The goal of medical education is to develop clinical competency among medical students by appropriate teaching and assessment methods. While the theory exams assess cognitive domain, the practical exams should be designed to assess the cognitive, psychomotor and effective domains like knowledge, attitude and skill. The scoring obtained may only reflect the overall performance of the student rather than the individual competencies (1). The traditional practical examination (TPE) of Biochemistry includes the qualitative experiments and practical viva voce, which students have to perform. This type of assessment does not provide the examiner, an opportunity to assess the skill of the student and the scoring by this pattern may be subjected to examiner bias. As a result, only, few learning outcomes was assessed by conventional methods (2). The CBME curriculum in medical education inherently incorporates assessment as a crucial element, involving objectivity, uniformity, validity and reliability as various modes of assessment, thus promoting a cohesive approach to teaching, learning and evaluation. The old conventional teaching method failed to satisfy all the elements of assessment (3). Hence a new pattern of objective structured evaluation was introduced and the competence is tested uniformly and objectively for all the students, taking up the practical examination (3b). The OSPE is a versatile multipurpose evaluation tool, that assess competency, based on objective testing through direct observation (4). The four levels of Miller’s pyramid: “Knows”, “knows how”, “shows how” and “does”, are incorporated in OSPE (5). The OSPE in CBME curriculum, is a comprehensive assessment method. It evaluates skills, competencies and professionalism in an objective, structured and standardized manner, thus aiming at removing bias and ensuring fairness and consistency (6). It comprises of multiple assessment stations where students are assessed by certified assessment facilitators where various competencies are evaluated in a comprehensive, consistent and structured manner (7). The OSPE has a very great potential, as the students can gain insights into the elements making up competencies as well as feedback on personal strengths and weaknesses (8). Thus, the present study aims to compare the performance of first-year MBBS students in traditional practical examination method versus the OSPE format, and also assess their efficacy as assessment tools.

OBJECTIVES

3. To evaluate the MBBS students by using teaching tools like Didactic lecture & OSPE.
4. To evaluate the perceptions of MBBS students in Biochemistry regarding Didactic Lecture & OSPE using a questionnaire

MATERIALS AND METHODS

The current study was a questionnaire-based study conducted from February to June 2025 in department of Biochemistry at Mamata Academy of Medical sciences, Bachupally, Telangana. The study included total of 150 MBBS students of 2024-25 batch. First a didactic lecture on Urine Analysis was delivered. OSPE was conducted for MBBS students on the same topic “Urine Dipstick analysis”, with one procedure station and marks were awarded. Google form questionnaire on Didactic Lecture & OSPE was circulated among the students. Their responses were recorded on Excel sheet. Statistical Analysis done and percentage graphs & student’s’ test using MS Excel were used. The study approved by the institutional ethical committee (IEC/MAMS/2025/172 Dtd 26/08/2025).

Inclusion criteria: The phase 1 MBBS students from 2024 batch who were voluntarily willing to participate were included in the study.

Exclusion criteria: Students who were not willing to participate, and students who were absent on the day of OSPE, as well as those from other batches and courses were excluded from the study.

The chosen topic by the faculty was “urine abnormal analysis”, a qualitative practical procedure and “dipstick analysis of urine”, OSPE. The topic for didactic lecture and OSPE was identified from the biochemistry competencies with the competency number BI-11.20. A practical demonstration session was taken for abnormal urine analysis. The students were made to perform the practical qualitatively, and another demonstration session of dipstick analysis of urine, with a procedure in the form of checklist is provided along with distribution of marks for each step in the checklist, and the procedure was performed by the students under faculty supervision. A well-structured and pre-validated questionnaire in the form of google form for both abnormal analysis of urine and dipstick analysis were made with 20 questions for each procedure and the students were asked to submit the feedback. The students responses collected and analyzed by statistician.

Procedure:

The students were divided into 4 batches and four OSPE stations were setup for all the students. The scoring was based on student performance, pre-procedure, procedure and post procedure. The total marks allotted were 5 marks and five minutes time was allotted for each student. (table). The faculty assessed the student with the aid of predesigned checklist and allocated marks accordingly. The feedback questionnaire was prepared as per the need of the study and given to the student at the end of the session. The responses were documented and analyzed.

RESULTS

From the following figures &  Questionnaire tables, we found that 64% of our First year Undergraduate Students found that Didactic lectures were not interactive,67% found the topics difficult to understand.48% found the lectures monotonous, whereas 57% had low attention span during the Lectures.

For 71% of students OSPE helped them in  clarity on practical aspects,65% in enhancing their skills,69% found Clinical Application helpful,75% found them more easy  in scoring marks, Around 76%students preferred OSPE over Didactic Lectures for better understanding & clarity.

Didactic Lectures Questionnaire

OSPE  Questionnaire

DISCUSSION

It was felt that a conventional method of teaching did not satisfy all the elements of Assessment. Competency based Medical Education involves the attainment of observable abilities by the students in a time independent learner centred manner⁹.A new pattern of Objective Structured Practical Examination was developed in 1975 & later modified by Harden & Gleeson in 1979.In OSPE each component of the competence is tested uniformly & objectively for all the students.^10,11

In our study, we took a Didactic lecture and OSPE on urine analysis & compared the feedback of students on both the modalities of teaching. Regarding  Didactic Lectures majority of the students found the topic of the lecture difficult to understand, not interactive, monotonous, with less attention span. Some students preferred the topic to be taken as OSPE, while others realized that the clinical application was less.

