1. FUTURE PRACTICE & RESEARCH
A “Wicked” Challenge: Using an Objective Structured Clinical Examination (OSCE) to assess attributes of the 6 C’s within Occupational Therapy students Mandy Graham Senior Lecturer Occupational Therapy, School of Clinical and Applied Sciences, Leeds Beckett University
INTRODUCTION
The publication of the Francis Report in 2013 highlighted a need for a change in the attitudes and values of health and social care professionals in the UK to ensure high quality care for all. Major recommendations for individual staff centred around refocusing on the basics of good quality patient care including utilising soft skills such as empathy, active listening and therapeutic relationships and fostering a common culture of putting the patient first (Francis, 2013). These qualities were later coined the 6 C’s – Care, Compassion, Competence, Communication, Courage and Commitment; and formed a new “Compassion in Practice” vision for the NHS (NHS England, 2016).
Values Based Recruitment was introduced to ensure that the right individuals were recruited into such professions (Health Education England, 2016) and higher education institutions had a duty and responsibility to not only teach the principles of good quality care but to also ensure the assessment of such aptitude and soft skills. However such skills have often been termed “Wicked Competencies” (Knight, 2007), as they are difficult to define and therefore accurately assess.
An Objective Structured Clinical Examination (OSCE) was used to assess professional values, attitudes and behaviours within MSc Occupational Therapy (pre-registration) students at Leeds Beckett University, using the framework of the 6C’s. The challenges of assessing wicked competencies, from both a student and academic perspective will be discussed, along with findings from the evaluation of using a simulation based approach.
WHAT IS AN OSCE?
An OSCE uses a simulated setting to assess practical skills and has been used within medical education training for a number of years (Najjar, Docherty and Miehl, 2016). An OSCE is typically a multi-station simulation with each station assessing a different skill, however within this example a scenario was designed to assess multiple elements of the 6 C’s at one time. Students were assessed using a scoring grid which was completed by an academic member of staff in collaboration with a service user assessor, and following feedback from the simulated patient. The students was required to pass the OSCE as a pre-requisite to going on their first practice placement. The OSCE’s took place within a simulated hospital ward and apartment / flat within the Clinical Skills Suite at the university.
Example OSCE scenarios:
A case study from an early intervention service of a young man with psychosis. The student had to respectfully gain access to the client’s home; introduce themselves and the service they were from; enquire about the client’s wellbeing; introduce the role of occupational therapy and answer the client’s questions about how occupational therapy differed from other professions who had tried to help him.
A case study concerning an inpatient on a medical ward reporting poor practice to a student. Students were required to discuss what action they would take; how they would establish the full facts regarding the incident; how they would demonstrate compassion towards the patient and what communication skills they would use to maintain trust and therapeutic rapport in the situation. Students were also required to discuss how they would report the incident following appropriate whistleblowing procedures.
BENEFITS
Academic/Student/Educator Perspective:
To better prepare students for practice placement
Increased confidence in being able to explain the role of occupational therapy to others
Increased confidence and courage in dealing with ethical dilemmas in practice
Assurance that students had been assessed to have the right attributes to be working with vulnerable patients and service users
To screen for any issues regarding professionalism
CHALLENGES
Academic Perspective:
Logistical considerations of organising a practical exam
Designing appropriate case scenarios to assess all aspects of the 6 C’s
Consistency when using simulated patients
Designing an appropriate scoring tool
Collaborative scoring between academics, service users and simulated patients
Student Perspective:
High anxiety levels due to consequences of failing the OSCE
Uncertainty about what to expect
Some students over focussed on policy elements such as the code of ethics, rather than actions to demonstrate compassion and care
Paper based OSCE scenarios did not elicit the same results in students as practical based OSCE simulations
FUTURE PRACTICE & RESEARCH
Following the evaluation of the use of the OSCE a few minor modifications were made to the delivery of the assessment for future cohorts. Rather than two separate OSCE’s a single OSCE was designed to capture all elements of the 6 C’s. This has had benefits to both the planning and delivery of the OSCE and in reducing the anxiety levels of students by only having to complete one assessment. It would be interesting to explore whether the undertaking of such an OSCE has a future impact on students’ performance within their first practice placement. The perceived levels of confidence and skills in professional interactions and therapeutic rapport could be explored from an educator, student and service user perspective.
CONCLUSION
OSCE’s can be useful way to assess the 6 C’s within occupational therapy students however academic staff must not underestimate the time involved in planning, designing and delivering such an assessment. Despite some student anxieties about the assessment the benefits of completing the OSCE is felt to result in more confident explanations of the role of occupational therapy to patients, service users and carers. It is hoped that fellow academics, students and clinicians will be inspired by this work and reflect on their own ideas of how such “wicked competencies” can be assessed in future generations of healthcare students, in order to ensure they are equipped to put compassion at the centre of care health delivery (NHS England, 2016).
REFERENCES
Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive summary. [Online]. The Stationery Office Limited. Available from: [Accessed on 09/06/17].
Health Education England (HEE) (2016) Values Based Recruitment (VBR). Available from: [Accessed on 09/06/17].
Knight, P. (2007) Fostering and assessing wicked competencies. Open University Press. Available from: [Accessed on 19/01/17].
Najjar, R. Docherty, A. and Miehl, N. (2016) Psychometric Properties of an Objective Structured Clinical Assessment Tool. Clinical Simulation in Nursing, 12 (3), pp
NHS England (2016) Compassion in Practice: Evidencing the impact [online]. Available from: [Accessed on 16/06/17]. NHS England.