical
examination (OSPE) and traditional practical examination (TPE).
1. The questions asked were
relevant.
2. Sufficient time was given
to each student.
3. The activity stations that
were used to demonstrate
skills were relevant.
4. OSPE is the same as the
earlier pattern of
examination (TPE).
5. OSPE covered a wide
range of knowledge
compared with TPE.
6. OSPE is more stressful
compared with the old
method (TPE).
7. OSPE is fair compared
with TPE.
8. OSPE is easier to pass
compared with TPE.
9. OSPE should be followed
as the method of
assessment of laboratory
exercises in physiology
henceforth.
No
Number
How We Teach
OBJECTIVE STRUCTURED PRACTICAL EXAMINATION
ACKNOWLEDGMENTS
We thank all the March 2007 students for participating in this study and
giving valuable feedback.
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