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OPINION

'Twenty minutes of aseptic hell'

  • 10 Comments

Nursing Times blogger Clare Aubrey on her first objective structured clinical examination

Well, I had my first objective structured clinical examination (OSCE) a few days ago. It was traumatic to say the least.

Twenty minutes of aseptic hell, being savagely overlooked by someone you can normally have a bit of a jape with, but who is in that moment a stony-faced symbol of ultimate power, ruling over your life.

Let’s just say I took it badly. My hands shook so badly that I had to stop several times and apologise as I couldn’t get the packaging open or get my gloves on. I couldn’t think straight and I certainly wasn’t capable of calmly referring back to all the practice sessions we had had, in order to pull off a brilliant performance. In short, I was a mess and I wasn’t alone. Afterwards were stories of upset and anger, and the general mood was grim. That coupled with a three week wait for the results and we were in pretty bad shape.

So my question is why are we put through this unnatural torture for the sake of a technique that we could quite easily have signed off during placement? Of course, OSCEs for skills that are denied students whilst in training make perfect sense. We need to have an opportunity to practise those duties which we will meet once qualified, but an OSCE for aseptic technique? Why?

Naturally, my argument stems from the fact that we were unnecessarily emotional wrecks for a good 20 minutes, meaning that instead of being a test of skill, it was more like a test of endurance and those who could hold their nerve. The idea of being put under such strange and unusual pressure meant that we were not in fact ourselves and so this was not a true representation of us as people or professionals. I can see the flip side, that we should be able to handle immense pressure as nurses, such is the nature of our jobs, however, this really is not the fight or flight kind of pressure, the do-the-right-thing-at-the-right-time pressure. This is the I don’t understand why this is making me so nervous gibbering idiot pressure. It’s the worst kind.

My second argument is the unnatural nature of the situation. As students who study at an off-campus location, our circumstances were compared with the campus students, who had more realistic equipment and environments in which to make their attempts. In fairness, we were given leniency in that it was accepted that we didn’t have the same prompts of the natural environment as them, such as an actual curtain to draw round the bed for privacy. (We didn’t even have a bed!) However, where do you draw that line? The OSCE felt like a staged performance, lines learnt, costume on. There is no way that I would behave in that OSCE how I would behave in real life on the ward. Stupid though it was, I even found myself not really checking the dates on the dressing equipment but just acting it out and saying I was doing it, such was the unnaturalness of the whole event. At no other time is a valid scenario so why be judged by it? Especially when there’s so much placement to be had…

I appreciate that the university have to monitor our progress and understand what kind of levels we are attaining in all things, including our clinical skills, but my question really is whether we should be judged on a moment’s madness which had no relation to life or work whatsoever, due to its fundamental fakery?

  • 10 Comments

Readers' comments (10)

  • For heaven's sake what where you trying to do ?

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  • It is about time that skill testing becomes a real lifelong learning experience. Good on you for voicing your comment about validating "role play" over real life experience.

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  • I remember my aseptic technique assessment as a student many years ago.
    It was an actual dressing on a real patient, so I had a real purpose. It still made me slightly nervous though being watched by the sister!!
    I then had a few questions to answer afterwards, but I passed no problem!
    If you know what you're doing, then you should be OK; besides, besides, we should always be using aseptic techniques on a regular basis anyway shouldn't we?

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  • The idea of doing something is to learn, how do to the task and to learn from the experience and be able to do it better the next time. As a student nurse i did the dressing round , started in a very awkward way and then got better with every patient. Also one had to keep up a brave face in front of the patient ! Do not be discouraged , you will get better ! I remember my first attempt at an intra muscular injection. The needle bounced off the patients bottom and I was terriified . When the patient said, " dont worry nurse, have another go " I felt so much better and then did it properly.

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  • You raise a valid point in your reflection, but you need to remember at the end of the day, You're training to be a nurse! High pressure situations will be a part of your everyday life. Get used to it. The OSCE's test your ability under pressure as well as the skill involved.

    I'm sure your 'performance' was outstanding. You clearly know your stuff. Try not to beat yourself up over it.

    Tell me.......would you rather do an OSCE on aseptic technique or another 3000 word essay?

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  • i think the OSCE is a good idea it gives you an idea about what it is like in the ward and it allows the student to reflect and also to receive feedbacks. i was nervous in the beginning as i forgot to raise the bed, but after that i became more relaxed. the clinical skill teacher was really helpful. i think nursing is about practice. the course should be 70% practice and 30% theory and less essays to write.

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  • I would like the opportunity to defend my article a little - I'm not for one moment suggesting that I do not appreciate practical tests or pressure but, in fact, I'm agreeing with you in that I think that placement is clearly the time to monitor these skills as there's no substitute for the real environment!
    And I would be happy to have an OSCE on skills that cannot be performed by students before qualifying, such as IV, as that makes perfect sense, but I am simply questioning the need for any practical test within the falseness of the university setting that could easily be performed whilst in practice. I am simply suggesting that this gives a little more validity to the scenario.
    I hope that this makes a little more sense. Many thanks for your comments - always greatly appreciated.

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  • I do not belive that the pressure we put ourselves under during these test in any way relates to the pressure of doing it for real. It is hard enough to learn a new skill and be able to reproduce this on demand under test conditions but to do this in hostile conditions ??????? Yes we need the skills however we do need to practice not only to prove we have it right but to give us the confindence to put it into practice.

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  • Your experience brought back memories of my student days and performing aseptic technique was always my bug bear. I tended to get 'the steps' confused and I know I worried like hell if I had to do one. However with practise it of course became so much easier and not the 'huge event' I had made it in my mind. So thanks for sharing your experience; it matches those of so many others. So best of luck for the future. I think the thing is to stop worrying and focus which of course is not what I did as a student.

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  • In sone ways OSCE reminds me of Role Play in training sessions where everyone is forced to participate in a 'real' situation. They are absolutely never reaslistic. Everyone is dreading the session and now, having been a trainer myself for 15 years, I no that zero value is achieved. I do however accept that OSCE assessments are needed, but support the majority view of real time assessments, not contrived role play. Not even a bed! It really begins to all seems somewhat amateur.
    I delievered Mov & Hand trg rcently for a private company and when I advised the Manager that 3 of his staff had turned up in high heels he was incredulous as to why I couldn't let them participate either in high heels or ........ bare footed! Your experiences of your asceptic OSCE just made me think of this trg situation.

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