AUBURN – Auburn University students studying to become pharmacists must learn about science as well as the day-to-day, personal relationships that develop with patients. One of the ways the Harrison School of Pharmacy teaches students both aspects is through its Objective Structured Clinical Examinations, or OSCEs (pronounced “ah-skeez”), given at the end of spring and fall semesters.
“Students interact with actors who play the roles of patients with varying ailments or medical conditions,” said Sharon McDonough, director of the School’s Office of Teaching, Learning and Assessment. “The students must apply their knowledge and skills as if they are treating actual cases.”
Working with faculty, McDonough’s office sets up exam rooms for actors who are assigned medical cases, such as cancer, COPD, or chronic obstructive pulmonary disease, gastrointestinal tract problems, HIV and other conditions.
“Many of the actors are retired persons from the community,” McDonough said. “They are given a printout ahead of time detailing the case information like medical history, family history and list of current medications. They also participate in training sessions with faculty who have written the cases, providing ample practice for them to play their roles.”
Each case incorporates two actors alternating between being the patient and being an observer who watches through a closed-circuit computer monitor in another room. The actors have a checklist to fill out based on whether the student asks the correct questions, educates the patient about medication and has a proper attitude and appearance. Faculty members participate in grading as well when their level of expertise is required to evaluate performance of a skill.
Mary Franklin, a local, part-time craft instructor, will begin her fourth year as an OSCE actor this fall.
“I really look forward to and enjoy every part – from the preparation and script reading to the evaluations at the end of each student encounter,” Franklin said. “The students seem to get more competent and confident every year as they go through the scenarios and interview us. All aspects of patient care are addressed to help them be more ready to dispense not only medicine, but information and instructions for care.
“The bonus for the actors is that we have formed some lasting friendships, not to mention we get to spend time on the Auburn campus again – how great is that?”
The exams can be stressful for students, as they have three minutes to read a brief case summary posted on the door and seven minutes to interact with the actor-patient in the room. The cases are not revealed ahead of time, so students must be ready to apply a range of knowledge and the ability to think and act quickly.
Garrett Aikens, a fourth-year pharmacy student who will graduate next May, says his attitude toward the exams has changed after taking six OSCEs during the past three years.
“As a first-year student pharmacist, the term ‘OSCE’ sounded foreign and its concept seemed a little frightening, even for someone with years of community pharmacy experience,” Aikens said. “Something about being recorded and graded while interacting with an actor, who probably knows what you are supposed to say and therefore notices when you say the wrong thing, is awkward and stressful.”
But now he says the opposite is true.
“I feel the OSCEs have made me much calmer during stressful, challenging community and clinical situations as well as much more effective at talking with patients, which is a critical part of what we do and can be just as challenging,” Aikens said. “The OSCEs also give us the opportunity to interact with patients in a variety of settings, from community pharmacy to clinical pharmacy.”
Clinical performance exams, such as the OSCEs, are more common among medical schools, so McDonough and other faculty and staff observed OSCE training sessions at the University of Alabama at Birmingham School of Medicine. “The cases take a lot of time to develop,” she said. “We also sent a team to a workshop at the University of Toronto to help develop our system.”
Auburn utilizes OSCEs in two ways. One OSCE, called the Milestone Assessment, is administered in the spring semester to all students in the second, third and fourth years. Currently, students receive formative feedback on the Milestone Assessment through a written report that has no effect on their grades. McDonough indicates the School of Pharmacy is considering a proposal to make the OSCEs a “high stakes,” graded exam system which students must pass in order to graduate. The school also utilizes OSCEs through its Contemporary Aspects of Pharmacy Practice course sequence, or CAPP, a skills lab course in which students receive grades for their performances.
The OSCEs are just one way that pharmacy students apply their knowledge and skills. First-, second- and third-year students visit volunteer patients in the community to monitor medication therapy and to provide pharmacy care under the supervision of faculty mentors, while fourth-year students train at pharmacies, hospitals and clinics across the state where they work under the supervision of licensed pharmacists.
“The OSCEs are very helpful and can be stressful for students, but they can be enjoyable, too,” McDonough said. “We even give an ‘OSCEr Award’ to the student who performs the best in his or her class on the Milestone Assessment each year.”
(Written by Charles Martin.)