In our study students found that Questions were clear, sufficient time was given for each station, helpful in scoring marks & enhancing practical skills.

They found OSPE gave them more clarity about practical aspects as compared to Didactic lecture. These observations were also there in studies by Rahman et al¹²& Menezes¹³ et al, who found OSPE as a better tool over the traditional methods for assessing the practical skills of MBBS students. Shiwani Jaswal¹⁴ et al reported that OSPE is very useful tool in Biochemistry. Other studies reported that OSPE helps to assess the performance grade of the students^15,16-21There were few students who found didactic lecture more informative. OSPE is helpful is assessing the competency of the students²².

CONCLUSION

In conclusion, OSPE is feasible & have good reliability for evaluating practical skills of Undergraduate Medical Students apparent by the  Examiners & students. OSPE  is significantly more effective than Didactic lectures in understanding a particular topic of Biochemistry. It increases their attention span, their interest in the subject and also helps in retention of learned concept better when compared with traditional lectures. Simultaneously, it motivates the students for self-directed learning and improves their communication skills and should be a regular part of the curriculum.

Limitations: Gender comparison was not assessed in the current study.

Source of funding: None

Conflict of Interest: The authors declare no conflict of interest

REFERENCES

1. Ramachandra SC, Vishwanath P, Ojha VA, Prashant A. Objective Structured Practical Examination (OSPE) Improves Student Performance: A Quasi-Experimental Study. JK Science: Journal of Medical Education & Research. 2021 Aug 20;23(3):149-54.
2. Rajkumar KR, Prakash KG, Saniya K, Sailesh KS, Vegi P. OSPE in anatomy, physiology and biochemistry practical examinations: perception of MBBS students. Indian J Clin Anat Physiol. 2016 Oct;3(4):482-4.
3. Anees S, Harakuni S, Kausar R. OSPE in Biochemistry–A step towards implementation of competency based undergraduate curriculum. Int J Clin Biochem Res. 2021;8(3):234-6.
4. Kundu D, Das HN, Sen G, Osta M, Mandal T, Gautam D. Objective structured practical examination in biochemistry: An experience in Medical College, Kolkata. Journal of Natural Science, Biology, and Medicine. 2013 Jan;4(1):103.
5. Ten Cate O, Carraccio C, Damodaran A, Gofton W, Hamstra SJ, Hart DE, Richardson D, Ross S, Schultz K, Warm EJ, Whelan AJ. Entrustment decision making: extending Miller’s pyramid. Academic Medicine. 2021 Feb 1;96(2):199-204.
6. Amberina AR, Tagore R, Sree BR.Evaluating Objective Structured Practical Examination as a Formative Assessment Tool in Biochemistry: A Cross-sectional Study from a Medical College in Telangana, IndiaJ Clin of Diagn Res.2025; 19(7):BC05-BC08. https://www.doi.org/10.7860/JCDR/2025/78821/21171
7. Rai N, Nair SK. Evaluation of perception regarding feasibility of introducing objective structured practical examination (OSPE) in the department of anatomy. Indian J Clin Anat Physiol. 2019;6:315-20.
8. Mokkapati A, Pavani G, Dass SM, Rao MS. Objective structured practical examination as a formative assessment tool for IInd MBBS microbiology students. Int J Res Med Sci. 2016 Oct;4(10):4535-0
9. Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, Harris P, Glasgow NJ, Campbell C, Dath D, Harden RM. Competency-based medical education: theory to practice. Medical teacher. 2010 Aug 1;32(8):638-45.
10. Ananthakrishnan N. Objective structured clinical/practical examination (OSCE/OSPE). Journal of postgraduate medicine. 1993 Apr 1;39(2):82-4.
11. Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Medical education. 1979 Jan;13(1):39-54.
12. Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J. 1975 Feb 22;1(5955):447-51.
13. Rahman N, Ferdousi S, Hoq N, Amin R, Kabir J. Evaluation of objective structured practical examination and traditional practical examination. Mymensingh medical journal: MMJ. 2007 Jan 1;16(1):7-11.
14. Menezes RG, Nayak VC, Binu VS, Kanchan T, Rao PJ, Baral P, Lobo SW. Objective structured practical examination (OSPE) in Forensic Medicine: students’ point of view. Journal of forensic and legal medicine. 2011 Nov 1;18(8):347-9.
15. Jaswal S, Chattwal J, Kaur J, Gupta S, Singh T. Assessment for learning with objectively structured practical examination in biochemistry. International Journal of Applied and Basic Medical Research. 2015 Aug 1;5(Suppl 1):S71-5.
16. MP S, ZK K. < An> objective structured practical examination to test students in experimental physiology.
17. Reznick R. Does it matter where you go to medical school?. Medical Education. 1999 Aug 1;33(8).
18. Tekian A. Have newly graduated physicians mastered essential clinical skills?. Medical education. 2002 May;36(5):406-7.
19. Ruth N. Communicating student evaluation of teaching results: rating interpretation guides (RIG's). Assessment & Evaluation in Higher Education. 2000;25:121-34.
20. Smee S. Skill based assessment. BMJ. 2003;326(7391):703-706. doi:10.1136/bmj.326.7391.703
21. Oberle B, Muma R. The OSCE compared to the PACKRAT as a predictor of performance on the PANCE [Internet]. 2006
22. Schoeman S, Chandratilake M. The Anatomy Competence Score—A new marker for anatomical ability. Anatomical sciences education. 2012 Jan;5(1):33-40.