The Dreaded OSCEs

The acronym OSCE triggers a certain reaction in medical and nursing students. I remember hearing about OSCEs from my nurse practitioner students and friends. The mere mention of OSCE would be followed by a heavy sigh and a dramatic story usually with fear as a theme. OSCE stands for objective structured clinical exam. When I was a student, our clinical exams didn’t have this lovely title.

Excited for OSCEs

The OSCEs were one of my first duties as a lecturer at KCN. Amber, a fellow GHSP volunteer, traveled down with KCN Lilongwe to partake in the OSCE fun. For this session of OSCEs, we were grading all 250 of the second year students. This is quite the production with lecturers from both campuses of KCN and several master’s students. 

Amber and I donning our lecturer uniforms (I'm rocking the Hopkins pins!)

 The first day, the students were tested on urinary catheter care and colostomy care. We had 20 stations set-up- 10 for each scenario. The second day, we were testing insulin administration, and thankfully, were able to have all 20 stations dedicated to this task. The students were given a scenario, for example: Mr. Basi is a diabetic who is on 10 units of soluble insulin daily. They were then responsible for demonstrating the procedure to administer insulin to Mr. Basi including proper documentation. As the examiners, we had a checklist in order to grade the student’s performance with two examiners per student. Each student was allotted 10 minutes to complete the procedure. We held the OSCEs at the Kameza campus, which was recently built, but the process of transferring the bachelor’s classes/students to this campus has not been completed. I heard there was an internet issue, but that is probably only part of the story. It is a beautiful campus located approximately 20-30 minutes outside of the center of Blantyre.

Kameza campus of KCN

Here is how the first (and longest) day of OSCEs went:

6:50 AM- Picked-up by KCN Lilongwe bus at my house. Make 2-3 more stops in Blantyre to pick-up other Lilongwe faculty.

7:45 AM- Arrive at Kameza campus and proceed to unload many of the supplies needed for the OSCEs.

7:55 AM- Realize that there is a lot of set-up needed before we can start. Proceed to wander around the campus looking for photo ops with Amber (see below for results).

8:30 AM- Wander back to the OSCE room and arrive just in time for the meeting to discuss the process.

8:45 AM- Divide into groups with two examiners per curtained-off station.

8:55 AM- Meet with everyone grading our scenario- urinary catheter care. Read the scenario and the grading sheet, and discuss proposed changes.

9:00 AM- Head back to our stations and await the first group of students.

9:10 AM- Grade the first set of two students.

9:35 AM- Meet again to discuss how the first set went. Discuss some more about the grading sheet, but make no changes.

9:45 AM- Grade more students.

11:45 AM- Tea time!!!

12:00 PM- Grade more students.

1:30 PM- Lunch

2:00 PM- Grade the rest of the students.

4:45 PM- Tea time.

5:00 PM- Head home.

Here is what would happen during a typical OSCE:

The student waits outside to be told to enter the area. When instructed, the student enters the room and is given 1 minute to read the scenario. A bell rings, which signifies the start of the 9 minutes. The student comes to the bedside of the “patient”, introduces themselves (usually in Chichewa), informs the patient of the procedure, and obtains consent. The next step is to provide privacy. In America, this is implied as our hospital rooms are set-up to already be either private or semi-private. In Malawi, there are sometimes 8 or more patients in a room (if there is a room) and no curtains. This was the one step in the checklist that I found most interesting. The student then continues the procedure describing the process to the “patient” (in English thanks to my fellow examiner). When the students finish (and hopefully after remembering to wash hands again), they document the procedure. Then, the bell rings again signifying for the student to leave and the examiners to finish grading. 

The full lecturer uniform

View from campus

Student dorm

The students did fairly well on their OSCEs. It was interesting that the students later in the day did better than the students in the morning. I was wondering if there were a bit of sharing on the part of the morning students- it is a communal society after all. The most frequent mistake during catheter care was not cleaning from the urethral meatus out. I could hear the voice of one of my nursing professors at Hopkins emphasizing this important point. Also, the students often forgot to assess not only the genitalia, but also the catheter. We have been told that the Malawian nursing students are very good at memorizing, but are challenged by critical thinking. Assessment is one of the most important roles of a nurse. I am determined to impart this on my students. I was overall impressed by the preparation of the students and sympathized with their evident nervousness.  What a way to jump into my role! I am now spending the requisite 4 weeks of orientation at a health center.  My next blog will focus on this experience- stay tuned.