The experience of the Medical University of Warsaw in conducting an OSCE for first-year students of the specialty “Nursing”

Abstract

The purpose of the study is to present the experience of conducting OSKI exams in the discipline “Propaedeutics of Nursing” for first-year bachelor’s degree applicants in the specialty “Nursing” at the Medical University of Warsaw, in order to study it, analyze it, and apply it in the educational process of our university. We believe that this evidence is important and interesting for participants in the educational process when organizing and conducting both final module controls and graduate certification. Materials and methods. The OSCI exam consisted of five examination stations located in two rooms. Each station contained a separate practical task that addressed the skills acquired during the classes. Two stations in the field of aseptic and two – non-aseptic activities, and the task of calculating drug doses. The candidates collected the necessary equipment from the prepared work area themselves. All tasks were assessed based on original checklists developed in accordance with current medical care standards. The following methods were used during the research: bibliosemantic, content analysis, structural and logical analysis. Results. During the certification of applicants in the discipline “Propaedeutics of Nursing”, five stations are provided: two nonaseptic and two aseptic, and one station for completing a theoretical task. At non-aseptic stations, candidates perform scenarios such as placing a nasogastric tube for enteral nutrition of the patient, or washing the stomach with a thick gastric tube; placing a gas evacuation tube, or a cleansing enema. At the aseptic station, the following scenarios were performed: performing subcutaneous or intramuscular injections; taking blood from a vein with a vacutimer, or placing a peripheral catheter with intravenous administration of drugs. Along with practically-oriented scenarios, during the exam, students solved tasks that consisted of calculating the dose of the drug that must be administered to the patient, taking into account the degree of dilution, non-standard dosage, and the rate of administration through an infusion machine: antibiotics, insulin, and other medications. The student chose the task randomly. The duration of the task is 15 minutes. The result of this stage was evaluated according to the criterion “passed/failed”. Highlighting critically important points in the checklist, failure to complete which automatically leads to a negative result, contributes to the formation of responsibility and discipline in students. It was noted that the distribution of time at the stations (5 minutes – preparation, 10 minutes – execution) allows students to demonstrate the full cycle of performing the manipulation – from preparing the workplace and equipment to the final disposal of the materials used. Experience has shown that such a structure stimulates the formation of algorithmic thinking in students, which corresponds to the real conditions of clinical practice. A feature of the described experience is the use of a scenario method using mannequins and the role of a standardized patient, which is performed by the teacherexaminer. This allowed us to assess not only technical skills, but also communicative competencies, such as obtaining informed consent, explaining the procedure to the patient, interpreting the clinical situation, and adapting the action algorithm in case of contraindications. This approach, combined with communicative tasks, contributes to the development of patient-oriented interaction skills in students. It is also important that even at the early stages of training, students are faced with tasks of increased complexity – for example, identifying contraindications to performing a manipulation and making a decision to change the algorithm of actions. This forms clinical thinking and the ability to act in non-standard situations, which is one of the key competencies of a nurse. Analysis of the exam results showed that most students successfully completed the tasks, but some of them had difficulties with the correct selection of instruments, compliance with asepsis and accurate dosing of drugs. The difficulties identified in some students confirm the need for additional training sessions before administering the OSCЕ, which is consistent with Zayyan’s (2011) recommendations for preparing for this type of assessment. The introduction of trial sessions, individual feedback, and simulations in small groups can help reduce the proportion of unsatisfactory results. Conclusions. Thus, conducting an exam for nursing students in the OSCЕ format increases the objectivity and transparency of assessment, promotes the development of clinical thinking, and forms integrated professional competencies (technical, communicative, and cognitive), which meets international standards for the training of nurses.