Abhishek Bhardwaj, Ranjana Beniwal
From the Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Web Publication2-Nov-2022

Correspondence Address:
Abhishek Bhardwaj
From the Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijd.ijd_575_21

How to cite this article:
Bhardwaj A, Beniwal R. Objective structured clinical examination as a training tool for leprosy in the time of elimination. Indian J Dermatol 2022;67:480
How to cite this URL:
Bhardwaj A, Beniwal R. Objective structured clinical examination as a training tool for leprosy in the time of elimination. Indian J Dermatol [serial online] 2022 [cited 2022 Nov 7];67:480. Available from: https://www.e-ijd.org/text.asp?2022/67/4/480/360341

Sir,

India attained the World Health Organisation (WHO) target of elimination for leprosy as a public health problem by the end of 2005 but is still among the 22 'global priority countries' that contribute 95% of the world numbers of leprosy.[1] In this paradoxical scenario, training young dermatologists to detect and treat leprosy at the earliest holds paramount importance. The objective structured clinical examination (OSCE), a performance based method seems to be a promising alternative to the conventional methods of training for leprosy [Table 1].

The traditional tools for training and assessment of medical students mainly consisted of written exams, bedside viva and clinical case presentation. These tools focus on the 'knows' and 'knows how' aspects, that is, the focus has been restricted to the base of the 'Miller's pyramid of competence'.[2] They have been criticized for lacking structure and standardization, having poor inter-rater reliability, and not minimizing examiner bias.[3] They test only the factual knowledge and do not evaluate the clinical competence of students. Important aspects such as performing a particular physical examination (shows how), clinical manoeuver, and communication skills are not tested. The students are tested on different patients (patient variability) and each student is adjudged by only one or two examiners, thereby a scope for marked variation in the marking by different examiners (examiner variability).[4]

The current emphasis on education is moving away from 'assessment of learning' to 'assessment for learning'. To foster actual learning, training and assessment should be educative and formative. Harden et al.[5] proposed the OSCE in medical school described it as 'a timed examination in which medical students interact with a series of simulated patients in stations that may involve history taking, physical examination, counselling or patient management.' Over the past few decades, OSCE has been proven to be a valid and reliable tool that can assess all the three learning domains (cognitive, affective, and psychomotor) and the 'shows how' level described in the Miller pyramid.

OSCE was used in our department of dermatology, venereology and leprology for semester examination wherein one of the stations was of a leprosy patient. The station had different items that evaluated one competency and could be scored by an examiner on a checklist [Table 2]. After the exam, students and examiners discussed about the common mistakes and proposed corrections for the students. As all the candidates were assessed at the same station turnwise, patient variability, lack of reliability and validity were nulled. OSCE enhanced communication skills, was comprehensive, fair and transparent and helped the students in self-feedback or identifying their weak areas.

Teaching tools such as OSCE are designed for determining whether one can 'do things' rather than simply remember, talk and write about them. It would be appropriate to use OSCE to assess specific clinical skills (psychomotor domain) and combine it with other methods to judge the overall competency.[4] We propose inclusion of OSCE, a skill based method for training dermatology residents about leprosy considering its higher objectivity, reliability, validity and acceptance among residents and teachers alike and its advantage of simulation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

   References 
1.Rao PN, Suneetha S. Current situation of leprosy in India and its future implications. Indian Dermatol Online J 2018;9:83-9.  
[PUBMED]  [Full text]  2.Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65:63-7.  
    3.Khan KZ, Ramachandran S, Gaunt K, Pushkar P. The objective structured clinical examination (OSCE): AMEE guide no. 81. Part I: An historical and theoretical perspective. Med Teach 2013;35:e1437-46.  
    4.Gupta P, Dewan P, Singh T. Objective structured clinical examination (OSCE) revisited. Indian Pediatr 2010;47:911-20.  
    5.Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J 1975;1:447-51.  
    

 
 

  [Table 1], [Table 2]