1. ICN INTERNATIONAL CONFERENCE. SOUTH AFRICA 27-30 JUNE 2006 Assessing Clinical Competence at Masters Level the case for the long case Helen Ward, Senior Lecturer / Nurse Practitioner London South Bank University, London, England

2. What is an OSCA? Objective Structured Clinical Assessment. An assessment that reflects the clinical complexity that students may encounter in the work place.

3. Masters level performance: Ashworth et al (2005) suggests four characteristics that can be attributed to masters level performance: Cognitive competencies Practice related competencies Research orientation Personal dynamism The OSCA assesses all of these.

4. Development of the OSCA In-depth search of the literature Consultation with other universities offering MSc in advanced practice (in the UK) Expertise of the Nurse Practitioner teaching team at London South Bank University.

5. Development of the OSCA Builds on elements of the OSCE Reflects a total patient presentation which also assesses students underpinning knowledge. Requires students to demonstrate competence in a range of clinical skills essential for the advanced nursing role.

6. Range of clinical skills: Communication History taking Advanced physical examination Clinical decision making Diagnostic reasoning Interpretation of results Developing and negotiating a treatment and management plan

7. LSBU OSCA Defined by the LSBU course leaders as: Two long-case scenarios consisting of five integrated components designed to reflect a total patient assessment. Each case presents a complex patient presentation which is marked against specific criteria considered essential for the advanced nursing role

8. Masters level examination Integrated stations (or components) are designed to reflect clinical complexity Effective management of this complexity together with the ability to articulate an understanding of the pathophysiological processes and clinical reasoning is essential for this examination.

9. 5 components of the OSCA 1. History taking 2. Physical examination 3. Clinical reasoning and diagnosis 4. Interpretation of results 5. Treatment and management

10. 1. History taking In-depth holistic history Marks awarded for structure and ability to communicate appropriately with the patient At the end student is required to generate initial multiple hypotheses, and discuss these with the examiner.

11. 2. Physical examination Student chooses and performs a comprehensive physical examination. More than one system may need to be examined. Marks are awarded for a systematic approach, technique and clear explanation of procedure

12. 3. Clinical reasoning and diagnosis 2-parts: 1. Viva questions relating to the underpinning knowledge related to physical examination. 2. Explanation with rationale of which initial multiple hypotheses the student will keep and which they will refute. Marks are awarded for evidence of clinical reasoning

13. 4. Interpretation of results Interpretation of 3 investigations relevant to the scenario. Students explain results to examiner Then to patient in terms of patient understanding. Marks are awarded for correct interpretation and clarity of explanation. The correct diagnosis is articulated at this point

14. 5. Treatment and management Students are asked to: Discuss a management plan, including initiating pharmacological treatment Or – hand-over the patient to a colleague giving specific information regarding findings, possible diagnosis, suggested follow up Or – write a referral letter Marks are awarded for accuracy, reference to appropriate guidelines / procedures, clarity and fluency

15. Student preparation for the OSCA Practice with clinical facilitators, peers and colleagues Mock OSCA OSCA handbook

16. OSCA examiners Experienced Nurse Practitioners Medical colleagues Members of the Nurse Practitioner Team Actors may be used as the simulated patient

17. Marking the OSCA Examiners are responsible for assessing each of the identified criteria. Examiners are encouraged to write constructive comments reflecting the students ability Marking is undertaken by the NP team and moderated by an external examiner.

18. Marking the OSCA Each component of each OSCA station is marked individually and a percentage awarded. An overall percentage is then calculated to give the final mark for the case. The average mark for the two long case scenarios determined the final mark

19. Pass / fail criteria The pass mark for the OSCA is 70% A reflection of the clinical competence required by Nurse Practitioners working in advanced clinical roles. 65 – 69% - students were offered a VIVA Below 64% - student referred and required to re-sit the OSCA at the next occurrence.

20. The OSCA An innovative, creative and rigorous method for the assessment of advanced clinical skills at Masters level. Only one method of assessing clinical competence. Other methods include: clinical placement assessment Clinical portfolio