The use of a formative OSCE for developing clinical skills necessary for
undertaking cervical cytology
S. Hughes
Consultant, Centre for Contraception and Sexual Health, Nottingham, UK
Introduction: The teaching and assessment of clinical competence has
always been a key feature of medical and nursing education. Historically, ‘on
the job’ learning and assessment was prominent. Concerns about the robustness
of this approach, lack of clinical opportunities has led to more formalised and
standardized approaches. National guidelines are in place for the content and
quality of cervical cytology screening training but implementation is variable
and many training programmes fail to address the fundamental issue of developing
and assessing clinical competencies. Within this context, it seemed appropriate
to develop, implement and evaluate an alternative way of developing and
assessing competence in clinical cytology screening through the use of a
formative OSCE.
Study design: The study examines 3 key questions: Can an OSCE (Objective
Structured Clinical Examination) be developed that assesses the competencies and
skills necessary for undertaking cervical cytology screening. Can the use of
appropriate and timely feedback make the OSCE an acceptable and useful form of
formative assessment? Is a formative OSCE an acceptable means of developing and
assessing clinical competency in cervical cytology screening for doctors and
nurses working in the community. 6 interactive stations were developed using a
matrix of components of competency and related skills and tasks. The OSCE was
run on 3 occasions and 15 participants and 4 facilitators and 2 role players
took part. The OSCE was evaluated by qualitative methods including a participant
questionnaire, facilitators and role player questionnaire, group feedback, lead
facilitator comments and analysis of scores.
Results: The semi-structured questionnaire completed by participants
and facilitators showed high rating in relation to usefulness for learning,
interesting, challenging/thought provoking. An open question about ‘thoughts
and feelings about OSCE’ revealed 70% of comments to be positive. The number
of participants meant statistical analysis of the marks was inappropriate.
Overall, observational analysis revealed scores above 70% for all stations.
Conclusions: In response to the 3 main questions. The findings showed
that an OCSE is very suitable for assessing competencies in clinical skills
necessary for cervical cytology. The feedback from all individuals involved in
the OSCE was very positive with the only negative area being performance anxiety.
