Virtual objective structured clinical examination during the COVID-19 pandemic: An essential addition to dental assessment

The use of objective structured clinical examination in dental education- a narrative review

The Objective Structured Clinical Examination (OSCE) is a performance-based assessment intended to assess medical students' clinical competency in a simulated, standardized environment. Because it measures the student's ability to use clinical knowledge, diagnostic skill, and decision-making, the OSCE is thought to be more objective than traditional tests. OSCE exams have been increasingly employed in dentistry schools, particularly in the last decade, and it is crucial to investigate instructors' and dental students' experiences with this evaluation approach.

Virtual and Interprofessional Objective Structured Clinical Examination in Dentistry and Dental Technology: Development and User Evaluations

BACKGROUND

Interprofessional education (IPE) facilitates interprofessional collaborative practice (IPCP) to encourage teamwork among dental care professionals and is increasingly becoming a part of training programs for dental and dental technology students. However, the focus of previous IPE and IPCP studies has largely been on subjective student and instructor perceptions without including objective assessments of collaborative practice as an outcome measure.

OBJECTIVE

The purposes of this study were to develop the framework for a novel virtual and interprofessional objective structured clinical examination (viOSCE) applicable to dental and dental technology students, to assess the effectiveness of the framework as a tool for measuring the outcomes of IPE, and to promote IPCP among dental and dental technology students.

METHODS

The framework of the proposed novel viOSCE was developed using the modified Delphi method and then piloted. The lead researcher and a group of experts determined the content and scoring system. Subjective data were collected using the Readiness for Interprofessional Learning Scale and a self-made scale, and objective data were collected using examiner ratings. Data were analyzed using nonparametric tests.

RESULTS

We successfully developed a viOSCE framework applicable to dental and dental technology students. Of 50 students, 32 (64%) participated in the pilot study and completed the questionnaires. On the basis of the Readiness for Interprofessional Learning Scale, the subjective evaluation indicated that teamwork skills were improved, and the only statistically significant difference in participant motivation between the 2 professional groups was in the mutual evaluation scale (P=.004). For the viOSCE evaluation scale, the difference between the professional groups in removable prosthodontics was statistically significant, and a trend for negative correlation between subjective and objective scores was noted, but it was not statistically significant.

CONCLUSIONS

The results confirm that viOSCE can be used as an objective evaluation tool to assess the outcomes of IPE and IPCP. This study also revealed an interesting relationship between mutual evaluation and IPCP results, further demonstrating that the IPE and IPCP results urgently need to be supplemented with objective evaluation tools. Therefore, the implementation of viOSCE as part of a large and more complete objective structured clinical examination to test the ability of students to meet undergraduate graduation requirements will be the focus of our future studies.

Structures, processes and outcomes of objective structured clinical examinations in dental education during the COVID-19 pandemic: A scoping review

INTRODUCTION

Objective structured clinical examinations (OSCEs) are an essential examination tool within undergraduate dental education. Fear of spread of the COVID-19 virus led to dental institutions exploring alternative means of conducting OSCEs. The aim of this scoping review was to investigate what structures, processes and outcomes of dental OSCEs were reported during the COVID-19 pandemic.

MATERIALS AND METHODS

This scoping review was conducted and reported adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review guidelines (PRISMA-ScR). Published literature was identified through a systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (Eric), ProQuest and Google Scholar. Identified articles were independently reviewed by two authors (KS, AD), followed by synthesis in terms of the reported structures, processes and outcomes. Articles reporting cancellation or rescheduling were also included, extracting data on reasons and any suggestions/recommendations.

