CHAPTER
ONE
INTRODUCTION
Background
to the Study
Evaluation of learning outcomes is an
important and inevitable part of the education process that has been carried
out in institutions of learning for ages. This is because; it is through
academic evaluation that one infers whether the learner has learned and how far
educational learning objectives have been achieved. Tyler in Basavanthappa (2009) defined
evaluation as a process of determining to what extent educational objectives is
being realized. Scriven in Mahara (2002) stated that evaluation is both a
process and a product. A process of systematically and objectively determining
the merit, worth and value of things and also denotes the product of that
process. Evaluation is done using evaluation tools, which are instruments used in
determining whether or not learning has taken place. A major focus of
evaluation in Midwifery education is to determine those students who have
acquired the knowledge and skills needed to practice Midwifery based on set
standards (already agreed upon by educators). This thus involves class room and
clinical evaluation. Clinical evaluation
in Midwifery Education is aimed at appraising the quality and standard of
clinical competence of students following training in order to produce
graduates who can perform competently in real life situation.
Clinical competence is said to be what
the students should be able to do at an expected level of achievement such as
at graduation. It is also the synthesis of all attributes necessary to do that
task for which one is being trained. College
of registered nurses of Mamtoba (2012), defined clinical competences as the
mastering of relevant knowledge and acquisition of a range of relevant skills
at a satisfactory level including interpersonal, clinical and technical
competences and the integration and application of the knowledge, skills,
judgment and attitudes required to carry out the role and work for which one is
being trained. Competencies can be cognitive or performance based. The cognitive measures of competence is more
efficiently measured psychometrically (e.g. self assessment test) while
performance based measures are better evaluated using performance based
assessment example OSCE.
Traditionally evaluation in clinical
setting in Schools of Midwifery was done using oral/practical examination,
where a number of students were examined in different clinical areas of
practice. According to Barman (2005), questions asked were not consistent. The
traditional method was very subjective, had poor-inter-rater reliability and
was subject to halo effect (Shaw, 2006).
Both teachers and students were dissatisfied with this method of
evaluation because of these deficiencies. This made evaluators to search for a
more appropriate objective and standardized alternatives to improve the
evaluation process. A standardized form
of examination to be used as tool for assessing clinical competence was deemed
necessary to help educators obtain accurate and objective information about
students understanding of what has been taught and so helps in determining
whether or not learning has taken place (Benner; Friedman; & Menin in
Mahara, 2002). This led to the introduction of objective structured clinical
examination (OSCE) in Schools of Midwifery in Nigeria, as a tool for assessing
clinical competence of Midwifery students.
According to Medinfo (2009), Objective
structured clinical examination (OSCE) is a form of performance based
assessment used to measure candidates’ clinical competences. OSCE is a more objective, comprehensive
consistent and standardized tool for assessing students’ clinical skills and
competence (Igbal, Khizar and Ziadi 2009) than the traditional oral practical
method of evaluation. According to Hala and Hanna(2012) OSCE is one of the most
valid, reliable and effective test to measure synthesis of knowledge and
clinical skills. OSCE stations provides
the mechanism for assessing the students application of knowledge as well as
his or her psychomotor and interpersonal skills, problem solving abilities,
teaching and assessment skills. OSCE is
also perceived as an excellent teaching and learning mechanism. However it is expensive and labour intensive.
It was introduced in 1975 by Dr. Ronald
Harden and his colleagues at University of Dundee in Scotland for clinical
assessment of medical students. OSCE was gradually adopted widely first in the
United States of America (USA), followed by United Kingdom (UK). OSCE is now
used in over 50 countries of the world (Praveen and Suman 2012). It has been
accepted as the main tool for clinical assessment in medical schools and
licensure bodies across USA, Canada, UK, Australia, New Zealand and other
countries of the world, due to the perceived benefit and merit of OSCE over
other evaluation tools like oral/practical exams, multiple choice questions,
viva voce etc. It is now being used in both health and non-health disciplines
like dentistry, nursing, midwifery, engineering and law (Praveen and Suman 2012).
The acceptance of OSCE as a standardized
tool for evaluation of clinical competence was based on teacher’s knowledge and
their perception of the benefits derived from using OSCE over a period of time.
The Nursing and Midwifery Council of
Nigeria (N&MCN) adopted the use of OSCE as an evaluation tool for assessing
clinical skills and competencies of student midwives since 1992. However since
the introduction of OSCE in school of midwifery in Nigeria it has not been
assessed. The current study is therefore
intended to investigate the perception of teachers on the use of OSCE for
measuring students’ clinical competence in order to provide evidence about the
feasibility of its use as an evaluation tool.
Statement
of Problem
Evaluation of clinical competence is an
important activity with a lot of consequences on the welfare of the patients
and community at large. Faulty method of evaluation will yield wrong data that
can lead to graduation of incompetent students whose practice can have
detrimental effects on the clients and thus increased morbidity and mortality
rates. In addition, graduation of students who do not merit pass based on
faulty evaluation tools may produce incompetent practitioners whose practice
can expose them to litigations and this also affect their self esteem and their
means of livelihood (Orchard in Mahara 2007). OSCE appears to be generally
accepted as a gold standard for assessing clinical skills in developed countries
of the world but it has not been used extensively in some schools in
underdeveloped and resource constrained locations. In some schools the use of OSCE was
introduced but was later replaced with traditional methods of clinical
evaluation (Ernesto, 2004). This is
because they perceived such methods to be better than OSCE due to problems
peculiar to OSCE which ranges from human resources, material resource and
organizational problems (Trocon, 2003). Schools of midwifery in Nigeria being a
low resource area may not be left out.
It is a known fact that resources invested into both health and
educational systems in Nigeria is not enough. This may have affected the
evaluation process in schools of midwifery in Nigeria as well. The N&MCN recently mandated educators in
schools of nursing and other post basic schools to plan for the introduction of
OSCE in their schools. If OSCE is to be
introduced successfully, there is need to find out the perception of educators
in schools of midwifery about OSCE. This is important in order to identify the
weaknesses of the already existing OSCE.
When these weaknesses are taken care of they will in no doubt lead to
successful introduction of a reliable, objective and valid OSCE.
Purpose
of Study
TEACHERS PERCEPTIONS OF THE USE OF OBJECTIVE STRUCTURED CLINICAL EXAMINATION TOOL TO EVALUATE STUDENTS CLINICAL COMPETENCE IN MIDWIFERY SCHOOLS SOUTH EAST NIGERIA
