Correspondence

2. Batmanabane G, Raveendran R, Shashindran CH. Objective structured prac- an option for us since some of the tasks (such as giving an
tical examination in pharmacology for medical laboratory technicians. Indian J I.V. injection, or communicating to patients on proper use
Physiol Pharmacol 1999;43:242-6.
of oral contraceptive pills) required this amount of time. If
3. Nayar U, Malik SL, Bijlani RL. Objective structured practical examination: A
new concept in assessment of laboratory exercises in pre-clinical sciences. we gave students less time it would amount to testing how
Med Educ 1986;20:204-9. fast they could do the task rather than how well they could
4. Cohen R, Reznick RK, Taylor BR, Provan J, Rothman A. Reliability and valid- perform it.
ity of the objective structured clinical examination in assessing surgical resi- 2. Logistical problems: There were technical difficulties in
dents. Am J Surg 1990;160:302-5.
setting up many sets of experiments for each station. For
example, we used to have a station where an isolated frog
Appendix 1: Pharmacy task station. rectus tissue was mounted (by us) and the student had to
You are provided with prepared benzyl benzoate emulsion. If inject a given volume of acetyl choline and record the re-
you are satisfied with it dispense 20 ml of it. sponse. We had to put up three tissues (three separate
Checklist for examiner Marks
baths) for a single station so that there was sufficient time
1. Measure 20 ml correctly 0.25
for the tissues to relax before the next student came to
2. Puts in a dark bottle 0.25
add the drug. We also needed one technician to standby
3. Puts a cork on it 0.25
4. Puts a dark colored cap over it 0.25 filling the reservoirs, rinsing the syringes and flushing the
5. Ties a pharmaceutical knot 0.25 baths. In the course of the examination, if one of the tis-
6. Label – primary sues stopped working or a technical fault developed, there
The emulsion 0.25 was no time to repair the set-up since the student had to
Patient’s Name 0.25 go to the next station or else would hold up the entire batch.
Patient’s Age 0.25 3. Maintaining uniform difficulty levels: Thirty students
Patient’s Sex 0.25 (half the batch) would have the same set of ten stations.
Patient’s Registration No. 0.25 The next batch of thirty would come after a gap of one
Directions – Apply all over the body from neck 0.25 week and have to be given another set of stations. Main-
Downwards, after a thorough cleansing bath. taining uniform difficulty levels between batches is indeed
Repeat the application after 12 h, followed by a a very difficult undertaking.
Change of clothing after 24 h. 4. Shortage of observers: In order to include more proce-
Pharmacist’s signature 0.25 dural stations we needed to have sufficient number of ob-
Date 0.25 servers. All faculty and residents had to be present as ob-
Pharmacist’s Address 0.25 servers whenever an OSPE was to be conducted. This left
Pharmacist’s Registration Number 0.25
us with few residents to tackle the organizing – like es-
7. Secondary label ‘for external use only’ 0.25
corting the students into the lab, giving instructions etc.,
8. Secondary label ‘Shake the bottle before use’ 0.25
Including technicians as observers was not feasible since
9. Neatly dispensed 0.75
Total 5.0 the lab staff were needed in the procedural stations to fa-
cilitate the observers (mopping up spills, topping up test
tubes with solutions, ringing the bell to keep time etc.).
The other side of OSPE Unless there was full attendance (among faculty and resi-
dents) it became difficult to conduct an OSPE with many
Sir, procedural stations.
Pharmacologists in India have been using Objective Struc- 5. Observer fatigue: After observing the same station for
tured Practical Examination (OSPE) as a method of evalua- ten or more students observers get tired, bored and care-
tion since the early nineties.1 It has been often touted as a less. On one occasion we found that the batch of students
good substitute for the conventional method of practical ex- who had a particular observer for a task scored between
aminations since it is more objective. At the department of 3-5 out of ten whereas the batch which went to another
pharmacology, Jawaharlal Institute of Postgraduate Medical observer (the task was the same) scored 8-10. We then
Education and Research (JIPMER), Pondicherry we have used learnt that the person giving more marks was giving tips
this method for evaluating medical laboratory technicians2 and to the students to complete the task. This happened be-
subsequently, in 1999, introduced it as a method of evaluation cause the observer got bored and wanted to interact with
for the formative exams conducted for medical undergradu- the students.
ate students in pharmacology. With the passing of time I have 6. Time consuming: Preparations are time consuming es-
become progressively disenchanted with this method for the pecially preparing the checklists, printing them, etc. A lot
following reasons outlined below. of planning has to be done. After the OSPE, tabulation of
1. Time constraint: In JIPMER we have to examine a batch marks takes a long time especially if many stations are
of approximately 30 students over a period of two and a arranged. Considering the fact that during six months of
half hours. Due to space restraints we are able to set up a the year we have three batches of students and that for
maximum of 10 stations only. If we allot each station 5 each batch we conduct five notified tests (all of which in-
min, it will take 50 min for a batch of 10 students to com- clude practical examinations) these cumbersome proce-
plete all stations. Hence we need three hours to examine dures soon became tiresome.
one batch. Cutting the time spent in each station was not 7. Problems with electricity: At times, just before the OSPE