RESULTS

The search yielded a total of 290 studies of which 239 sources were excluded after removal of duplicates, leaving 51 studies for title and abstract evaluation. Thirty-four articles were excluded as they did not report on the topic of interest, leaving 17 for full-text evaluation, of which nine were analysed according to the pre-set themes. All dental OSCEs taking place (n = 6) were conducted online whilst the remaining (n = 3) were either cancelled or rescheduled. Data on structures reported specific online videoconferencing software used and provision of staff and student training. Processes on the execution of online OSCEs varied significantly from one study to the other, providing rich data on how dental institutions may carry out such assessments tailored to their need. Information regarding outcomes was sparse, as little attention was paid to the results of the students compared to pre-pandemic, lacking investigation into reliability and validity of online dental OSCEs.

CONCLUSION

Dental OSCEs could be conducted online implementing well-planned structures and processes; however, further evidence is needed to prove its reliability and validity based on outcomes. Dental institutions may need to consider alternative methods to assess practical competencies if online OSCEs are to take place.

Innovations in assessment in health professions education during the COVID-19 pandemic: A scoping review

BACKGROUND

After an initial period of uncertainty during the COVID-19 pandemic, medical universities responded to the pandemic by innovating their methods of teaching-learning and assessment. This scoping review aimed to identify innovations in assessment in medical, dental and nursing education at the undergraduate and postgraduate levels during the pandemic.

METHODS

This review was conducted utilising Arksey and O'Malley's framework where three electronic databases-PubMed, Embase and Web of Science-were systematically searched in February 2022 for articles in English describing innovations in assessments published in or after January 2020.

RESULTS

A total of 70 articles were included in the review. Among the primary research articles, 82.1% reported online assessment, 76.1% were related to medical speciality, 74.6% described assessment at the undergraduate level, 68.7% described summative assessment and 58.2% reported assessment of practical skills. All assessments of theoretical knowledge were done virtually with MCQ being the most used assessment tool and virtual OSCE being the most popular assessment tool to assess practical skills; however, it was acknowledged that the assessment of procedural skills was its limitation. Although the studies described the newer forms of assessments as feasible and acceptable, few studies reported the reliability and validity of the assessments.

CONCLUSIONS

This scoping review identified several innovations in assessment during the COVID-19 pandemic with an overall shift towards virtual or hybrid forms of assessment. However, there was a dearth of evidence regarding the effectiveness of these assessment tools suggesting a need for more research before the tools can be implemented post-pandemic.

Implementation of virtual OSCE in health professions education: A systematic review

INTRODUCTION

The Objective Structured Clinical Examination (OSCE) has been widely used in health professions education since the 1970s. The global disruption caused by the COVID-19 pandemic restricted in-person assessments and medical educators globally sought alternative means to assess and certify students and trainees to meet the acute demand for health-care workers. One such solution was through virtual OSCE (vOSCE), which modified traditional in-person OSCE using videoconference platforms. This meta-ethnography sought to synthesise qualitative literature on candidates' and assessors' experiences of vOSCE to evaluate whether it may have a role in future assessment practices.

METHODS

In June 2022, we systematically searched PsycINFO, Medline and ERIC for peer-reviewed qualitative and mixed-methods articles that described candidates' and assessors' experiences of virtual OSCE in health professions education. Of 1069 articles identified, 17 were synthesised using meta-ethnography.

RESULTS

The final synthesis represented 1190 candidates and assessors from faculties of medicine, dentistry, nursing, pharmacy and osteopathy. We developed our findings into four key concepts. 'Strengthening confidence in a virtual environment' highlighted attempts to overcome and mitigate concerns associated with transitioning from in-person to virtual assessment. 'Understanding the scope of use as an assessment' reflected on the suitability of vOSCE in assessing various skills. 'Refining operational processes' emphasised the technical challenges of implementing vOSCE and impacts on accessibility and resources. 'Envisioning its future role' considered the applicability of vOSCE in the climate of rapid development in telehealth.

CONCLUSION

This meta-ethnography highlighted that although vOSCE was primarily considered a temporary and crisis response, candidates and assessors recognised positive, as well as negative, consequences of the transition towards them. Moving forward, medical education policymakers should carefully consider the extent to which elements of vOSCE could be incorporated into assessment systems, particularly in light of the rise of telehealth in clinical practice.

