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Students in the Harrison School of Pharmacy continue to consider the Objective Structured Clinical Exam to be one of the more difficult exams required in the school.
But next year, the difficulty rises to a new level, with much more at stake than ever before – graduation.
Since 2005, with the start of a new curriculum, the school has used the OSCE (pronounced "ah-skee") to test students on the objectives covered each semester for three years in the skills lab course, Contemporary Aspects of Pharmacy Practice. Students are graded on skills they exhibit in real-life situations with community members 'acting' as patients.
Simulations are also used for the Milestone, a type of OSCE that tests students at the end of the second and third years on everything they've learned up to that point in school. The school has been administering the Milestone for the past 13 years.
"When they take the Milestone at the end of the third year, they can be tested on any skills that they have been practicing since the time they were a P1 (first-year student)," said Sharon McDonough, director of the Office of Teaching, Learning and Assessment, which administers the Milestone.
The office issues constructive feedback to students instead of grades. But starting next year, a less than minimal performance on the Milestone after the third year can influence fourth-year rotations and perhaps graduation.
If a third-year student is found to be deficient in a particular skill covered by the Milestone, such as communication, information gathering, or professionalism, McDonough said they will have to participate in a remediation plan during the fourth-year, along with rotations. When they retake the Milestone at the end of the year, they will have to demonstrate a proficiency of all skills in order to graduate.
School officials believe the "high stakes" format helps to insure that the school's curriculum is preparing students for success after graduation.
"I think it's better for us to experience these real life situations before we actually are out in the real world and we really have to handle a patient," said Lindsay Edwards, a fourth-year student (P4).
She remembered one patient who was in such a hurry there wasn't enough time for Edwards to tell her everything she needed to know about her prescription.
"That's real life," Edwards admitted.
Fellow P4 Sarah-Anne Swann remembered nearly having a panic attack during her first OSCE because she didn't know what to expect. Through the years, though, she's realized the value of testing her nerves as well as her knowledge.
"What good are we to patients if we don't know more than how to dispense medications?" she asked.
Regis Ledoux sees his work as a 'patient' as a type of community service.
"I remember the names and I remember the faces when I come in and each year, they seem to have learned more," he said. "It's my hope that we are a small part of helping them get to the real world."
Community members take on specific roles to play, such as a parent with questions about their child's prescription. Ledoux said it can be tempting to step out of the character to help a student who struggles to explain a drug or who forgets to ask an important question, but they all know they shouldn't because that's not how it is in the real world.
Each simulation is designed to last only 10 minutes. Students have three minutes to read a prompt on the door that explains, either in detail or vaguely, the particular situation, and assess what prescription or other material is inside the room. They spend the remaining time interacting with the patient, including questioning and counseling them.
Stephen Jamison, a fourth-year student, never thought he would be able to verbalize what he had learned in class until he experienced the OCSEs. As soon as he walked into a room and a 'patient' entered, he said he became a pharmacist, facing a real patient.
"You can be book smart all you want and study all you want, but when it comes down to it, it's that interaction between you and the patient that really matters," he said. "I'm not trying to impress them with my knowledge and big words. It's my responsibility to make it accessible for the patient so they can actually use that information. It's not just 'what do you know?' but 'what can you convey to the patient?'"
Jamison's method seems to work for him. He was recognized in 2010 as a second-year student with a Milestone award, given to those who finished in the top 5 percent of the class.
"It's just like you're working in a retail pharmacy. Somebody walks in, what are you going to say? You can't let them leave without telling them everything that's going to make them better," he said.
Last Updated: Jun. 14, 2011