Introduction

The training of health professionals involves teaching and evaluation methods that facilitate the assessment of their knowledge, skills, and attitudes, all of which are collectively referred to as professional skills to solve problems that are inherent to their professions in specific contexts.^1-5

Education in physical therapy programs is aimed at the development and acquisition of learning outcomes (LO), defined as the knowledge and actions students must master at the end of a learning period, which requires the use of teaching methods focused on the students' learning needs regarding their professional practice.^6-8

LOs comprise the knowledge, skills, and attitudes that students must acquire and develop in a given learning period and in accordance with certain conditions and evaluation criteria established in the academic program.^9-16

In the field of physical therapy, physical agents are defined as therapeutic resources that are commonly used in rehabilitation processes. They are often used to relieve pain, reduce edema, treat muscle tone alterations, promote tissue repair and muscle strength augmentation, or to increase the effectiveness of other interventions aimed at solving mobility problems and promoting functional rehabilitation. These resources are based on the use of electromagnetic, acoustic, and mechanical energies to produce biophysical changes in cells and tissues that will lead, ultimately, to physiological and clinical changes in the patient.^17-19 Adequate use of physical agents is a requirement that undergraduate physical therapy students must meet during their training, as it is a key component of physical therapy programs.^20,21

Physical therapists are required to properly use these resources to prevent the occurrence of adverse effects in patients. This implies not only their training in using physical agents, but also appropriate assessment of these professional skills,^22-23 which is why the development of teaching and evaluation strategies that allow assessing physical therapy students' skills and clinical reasoning capacity when selecting and using physical agents is required.^20-23

Objective Structured Clinical Examination (OSCE) is regarded as a valid methodology to assess clinical skills in health sciences students. An OSCE is comprised of several evaluation strategies implemented throughout a circuit of stations that simulate clinical scenarios.^24-27 Therefore, it is recognized as a multipurpose and versatile tool that can be used to assess, with uniform criteria, a wide array of clinical skills in different health sciences students in specific clinical contexts; likewise, it is a useful instrument to provide feedback, foster reflection, and improve the development of skills during the training of future health professionals.^28-32 Since OSCE is an efficient tool to provide feedback to students and facilitate the improvement of their clinical skills and reasoning to apply an intervention, it allows them to reflect on and assess the quality of their performance in each of the OSCE stations and identify the aspects to be improved. This is of great importance, for the assessment of one's own skills may enhance one's performance in future professional practice.^33,34

However, there is a double challenge that must be addressed: 1) having a well-designed OSCE that makes it possible to assess clinical skills and provide students with feedback on their performance, and 2) making sure that the observed (objective) performance is in line with the performance perceived by the students (subjective). Objective performance in a test such as OSCE must be positively correlated with the performance perceived by students, for it will facilitate the identification of strengths and aspects to improve, and it will promote self-reflection on their acquisition of clinical skills. This will result in the enhancement of the teaching-learning process through effective feedback.^35-40 Another relevant aspect of OSCE is the students' level of satisfaction with the instrument, as it provides feedback on its design, usefulness and efficacy to assess their skills during their professional training.^29,39

Taking this into account, the objectives of this study were to determine the correlation between the performance and self-evaluation (perceived performance) of Chilean physical therapy students in an OSCE designed to assess their clinical skills when using physical agents, and to assess their level of satisfaction with it.

Materials and methods

Discussion

The training of health professionals is not only aimed at acquiring knowledge, but also at acquiring and developing skills that will allow them to solve clinical problems. ^17,44,45 In the case of physical therapy students, the learning and development of skills related to the planning and implementation of therapeutic and rehabilitation interventions must be emphasized, since such interventions require physical therapists to constantly interact with patients and, based on said interaction, use several procedures and techniques, including physical agents, to generate changes in the health condition or conditions affecting the patient.²⁰