388 Indian J Pharmacol | December 2004 | Vol 36 | Issue 6 | 385-389


was due to start the electricity would fail. This used to
throw the entire session out of gear unless an alternative
station could be set up or another power source located.
8. Miscellaneous:
(a) As the years went by, there was an increasing trend to
include more number of response stations in a bid to
“save” on observers. This amounted to students an-
swering short answer questions even though we in-
cluded calculation of drug dosage, statistical problems
and so on which could be described as essential intel-
lectual skills needed for pharmacologists. However, this
does not detract the fact that these skills can be tested
in a theory paper too and does not need to be labeled
OSPE.
(b) After two years, some of the questions had to be re-
peated. Then it became a simple matter of testing re-
call mainly since students already knew the answers to
most of the problems. In trying to setup “new” sta-
tions there was a trend to make the tasks either more
difficult or trivial.
(c) Even though the checklists were being modified each
time, taking into consideration the comments of the
faculty manning a particular station, the loopholes were
many. For example, one of the points in the checklist
on communication skills was that the student had to
greet the patient. Many students forgot to do that and
remembered it only at the end of the interaction. How-
ever, since they knew they would get one mark for greet-
ing the patient they went ahead and did so. The ob-
server gave these students the mark allotted for it as
the checklist did not specify that the student had to
greet the patient first and not in between or last!
Due to these problems we decided to use a method that I
would prefer to call SOSPE or (Semi Objective Structured Prac-
tical Examination) for want of a better name. It is an amalgam
of the older (conventional) method of practical examination
where the student is asked to conduct one experiment and is
questioned on it and OSPE. In this method, the student is asked
to conduct one experiment and the examiner gives marks based
on a structured check-list. 15 marks are allotted for this exer-
cise which has 5 parts with equal distribution of marks (three
each). The five parts are: (a) Procedure / Methodology (b) Tabu-
lation of results / graph (c) Demonstration of skill (d) Inter-
pretation of results (e) Seat viva. For each part the examiner
accords marks which are totaled in the end. Under tabulation
of results (part b), the examiner checks whether observations
have been presented properly in a table and also looks for the
Correspondence
correct title (heading), inclusion of units, number of animals,
name, dose and route of administration of drug etc., The ex-
aminer also asks the student to perform a skill (part c) con-
nected with the experiment such as loading a particular vol-
ume of drug into a syringe, injecting subcutaneously etc. There
may not be much difference from the previous, older method
of global assessment, except that students need to pay atten-
tion to all parts of the practical experiment and faculty have to
observe a skill being performed and give marks for the vari-
ous components of the exercise.
We follow this up with an exercise on communication skills
wherein the student is given a drug/device/dosage form and
asked what instructions he/she will give the patient. This ex-
ercise is marked out of 10 marks. For another 50 marks we
give 5-6 problems on various aspects of clinical pharmacol-
ogy such as prescription writing, ADR monitoring, essential
drugs list, therapeutic drug monitoring, critical appraisal of
drug advertisements and so on. For each problem, the evalu-
ation is structured.
The method described above is easier to plan, set-up, con-
duct and does not need as much manpower as OSPE. Even
though there is an element of subjective bias, the checklist
eliminates that to some extent. There is also a dialogue be-
tween the examiner and the student which permits the exam-
iner to identify the very good from the good and also point out
mistakes. This element of student-examiner interaction was
greatly missed by many of our faculty during OSPE. However,
each examiner needs to spend at least ten minutes with a stu-
dent. Hence the number of students who can be examined by
one examiner is 6 - 8 during a single session. The method
outlined above is the one currently employed for most of the
formative exams in JIPMER. We still use OSPE for one or two
exams. Meanwhile I feel my brief honeymoon with OSPE is
over and the search for adopting better methods of evaluating
students in practicals goes on.
B. Gitanjali
Department of Pharmacology, JIPMER, Pondicherry, India.
E-mail: gitanjali@jipmer.edu
References
1. Natu MV, Singh T. Objective structured practical examination (OSPE) in phar-
macology – students’ point of view. Indian J Pharmacol 1994;26:188-9.
2. Batmanabane G, Raveendran R, Shashindran CH. Objective structured prac-
tical examination in pharmacology for medical laboratory technicians. Indian J
Physiol Pharmacol 1999;43:242-6.
Indian J Pharmacol | December 2004 | Vol 36 | Issue 6 | 385-389 389