Die Implementierung von Objective Structured Clinical Examinations (OSCEs) im Fach „Klinische Pharmazie“ – Eine Studie zur praxis- und kompetenzorientierten Lehre und Prüfung

The role of the pharmacists has changed significantly over the last decades: Beyond the traditional dispensing role, community and hospital pharmacists increasingly provide patient care and take an active part in pharmacotherapy. The patient has become the center of attention for a multi-professional therapeutic approach. Medication therapy management, pharmacotherapy safety and inter-professional collaboration are becoming more relevant in community and hospital pharmacy settings. Due to ongoing developments in the pharmacy profession, today’s demands on pharmacists are also increasing. Thus, the curricula for pharmacy education at German universities with the present teaching and assessment methods should be reconsidered to meet the increasing demands in the pharmacy profession. Objective Structured Clinical Examinations (OSCEs) are an apt tool to assess clinical competencies such as the students’ clinical-pharmaceutical knowledge, problem-solving, communication and counselling skills. OSCEs are an assessment method in which the examinees rotate through a series of time limited stations and are assessed with regards to their professional performance in a simulated environment against a standardized scoring system. OSCEs show a high degree of objectivity and standardization. Internationally, OSCEs have already proved their role as a reliable and valid assessment method, especially in terms of medicine, nursing and pharmacy courses. However, at German universities there is still the need for progression in practice-related, competency-based education and assessment methods to meet the current changes in the pharmacists’ world. Only few OSCE approaches have been undertaken. Thus, the aim of this study was to evaluate the reliability, validity and feasibility of the conducted OSCEs to provide a scientific basis for the implementation of OSCEs in pharmacy curricula in Germany. The reliability of the OSCEs was assessed by means of Cronbach’s alpha. For validity purposes, the correlation coefficient Spearman’s rho was calculated. Correlation to the final written examination in the Clinical Pharmacy course and correlation to the oral Second State Examination in Clinical Pharmacy was undertaken. Further correlations between OSCE stations and different parts of the final written exam were investigated. Furthermore, the emerging costs and personnel required were recorded to determine OSCE feasibility. The overall cost of a 10-station-OSCE for 100 pharmacy students and the cost per student were estimated, with the aim to give decision support to institutions considering the implementation of OSCEs in their pharmacy curriculum. Continuous evaluations of the students as well as the staff members were carried out for OSCE revision and improvement. The project was sited at Philipps-University of Marburg, Germany. A two-phase study design was selected: The first phase of the project focused on the evaluation of the most appropriate concept of OSCE conduction for the pharmacy course of Philipps University of Marburg. Different OSCE settings were tested, such as the participation of pharmacy students of different semesters and the introduction of a tutorial course on communication and counselling. Further variations of the OSCE itself were undertaken to determine the number of OSCE stations and the OSCE design needed to assure assessment quality. For the second phase of the project, the OSCE concept was transmitted to larger cohorts of pharmacy students up to a maximum of 100 students. The conducted OSCEs were analyzed in terms of reliability, validity and feasibility. Data on the students’ evaluations was collected and analyzed. The OSCEs indicated a moderate to high reliability, comparable to international and national OSCEs of internal medicine. The OSCEs correlated moderately with the written final examination and not at all to only moderately with the oral Second State Examination in Clinical Pharmacy. Generally, OSCEs measure competencies of a higher level, according to Miller’s pyramid. Hence, a combination of predominantly knowledge-based assessment methods and competency-based, practice-related assessment tools such as OSCEs may provide a more comprehensive evaluation of the students’ clinical competence and professional performance. This conclusion is consistent with findings and recommendations in literature. The findings of this project show that the development and conduction of OSCEs in cohorts of up to 100 students are feasible. However, there are high personnel and financial requirements for an optimal conduction of the OSCEs. All in all, the OSCEs proved to be a reliable and valid assessment method and, more importantly, an educational tool, that students, in particular, would like to see included as part of the pharmacy curriculum.