Student Performance on an Objective Structured Clinical Exam Delivered Both Virtually and In-Person

OBJECTIVE

Passing a milestone objective structured clinical examination (OSCE) is a graduation requirement for the University of Waterloo Pharmacy students. In January 2021, the milestone OSCE was offered concurrently both virtually and in-person, with students being able to choose their desired format. The purpose of this study was to compare student performance between the 2 formats and to identify factors that may have predicted student choice of format.

METHODS

Objective structured clinical examination scores for in-person and virtual exam-takers were compared using 2-tailed independent t tests with Bonferroni correction. Pass rates were compared using χ2 analysis. Prior academic performance variables were analyzed to identify predictors of the chosen exam format. Student and exam personnel surveys were used to capture OSCE feedback.

RESULTS

A total of 67 students (56%) participated in the in-person OSCE, and 52 students (44%) participated virtually. There were no significant differences in overall exam averages or pass rates between the 2 groups. However, virtual exam-takers scored lower in 2 of 7 cases. Previous academic performance did not predict the choice of exam format. Feedback surveys indicated that the exam organization was perceived as a strength regardless of format, but in-person students felt more prepared for the exam than virtual exam-takers with technical challenges and difficulty navigating station resources being noted as barriers in the virtual offering.

CONCLUSION

Virtual and in-person administration of a milestone OSCE resulted in similar student performance, with slightly lower performance on 2 individual case scores with virtual delivery. These results may inform the future development of virtual OSCEs.

Adaptation to Virtual Assessment during the COVID-19 Pandemic: Clinical Case Presentation Examination

BACKGROUND

Case presentation assessment is common in both medicine and dentistry and is known under various names depending on the country and institution. It relates mainly to aspects of diagnosis and treatment planning and is considered highly authentic and useful. The COVID-19 pandemic necessitated the movement of this assessment from face-to-face to online. The aim of this investigation was to explore the students' impressions of the two different examination modalities. With this information, a decision on future diets of this examination can be made to accommodate the students' perspectives.

METHODS

Quantitative and qualitative data were gathered using an online, self-administered survey.

RESULTS

The students were split 50/50 regarding which assessment modality they preferred. Overall, they considered the online examination to be fair, and the majority agreed that the online format allowed them to display their knowledge as well as face-to-face.

CONCLUSIONS

The delivery of case presentation examination is possible online. An online case presentation is a fair, useful, and authentic assessment that is appropriate to the needs of the faculty and students. Satisfaction with the two possible methods of conducting this assessment suggests it would be reasonable to conduct this examination online in the future.

The changing landscape of dental education - Glasgow Dental School

Glasgow Dental School was set up in 1879, and since that time, dental education has been changing and evolving into the current landscape we recognise today. Changes in demographics and numbers of dental students have led to a more diverse community of students from wide and varied backgrounds. The years have also seen the development of educational theory and practice, and in more recent times, the introduction and expansion of digital and technology-enhanced learning and teaching have revolutionised the delivery of the dental curriculum. One of the most notable changes in the dental programme is the incorporation of student support, health and wellbeing. The modern dental course takes a more holistic approach to education, with the provision of training in generic and life skills, as well as the clinical skills required in an ever-expanding field. The demands and pressures of studying dentistry in the setting of modern, fast-paced life cannot be underestimated and the course must be ever-changing to reflect this. However, the one thing that has not changed is the enduring Glasgow Dental School community.

There have been marked changes in applicant and student demographics and numbers over the years, resulting in the enrichment of the student body and dental community.

The evolution of educational methods and the development of digital and technology-enhanced learning and teaching has had a significant and positive impact on the delivery of the dental programme.

Student support, health and wellbeing, as well as acquisition of generic and translational skills, are a key feature of the modern dental curriculum.