A Formulation and Critical Evaluation of an Inter-Personal Communication Skills Objective Structured Clinical Examination (OSCE) in Pre- Registration Occupational Therapy Education Item Type Thesis Authors Rowe, Pauline Citation Rowe, P (2015) A Formulation and Critical Evaluation of an Inter- Personal Communication Skills Objective Structured Clinical Examination (OSCE) in Pre-Registration Occupational Therapy Education Download date 01/10/2021 15:46:17 Link to Item http://hdl.handle.net/10545/556935 UNIVERSITY OF DERBY A Formulation and Critical Evaluation of an Inter-Personal Communication Skills Objective Structured Clinical Examination (OSCE) in Pre-Registration Occupational Therapy Education Pauline Rowe Work Based Project submitted to the University of Derby in partial fulfilment of the requirements for the degree of Doctor of Education CONTENTS Page No. Abstract Chapter One: Introducing the Project 1- 7 Introduction 2 Personal statement 3 Chapter Two: Literature Review 8-37 The WBP in the context of occupational therapy education 9 Fitness for practice and purpose in a first Practice Placement Education 12 Client centred practice 18 Identification of interaction skills and the assessment of them 23 Competence 25 Objective Structured Clinical Examinations 27 Validity and reliability of OSCEs in assessment 28 OSCEs for inter-personal communication 31 The potential of OSCEs in teaching and learning 33 Conclusions 35 Aims of the WBP 37 Chapter Three: Research Methodology 38-67 General research methodology and my personal stance 39 Formulating an OSCE of inter-personal skills with content validity 42 Trialling the OSCE for student perceptions of its value 48 Questionnaires 49 Interviews 53 Evaluating the OSCE checklist as an aid to self-evaluation and assessment of students’ self-awareness and skills of reflection. 56 Ethical considerations 60 Overview of the research design 65 Summary 67 Chapter Four: Findings and Analysis 68-159 Introduction 69 Formulating a valid OSCE –First round of focus groups with PPEds 70 Formulating a valid OSCE -Second round of focus groups with PPEds 74 Face Validity of the OSCE 83 Summary 93 Student evaluation of the OSCE and the module 94 Questionnaires 95 What students would keep the same if designing the module 96 What students would you change if designing the module 99 Summary 102 Student interviews 104 Views on OSCE as the assessment 116 Summary 121 Evaluating the OSCE checklist as an aid to self evaluation and assessment of students’ self-awareness and skills of reflection 123 Summary 145 Third year students’ perspective on the OSCE 147 Summary 157 Concluding remarks 158 Chapter Five: Discussion 160-188 Introduction 161 The content validity of the proposed OSCE 163 The role of the checklist in assessment 168 The students’ perspective 171 The potential impact on student learning 177 The OSCE in feedback, formative self-assessment and reflection 182 Summary 187 Chapter Six: Reflections, Conclusions and Recommendations 189-198 Introduction 190 Reflections on the research process 190 Conclusions 195 Recommendations 197 Concluding remarks 198 References: 199-225 Appendices List of Tables Page No. Table 1 Skills to be developed prior to a first practice placement 72 Table 2 PPEds grading of DVD role played OSCE 75 Table 3 Students’ evaluation of the module 96 Tables 4 a,b,c&d Comparison of staff – student ratings for each student for each skill descriptor 124-127 Table 5 Totals for each descriptor where student self-assessment was over rated, matched or under rated compared with tutor ratings 128 Table 6 Staff–student grades comparison for each descriptor 130 Table 7 Skills for which students self under- and over- rated by two grades 131 Table 8 Skills which most predominantly rated good or poor 134 Table 9 a, Comparison of staff – student ratings for each student for each skill descriptor for students globally rated as poor 136 Tables 9 b & c, Comparison of staff – student ratings for each student for each skill descriptor for students globally rated as adequate 137-138 Table 9 d, Comparison of staff – student ratings for each student for each skill descriptor for students globally rated as good 139 Table 10 Summary of skills match ratings for poor adequate and good students 140 Table 11 OSCE staff checklist scores versus global ratings 143 List of Figures Figure 1 Proposed schedule of events during the research process 56 Figure 2 Summary of research process: Schedule, methods, rationale and analysis 66 List of Appendices Appendix 1: Focus group schedule for PPEds Appendix 2: Focus group schedule for HEI lecturers Appendix 3: Student Questionnaire-Evaluation of the module and OSCE Appendix 4: Information to first year students requesting participation in interviews Appendix 5: