CHAPTER ONE

INTRODUCTION

Background to the Study

Evaluation of learning outcomes is an important and inevitable part of the education process that has been carried out in institutions of learning for ages. This is because; it is through academic evaluation that one infers whether the learner has learned and how far educational learning objectives have been achieved.   Tyler in Basavanthappa (2009) defined evaluation as a process of determining to what extent educational objectives is being realized. Scriven in Mahara (2002) stated that evaluation is both a process and a product. A process of systematically and objectively determining the merit, worth and value of things and also denotes the product of that process. Evaluation is done using evaluation tools, which are instruments used in determining whether or not learning has taken place. A major focus of evaluation in Midwifery education is to determine those students who have acquired the knowledge and skills needed to practice Midwifery based on set standards (already agreed upon by educators). This thus involves class room and clinical evaluation.  Clinical evaluation in Midwifery Education is aimed at appraising the quality and standard of clinical competence of students following training in order to produce graduates who can perform competently in real life situation.

Clinical competence is said to be what the students should be able to do at an expected level of achievement such as at graduation. It is also the synthesis of all attributes necessary to do that task for which one is being trained.  College of registered nurses of Mamtoba (2012), defined clinical competences as the mastering of relevant knowledge and acquisition of a range of relevant skills at a satisfactory level including interpersonal, clinical and technical competences and the integration and application of the knowledge, skills, judgment and attitudes required to carry out the role and work for which one is being trained. Competencies can be cognitive or performance based.  The cognitive measures of competence is more efficiently measured psychometrically (e.g. self assessment test) while performance based measures are better evaluated using performance based assessment example OSCE. 

Traditionally evaluation in clinical setting in Schools of Midwifery was done using oral/practical examination, where a number of students were examined in different clinical areas of practice. According to Barman (2005), questions asked were not consistent. The traditional method was very subjective, had poor-inter-rater reliability and was subject to halo effect (Shaw, 2006).  Both teachers and students were dissatisfied with this method of evaluation because of these deficiencies. This made evaluators to search for a more appropriate objective and standardized alternatives to improve the evaluation process.  A standardized form of examination to be used as tool for assessing clinical competence was deemed necessary to help educators obtain accurate and objective information about students understanding of what has been taught and so helps in determining whether or not learning has taken place (Benner; Friedman; & Menin in Mahara, 2002). This led to the introduction of objective structured clinical examination (OSCE) in Schools of Midwifery in Nigeria, as a tool for assessing clinical competence of Midwifery students.

According to Medinfo (2009), Objective structured clinical examination (OSCE) is a form of performance based assessment used to measure candidates’ clinical competences.  OSCE is a more objective, comprehensive consistent and standardized tool for assessing students’ clinical skills and competence (Igbal, Khizar and Ziadi 2009) than the traditional oral practical method of evaluation. According to Hala and Hanna(2012) OSCE is one of the most valid, reliable and effective test to measure synthesis of knowledge and clinical skills.  OSCE stations provides the mechanism for assessing the students application of knowledge as well as his or her psychomotor and interpersonal skills, problem solving abilities, teaching and assessment skills.  OSCE is also perceived as an excellent teaching and learning mechanism.  However it is expensive and labour intensive.

It was introduced in 1975 by Dr. Ronald Harden and his colleagues at University of Dundee in Scotland for clinical assessment of medical students. OSCE was gradually adopted widely first in the United States of America (USA), followed by United Kingdom (UK). OSCE is now used in over 50 countries of the world (Praveen and Suman 2012). It has been accepted as the main tool for clinical assessment in medical schools and licensure bodies across USA, Canada, UK, Australia, New Zealand and other countries of the world, due to the perceived benefit and merit of OSCE over other evaluation tools like oral/practical exams, multiple choice questions, viva voce etc. It is now being used in both health and non-health disciplines like dentistry, nursing, midwifery, engineering and law (Praveen and Suman  2012).

The acceptance of OSCE as a standardized tool for evaluation of clinical competence was based on teacher’s knowledge and their perception of the benefits derived from using OSCE over a period of time.

The Nursing and Midwifery Council of Nigeria (N&MCN) adopted the use of OSCE as an evaluation tool for assessing clinical skills and competencies of student midwives since 1992. However since the introduction of OSCE in school of midwifery in Nigeria it has not been assessed.  The current study is therefore intended to investigate the perception of teachers on the use of OSCE for measuring students’ clinical competence in order to provide evidence about the feasibility of its use as an evaluation tool.

Statement of Problem

Evaluation of clinical competence is an important activity with a lot of consequences on the welfare of the patients and community at large. Faulty method of evaluation will yield wrong data that can lead to graduation of incompetent students whose practice can have detrimental effects on the clients and thus increased morbidity and mortality rates. In addition, graduation of students who do not merit pass based on faulty evaluation tools may produce incompetent practitioners whose practice can expose them to litigations and this also affect their self esteem and their means of livelihood (Orchard in Mahara 2007). OSCE appears to be generally accepted as a gold standard for assessing clinical skills in developed   countries of the world but it has not been used extensively in some schools in underdeveloped and resource constrained locations.  In some schools the use of OSCE was introduced but was later replaced with traditional methods of clinical evaluation (Ernesto, 2004).  This is because they perceived such methods to be better than OSCE due to problems peculiar to OSCE which ranges from human resources, material resource and organizational problems (Trocon, 2003). Schools of midwifery in Nigeria being a low resource area may not be left out.  It is a known fact that resources invested into both health and educational systems in Nigeria is not enough. This may have affected the evaluation process in schools of midwifery in Nigeria as well.  The N&MCN recently mandated educators in schools of nursing and other post basic schools to plan for the introduction of OSCE in their schools.  If OSCE is to be introduced successfully, there is need to find out the perception of educators in schools of midwifery about OSCE. This is important in order to identify the weaknesses of the already existing OSCE.  When these weaknesses are taken care of they will in no doubt lead to successful introduction of a reliable, objective and valid OSCE.

Purpose of Study