Implementation of Objective Structured Long Examination Record as an Assessment Method for Formative Assessment in Surgery among MBBS Phase 3 Students

Background: The traditional long case examination (LCE) is largely unobserved, statistically unreliable and often poorly structured. The examiner’s thought process can influence the ratings, and the competencies assessed are not clearly defined. If specific marks are not allotted to different competencies, the examiner tends to give average marks which cannot distinguish between high performers and low performers. For proper assessment of the whole clinical problem, one should use a method which is structured. Objective structured long examination record (OSLER) retains the comprehensiveness of LCE, but with a better quality of assessment. In the structured clinical examination, the variables and complexity of the examination are more easily controlled, its aims can be more clearly defined, and more of the student’s knowledge can be tested. Objectives: The objectives of this study are to evaluate student performance by the traditional method of assessment (LCE) and the OSLER method of assessment of clinical competence and to analyze the perception of assessors and students about both the methods. Methodology: MBBS Phase 3 students were divided into two groups, A and B, of 8 students each. In the 3 rd week of their ward rotation, Group A had traditional LCE. Group B was assessed by the OSLER method. During the 4 th week, Group B had traditional LCE and Group A was assessed by the OSLER method. The OSLER method concentrated on 10 items. Marks were given to each component of OSLER. Examiners were asked to observe the OSLER group students when they were eliciting the history and examining the patient. Perception regarding both examination methods was assessed among the students as well as the assessors using a standardized Likert’s questionnaire scale after the exam. Time taken for assessment by examiners in both the groups was recorded. Standard deviation and P value were calculated for the mean marks obtained for each of the two groups and the time taken. Differences in means were analyzed using a paired t -test. Results: Regarding the mean time, the standard deviation in the LCE Group was more than that of the OSLER Group, indicating a wider range of variability in the time taken for the assessment in traditional LCE. The difference in the mean marks scored among the two groups was statistically significant. The Standard deviation in the OSLER Group (minimum score = 40, maximum score = 80) was higher than in the traditional LCE group, indicating the ability of OSLER in discriminating between the high performer and the low performer. Conclusion: The present study proved the statistically significant superiority of OSLER over the traditional method of examination and demonstrated OSLER’s ability to discriminate between high performers and low performers within a fixed time range, which definitely does justice to the students.