Formative OSCE
I participated in a peer-lead formative Objective Structured Clinical Examination (OSCE) in February of this year and last. This was designed to help the foundation phase vet students, myself included, prepare for the summative OSCE at the end of our second year at vet school. We each completed different stations focusing on a variety of clinical skills, and we were assessed by volunteers from the third and fourth-year classes. The stations I had were suturing, IV fluid setup, aggressive cat handling, equine and canine IV injection, PVC testing, closed gloving, and a euthanasia consult.
Reflective Commentary
For the formative OSCE session, I had five stations each year. These included simple continuous and cushing suturing patterns, IV fluid setup, aggressive cat handling, equine and canine IV injection, communication skills, closed gowning and gloving, and PCV testing. The cadre of clinical phase students who volunteered to help with the assessment was very kind and had a lot of useful feedback to give for each station, both positive and negative. Overall the assessment was helpful, but it was extremely nerve-wracking.
Besides learning how to prepare for and complete the real OSCE, I had a personal goal for myself. I struggle with anxiety and having someone watch me silently and judging me while I complete a task is sometimes enough to trigger a full-blown anxiety attack, let alone stealing my focus. I know that I will have to do this again, in my summative OSCE in future years and when I’m a practicing vet performing procedures in front of my peers and clients. My goal for the formative OSCE was to complete it without having an anxiety attack and to force myself to focus on the task as much as I could. I didn’t end up having an attack, but I lost focus a couple times and made unwarranted errors that would have cost me points on the summative exam.
My performance in the formative OSCE during my first year ranged from perfect in the PCV test (or at least earning all of the marks) to atrocious in the equine IV injection. The equine injection station is an example of a time when I made a mistake and lost focus for the rest of the procedure. I wasn’t confident in my drug calculation skills before the assessment, and I calculated the drug dosage wrong. I knew it was wrong, but I didn’t know how to fix it, so I just moved on. After that, I made a bunch of mistakes even though I had done IV injections correctly on real horses as well as on the model in lab previously. The biggest ones were not holding off the vein during the injection and not inserting the needle to the hub. I understand how important it is to perform intravenous injections appropriately, as poor technique during vessel sampling or injection can damage the vessel and negatively impact the patients welfare by increasing stress [1]. Even though I made several mistakes at this station, I was surprised that I still would have earned points for the things that I did well, like choosing the correct needle and syringe. I suppose that when I make a big mistake in the real exam, I should just keep going and get as many of the other points as I can.
Now that I have completed the OSCE in a formative setting, I know more-so what to expect from the summative OSCE that I will take at the end of second year. Even though the formative OSCE made me feel very anxious, I know that it will help me become a competent veterinarian. One study on the benefits of mock OSCEs showed similar feedback from other medical students who are required to take an OSCE in their course as well [2]. I think our formative OSCE sessions helped improve my confidence in my clinical skills, and it showed me where to improve for the scored exam. I doubt that I will be entirely comfortable when the exam comes around, but I am at least confident that I won’t be as anxious about it.
[1] May M, Nolen-Walston R, Utter M, Boston R. Comparison of Hematologic and Biochemical Results on Blood Obtained by Jugular Venipuncture as Compared with Intravenous Catheter in Adult Horses. Journal of Veterinary Internal Medicine. 2010Aug24;24(6):1462–6.
[2] Young I, Montgomery K, Kearns P, Hayward S, Mellanby E. The benefits of a peer-assisted mock OSCE. The Clinical Teacher 2014;11:214–8. doi:10.1111/tct.12112.
Intended Learning Outcomes Satisfied
1. Communication Skills – I communicated with the several of the station volunteers about my assessment: the things I did well and the things I needed to work on.
2. Independent and Collaborative Learning – I practiced the skills I learned to prepare for the OSCE by myself and with my friends before the assessment. I also collaborated with my instructors during labs and with my peer assessors during the OSCE to understand what to do for the summative OSCE.
3. Safety – Several of the skills on the OSCE were chosen to improve the safety of students and animals in the clinic, so practicing these skills (aggressive cat handling, large animal injections etc.) will improve safety for myself, my coworkers, and the animals when I start working in a clinic.
4. Animal Handling – Some of the stations in the OSCE required a degree of animal handling skills, particularly the aggressive cat handling stations. Preparing for the exam required me to practice my animal handling skills.
5. Clinical Skills – The aim of the OSCE is to demonstrate proficiency in clinical skills. I practiced and was assessed in skills like PCV testing, IV fluid setup, IV injections, and suturing. These are skills that will translate directly to my job as a veterinarian.
8. Animal Body Systems – to pass the OSCE I had to have an understanding of body systems of several species. For the formative OSCE, I had to understand tissue layers to place appropriate sutures, and the location of the correct veins in horses and dogs to use for IV injections and catheter placement. I didn’t have veins to choose from in the models used for the exam, but the ones they had were in the same general location as they would be in a real animal.
10. Ethics and Welfare – Practicing the skills in the OSCE increases my ability to perform them on real patients in the future effectively. Hurting an animal unnecessarily during a procedure like IV injection or fluid administration negatively affects their welfare and is unethical when these are skills I could practice on a model beforehand.
13. Pharmacology – During the OSCE, I had to show that I could do drug and fluid calculations proficiently and that I could measure and administer the appropriate amounts of these substances.
14. Professionalism – The Formative OSCE was held in Clinical Skills like the summative one will be, and we were expected to wear our scrubs just like we would in the summative exam - as well as in a real clinic. We looked like professionals, and we were expected to conduct ourselves like professionals during the exam.
15. Animal and Human Health – the stations that required drug or fluid calculations had points assigned for giving the correct amount of medication. This emphasized an understanding of the appropriate use of medicine, particularly the amount and administration technique.
16. Reflection – After each station, I reflected on my performance with the student assessors. Then afterward, I met up with my friends and we reflected on it again, comparing our mistakes.
Documentary Evidence
Attached is the feedback from my peer assessors during the Formative OSCE.