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
[email protected]
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.
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
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.
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:
http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf [Accessed on 09/06/17].
Health Education England (HEE) (2016) Values Based Recruitment (VBR). Available from: https://www.hee.nhs.uk/our-work/attracting-recruiting/values-based-recruitment [Accessed on 09/06/17].
Knight, P. (2007) Fostering and assessing wicked competencies. Open University Press. Available from: http://www.open.ac.uk/opencetl/files/opencetl/file/ecms/web-content/Knight-(2007)-Fostering-and-assessingwicked-competences.pdf [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.88-95.
NHS England (2016) Compassion in Practice: Evidencing the impact [online]. Available from: https://www.england.nhs.uk/wp-content/uploads/2016/05/cip-yr-3.pdf [Accessed on 16/06/17]. NHS England.