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EducationalAssessment. Classroom MCQs Clinical OSCE. Objectives. By the end of seminar learners will be able to: Define assessment Overview of assessment and educational assessment Explain attributes of assessment

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By the end of seminar learners will be able to:

  • Define assessment

  • Overview of assessment and educational assessment

  • Explain attributes of assessment

  • Describe multiple choice questions (MCQs)

  • Discuss the steps of designing MCQs.

  • Identify advantages and disadvantages of MCQs

  • Define OSCE

  • Discuss the process of OSCE

  • Converse approaches/models of OSCE

  • Debate on OSCE

  • Discuss Ethical issues in OSCE

  • Know the views of students and faculty for OSCE

Definition of assessment
Definition of Assessment

  • Assessment comes from the old French word assessor, meaning to sit by as an assistant judge or guide.

  • The process of collecting information on student achievement and performance. Provides information for basis of sound decision making regarding teaching and learning.


  • “The process of assessment is to gather, summarize, interpret, and use data to decide a direction of action”

    (Bastable 2003)

  • “Begins with educational values, works best when program has clear purposes…is ongoing and meets the responsibilities to students and public”

    (Billings 2003)

Educational assessment
Educational Assessment

  • “Is the process of documenting, usually in measureable term, knowledge, skills, attitudes, and beliefs”

  • “It focus on the individual learner, the learning community, the institution, or the educational system as a whole”

Overview of assessment
Overview of Assessment




Of What






  • What? process of gathering…

  • Why?

    • Measure academic achievement

    • Identify areas for improvement

    • Predict future performance

Of what




Affective (Attitude)

Psychomotor (Skills)


Facts and principles


Signs and symptoms

Clinical methods




Of what?


  • Written tests

    • Essay

    • True false

    • MCQs

    • MCIs

    • Viva/oral

    • Practical

    • Long case/short case

    • Osce

    • Projects


Performance assessment in vivo

Undercover SPs, Video, Logs only in real world of



Performance assessment in vitro

OSCE, Standardized-patient based test

Shows how

(Clinical) Context based tests

MCQ, essay, oral

Knows how

Factual test: MCQs, Essay, Oral


Both areas tested by traditional written exams….

(Miller 1990)


  • Testing in situations similar to

    those in training and practice,

    enable to make justifiable


Attributes of assessment
Attributes of Assessment

Curricular attributesinclude

  • Program and course objectives

  • Critical learning experiences

  • Learning outcomes

    Faculty attributes comprise

  • Level of content knowledge

  • attitude about teaching

  • Instructional skills

  • Appropriate knowledge of teaching learning theories

    Students’ attributes consist of

  • Knowledge and skills

  • Cognitive abilities

  • Learning styles

  • Motivation to achievement (Billings 2005)

How to develop effective assessments
How to develop effective Assessments?

  • Should be RELIABLE and VALID

  • Reliability: A reliable assessment is one that provides consistent “scores”.

  • Validity: An assessment is valid when it accurately measures what is to measure.

Multiple choice questions mcqs

Consists of two



Can be a question or an incomplete statement, scenario, problem

Several options/ distracters

But to choose the best response

Multiple Choice Questions. MCQs

Steps in designing mcqs
Steps in Designing MCQs


  • Clear single problem

  • Content should be common

  • Independent of all others in the test

  • Information in one stem should not give clue to another item

  • Scenarios incorporated carefully

  • Use of action verbs of Bloom taxonomy (1956) according to cognitive level of students

  • Knowledge, comprehension, application, analysis

  • (Billings, 2005)

Steps in designing mcqs1
Steps in Designing MCQs


  • Grammatically consistent with stem to avoid giving clues to right one

  • Arrangement order, alphabetical, numerical

  • Having same length

  • Give only one best option, to which all faculty agree

  • Should not use all of above, none of above

Examples of mcqs
Examples of MCQs

  • Knowledge

    1. A patient’s father died of Huntington’s chorea. What are the chances that pt will have the disease?

  • 25%

  • 50%

  • 75%

  • 100%


2. A pt resists the nurse's attempts to get him out of bed. If this attempt is without pt’s approval, what legal charge could nurse face?

  • Assault

  • Battery

  • Negligence

  • Tort


3. On the 1st post-op day after an open reduction and internal fixation (ORIF) of the tibia with application of long leg cast, the pt begins complaining of severe pain uncontrolled by his scheduled pain med. What would be the priority nursing intervention?

  • Administer a narcotic bolus as ordered

  • Assess the neurovascular status of leg

  • Lower the leg to increase arterial flow

  • Raise the leg to decrease venous return


4. A 70 yrs old woman is admitted to the hospital with a diagnosis of dehydration. Vital signs are stable. Serum sodium level is 165 mmol/L. Which of the fluid replacement is most likely to be administered?

  • Hypertonic

  • Hypotonic

  • isotonic

What makes mcqs good
What makes MCQs “Good”?

