CADD CORNER

Educating the Next Generation of Social Workers with OSCE: New Options in Preparing Practitioners

By Mary Rawlings, PhD, LCSW, Professor and Chair, Department of Social Work, Azusa Pacific University

I first became interested in Objective Structured Clinical Exams (OSCE) about 15 years ago, while pursuing my doctorate and simultaneously working as an assistant professor in a BSW program. While I believed we were training our students well, I was interested in finding evidence on if we were actually preparing BSW students for professional practice any differently than other social science type majors on our campus. We marketed our program on campus as a professional program, we had skill-based courses using role plays, and an internship program with the requisite “process recordings.” Yet, in a state without title protection or licensing for BSW level practitioners, I often felt like I was constantly trying to argue the worth of the degree on campus. I wanted something to “back up” my claims. Could we prove our students were better prepared for practice having graduated with an accredited BSW degree than students graduating in non-accredited related undergraduate majors?

I began exploring how I could standardize a role play scenario and rate student performance. While some attempts at standardization had been tried in social work, I discovered professions of medicine and nursing had successfully been doing this for some time creating valid and reliable scenarios using a format they called OSCE. So what is an OSCE? An OSCE typically involves a student engaging an actress/actor simulating a client in a specific clinical scenario (Structured) while being directly observed in the room by a trained evaluator (Objective) who rates the student using specific performance criteria resulting in a scoring of competence (Exam). They are typically brief, lasting approximately 15 to 20 minutes in length. Scenarios are carefully designed to allow students to demonstrate specific skill sets and for the actor to play the role consistently allowing each student a fair opportunity to demonstrate ability.

I must admit I was skeptical if this format could work in social work. Social work practice is complex, it involves more than just checking off on a list if a participant asked the right question for a diagnosis. Could you train an actress to play complex social work cases? Our interactions are longer than 15 minutes, how could you rate competence in such a short amount of time? How would students respond with a rater in the room evaluating them?

My concerns were allayed when I had the privilege of being invited to observe third-year medical students engage in psychiatry OSCEs at the end of their rotation. Students went through a series of five interview stations involving five different scenarios. If they did not get a passing score, they could not proceed to the next rotation without remedial work. I was amazed at what I saw. I saw actors and actresses portray acute mental illness better than I had seen on TV, not just once, but over and over again. I saw students managing their anxiety and performing interview and assessment skills in front of raters sitting closely by in the room. I saw a program holding students to a high standard of performance. I saw that in social work education we had not been pushing ourselves enough to really understand what our students knew or did not know about social work practice.

From that experience, along with social work colleagues from Azusa Pacific University, and in partnership with social work colleagues pursuing a similar interest from the University of Toronto, I set out to implement OSCEs in our BSW program. Over the years, we have grown and developed our OSCE program. Students at both the BSW and MSW program now engage in an OSCE as part of a practice course. Students in health care and child welfare courses participate in OSCEs centered in that practice area.

We have learned a lot at my university through the use of OSCE. We have learned that students want to be challenged to develop their skills. While nervous, once OSCEs are completed many students ask for more simulation experiences. Students are amazed by how authentic the actresses are, that they forget the rater is in the room, and by how much they learned. Students want to grow and develop skills in safe spaces that hold them accountable to high standards, and OSCEs give them that opportunity. OSCEs help us to identify students that may need more training and support as they enter into field internships. We have learned that students from disadvantaged educational backgrounds, who may struggle in areas such as writing, often excel when tested on interpersonal engagement. Directly observing skills has helped us move beyond understanding what students know, to understanding what students can do.

Perhaps more important, however, is what OSCE taught us as academics about our own programs. We learned that while we thought we were training students in active listening, we had much left to do. While we thought we were training students in cultural competence and humility, students struggled to implement this in practice. While we thought students understood use of self, they did not. By our direct observation of students demonstrating live clinical skills learned in the classroom, we were able to see deficits in our curriculum we were previously unaware of and subsequently make the necessary revisions to better train our students.

Today, use of OSCEs is  emerging across social work education. More and more programs are experimenting with use of simulation for evaluation of competence. For example in social work education, OSCEs have been used to evaluate skills of engagement (Bogo, et al., 2011), child welfare assessment (Tufford, et al., 2015), substance abuse intervention (Baez, 2005), and cultural competency (Lu, et al., 2011). Some social work OSCEs add a reflective component to capture students’ emotional regulation and awareness, as well as their ability to think critically about their practice (Bogo, et al., 2014).

While OSCEs are only one of many assessment innovations currently taking place in social work education, it is exciting to see the academy hold themselves accountable to developing new and creative ways to ensure we are graduating students prepared for practice.

References

Baez, A. (2005). Development of an Objective Structured Clinical Examination (OSCE) for Practicing Substance Abuse Intervention Competencies: An Application in Social Work Education. Journal of Social Work Practice in the Addictions, 5(3), 3–20.

Bogo, M., Rawlings, M., Katz, E., & Logie, C. (2014). Using simulation in assessment and teaching: OSCE adapted for social work. Alexandria, VA: Council on Social Work Education Press.

Bogo, M., Regehr, C., Logie, C., Katz, E., Mylopoulos, M., & Regehr, G. (2011). Adapting Objective Structured Clinical Examination to assess social work students’ performance and reflections. Journal of Social Work Education, 47(1), 5–18.

Lu, Y. E., Ain, E., Chamorro, C., Chang, C.-Y., Feng, J. Y., Fong, R., … Yu, M. (2011). A New Methodology for Assessing Social Work Practice: The Adaptation of the Objective Structured Clinical Evaluation (SW-OSCE). Social Work Education, 30(2), 170–185.

Tufford, L., Bogo, M., & Asakura, K. (2015). How Do Social Workers Respond to Potential Child Neglect? Social Work Education, 34(2), 229–243.