Student interviews Appendix 6: Practice placement educators’ letter of information and consent Appendix 7: OSCE – Communication Skills Checklist Appendix 8: OSCE DVD case scenario information Appendix 9: Sample of Turning Point grading of the role played OSCE Appendix 10: Focus group schedule -second round with PPEds Appendix 11: Revised OSCE Communication Skills Checklist Abstract Occupational Therapy is a client centred, holistic allied health profession in which the quality of a supportive, empowering therapist-client relationship is seen as having a key and central role in effective therapy. A minimum of a 1000 hours of practice placement education (PPE) must be successfully completed in pre-registration programmes, which are charged with ensuring graduates are fit for practice and purpose. This Work Based Project focussed on how pre-registration education can best equip students for a first PPE in terms of sufficient inter-personal communication skills. Primary data collection was conducted between November 2008 and March 2010. The project firstly employed thematic content analysis of data elicited from two rounds of focus group surveys of practice placement educators (PPEds) to identify a baseline of inter-personal communication skills required prior to embarking on a first PPE. This data was used to formulate an objective structured clinical examination (OSCE) checklist of inter-personal communication skills, which was then utilised as a formative assessment and in role play scenarios in taught sessions with one first year pre- registration occupational therapy cohort. This cohort was surveyed via a questionnaire and in addition five students were interviewed. Subsequently a group of third year students, who role played clients for the OSCE, participated in a facilitated discussion on their perceptions of the OSCE. The data on students’ perceptions and an analysis and comparison of staff and student ratings of performance in the formative OSCE, were utilised in a critical evaluation of the use of this OSCE as a teaching and assessment tool. The findings indicate a level of agreement on the content of the OSCE checklist, providing content validity to this particular assessment. PPEds, and first and third year students are positive about the use of an OSCE when it is used as a formative experience. Students recommend that if used as a summative assessment the OSCE is combined with a reflective piece. Objective structured clinical examinations have long been established in other health care professions such as medicine and nursing. This project has provided evidence indicating that an OSCE of inter-personal communication skills is a valid assessment tool for occupational therapy pre- registration students, and that it can also facilitate student reflection, self- awareness and learning. It has also identified profession specific inter- personal communication skills required for embarking on a first PPE. Chapter One: Introducing the Project Introduction Personal Statement 1 Introduction Occupational therapy (OT) is defined by its professional body, the College of Occupational Therapists (COT) as a profession which: “assists people of all ages to achieve health and life satisfaction by improving their ability to carry out the activities that they need or choose to do in their daily lives”, (COT, 2013, p.2, citing COT Council, 2005). Qualification to practice as an Occupational Therapist (OTt) is gained via successful completion of a relevant degree course, which has the overarching remit of ensuring graduates are fit for practice and purpose. To meet this, however, there exists a tension between theoretical and practical knowledge and ability, in short, between the academic /tacit and propositional knowledge, and when and how to best develop and assess this. National curriculum (COT, 2009) and standards of education and proficiencies required of health professionals by professional and registering bodies, the COT (2008) and Health and Care Professions Council (HCPC, 2012a & 2013) respectively, guide providers of education whilst still leaving flexibility in course design and delivery. A key element, in line with the requirements of the World Federation of Occupational Therapists (WFOT, 2002) is that each student must have successfully completed a minimum of 1000 hours in practice placement education, (PPE). Higher education institutes (HEIs) also therefore need to consider how best to prepare students for PPE, which can be in very diverse areas of practice. It may seem an impossibly huge task to prepare students for the specifics of every PPE they may be allocated. However, originally founded on humanistic principles, OT theory and practice, although having evolved over the decades, has continued to retain the