  • Alignment: to content, learning outcomes/goals,

  • Importance: testing details is a waste of resources; concentrate on fundamental concepts

  • Clarity: the intent of the task and the meaning of the options must speak for themselves and be interpreted in the same way by all examinees

  • Item construction: well-constructed items can be answered successfully by examinees who have the knowledge or skill you are testing, and NOT by examinees who are lacking the skill or knowledge


Large content in single test

Scored easily and objectively

Measure understanding at numerous cognitive levels in taxonomy category


Time consuming in designing for faculty

More time needed by students to read and understand

Differentiate against creative, verbal student

Writing style affects scores

Difficult to write MCQs at synthesis and evaluation level







CPR being performed on a mannequin used for training

Objective structured clinical examination
Objective Structured Clinical Examination

  • OSCE is a competency-based evaluation aimed at testing the psychomotor and affective domains with an inbuilt system for systematic feedback.

  • OSCE is a modern type of examination often used in health sciences (e.g. medicine, physical therapy, nursing, pharmacy) to test clinical skill performance and competence such as communication, clinical examination,


medical procedures / prescription, exercise prescription, joint mobilization / manipulation techniques, and interpretation of results.

  • Also known as “Standardized Patient Exams SPEs, described as an acceptable and powerful instrument in clinical performance evaluation… pretended patients in an artificial environment designed to simulate actual clinical condition”

    (Borbasi & Koop 1994 as cited in Billing 2005)

Process of osce
Process of OSCE

  • It normally consists of several short (5-10 minute) stations, in which each is examined on a one-to-one basis with an impartial examiner and either real or simulated patients (actors).

  • Considered to be an improvement over traditional examination methods because the stations can be standardized enabling fairer peer comparison and complex procedures can be assessed without endangering patients health


  • The other ways an OSCE is made objective is by having a detailed mark scheme and standard set of questions.

  • For example, a station concerning the demonstration to a simulated patient on how to use a Metered dose inhaler would award points for specific actions which are performed safely and accurately (e.g. candidate explains to patient the need for a seal around the mouthpiece, etc.)

Approaches models to osce
Approaches/Models to OSCE

Multi station


AKU Med students

1st & 2nd year


Scenario based OSCE

(sometimes called obj

structured clinical




3rd & 4th year

Top to Toe


OSCE /simulated

Assessment with random


Some centers also use viva, or Q/A with

these models

(Rushforth 2007)

Is osce debatable
Is OSCE debatable?

OSCE stations can never be truly standardized and objective in the same way as a written exam.

  • It has been known for different patients / actors to afford more assistance, and for different marking criteria to be applied (literature shows marking criteria as pass/fail, checklist, likert scale, percentages, done/not done)

  • It provides a formative evaluation for both students and the educational institution.

    (Rentschler et al, 2007)


  • It is a fast and well-organized evaluation method, allows rapid feedback to students about their clinical deficits (Billings 2005)

  • OSCE has been tested and found to be reliable, valid in various settings, provides a controlled clinical situation that is realistic and nonthreatening

  • # of stations 16 minimum, 37 max

    (as cited in Rushforth 2007)

  • Easy in controlled setting but difficult in real world

    Literature says that it should be mandatory for nursing students as well

    (Rentschler et al, 2007)

Ethical issues in osce
Ethical Issues in OSCE

  • Perceived inequity between students

  • Lack of honesty and professionalism of peers


  • Discuss the OSCE cases with other students after the OSCE? violation of the honor code.

  • Why not children as simulated patients?

Views of students and faculty


Overall satisfied


Improve performance

Can practice on peers as well

Encouragement and motivation


Overall satisfied

Students practice actively

Provide evaluation to students soon after exam

Views of students and faculty


Billings,D.M,Halstead,J.A. (2003).Teaching in nursing: A guide for faculty. 2nd ed.

Bastable,S.B.(2003).Nurse as educator:principles of

teaching and learning for nursing practice. 2nd ed.New York: Jones and Bartlett Publishers.

Hammond,L,D & Bransford, J.(eds) (2005). Preparing

teachers for a changing world:what teachers should learn and be able to do. USA. Jossey Bass. pp 275-326


Norman, G. (2002) The long case versus objective structured clinical examinations. BMJ324: 748-749

Objective Structured Clinical Examination. Retrieved Jan 29, 2009 from

Parks,R.,Warren,P.M.,Boyd,K.M., Cameron,H.,Cumming, A., & Jones, J.L. (2006).The Objective Structured Clinical Examination and student collusion: marks do not tell the whole truth.Journal of Medical Ethics,32. 734-738


Rentschler,D.D; Eaton,J; Cappiello,J; McNally,S.F; & McWilliam,P.(2007). Evaluation of undergraduate students using objective structured clinical examination. Journal of Nursing Education, 46 (3) 135-139

Rushforth, H.E. (2007). Objective structured clinical examination (OSCE): Review of literature and implications for nursing education. Nurse Education Today ,27, 481-490

Stiggins,R. J.(1999). Assessment, Student Confidence, and School Success. Phi Delta Kappan,81, (3) Retrieved Jan 23, 2009 from 2002.doc