In this sense, defining which physical agents can be used and how to use them (e.g., their dosage) requires the development of clinical reasoning skills to assess their relevance and therapeutic benefits to treat a given health condition. Furthermore, some problems frequently observed when using physical agents in clinical practice involve their installation and configuration with pre-established parameters, especially in the case of electrotherapy resources.^8,21 This is why implementing teaching strategies that include the development of clinical skills related to the use of physical agents in the training of physical therapy students is of great importance.²² OSCE is a multidimensional tool designed to assess the performance of health sciences students in specific clinical settings by testing their knowledge, attitudes, and their clinical reasoning and interpersonal communication skills. The use of this instrument for the training of other health professionals has already been validated.^4,7,40,46,47 Likewise, students play a major role in this process, so obtaining information about their perceived performance and their levels of satisfaction with it is essential to carry out feedback processes.^{28-31,34,37,48}

The aims of this study were to determine the correlation between the performance and self-evaluation (perceived performance) of Chilean physical therapy students in an OSCE designed to assess their skills when using physical agents, and to assess their level of satisfaction with it.

Regarding the students' performance in the OSCE, a passing rate > 75% was observed in stations S1, S2, S3, and S4, which means a high performance in terms of the achievement of the LOs assessed in said stations. In the case of station S3, the P₅₀ and P₂₅ scores were greater than the passing score, however the passing rate in this station did not reach 70% (69.30%); therefore, it can be concluded that students had an average performance in S3. On the contrary, low passing rates were observed in stations S5 and S6 (48.25% and 34.21%), that is, a low performance.

Regarding the results of the self-evaluation survey, it was found that more than 60% of students perceived their performance as good or very good in stations S1, S2, S3, and S4 (S1=62.15%; S2=64.85%; S3=62.16%; S4=57.66%); however, it should be noted that in stations S5, S6, and S7 less than 50% thought they had had a good or very good performance (S5=20.73%; S6=44.13%; S7=43.25%). Self-evaluation results (subjective performance) allow knowing the level of attainment of LOs that students believe they have achieved during the course. On the other hand, scores obtained in the OSCE (objective performance) show the LOs attained by the students and allow them to analyze their own performance in each station in terms of high, average or low performance, which facilitates their reflection on their ability to use in their professional practice what they have learned during their training.^20,27,26,39

Furthermore, a positive and significant correlation between the students' perceived performance (self-evaluation) and the actual scores obtained in the OSCE was found in 5 out of 7 stations (S3-S7). It should be noted that this correlation was observed in stations where students had both a high (S4) and a low performance (S5 and S6), which shows a high level of agreement between the students' real performance (as observed by the evaluators) and the students' perception of their own performance. Also, these findings allow the making of improvements to the training process, the implementation of self-reflection practices, and the generation of effective feedback for both students and instructors as reported by other studies.^24,29,35

Regarding the level of satisfaction with the OSCE, the majority of students reported having a high level of satisfaction with it, as more than 82% rated the instrument with positive qualitative criteria (agree and strongly agree) through all the five questions asked in the survey. In fact, most of them said the OSCE was well organized (89.18%) and that it was useful for their training process (92.79%).

Finally, considering the results reported here, we recommend to include more stations in the OSCE in order to reinforce those clinical skills where a lower performance was observed, as well as to enhance the development of such skills during the training process.^47,49

A limitation of the present study might be the number of stations used and the time established for the completion of the tasks of each station, which in future applications of the OSCE could be adjusted by increasing the number of stations or the time allotted per station, which will probably result in a better overall performance by students.^50,51 However, it must be noted that this type of assessment requires a large amount of resources, including equipment, properly trained human resources, and support personnel.

Another limitation is that during the physical agents course students did not receive enough training with dummies and standardized patients. As the use of the OSCE was a first-time approach to this assessment modality in the course, it would have been ideal that students would have had more experience in performing these tasks in order to improve their confidence levels in the execution of every task included in the stations where the participation of standardized patients and/or the use of dummies was involved.

Conclusions

The OSCE is a useful instrument to assess both clinical skills and clinical reasoning in physical therapy students. Thus, implementing it as a final examination tool is essential to assess the achievement of LOs.

The overall passing rates and the positive significant correlation between the scores obtained by the students and their perceived performance observed in most of the stations included in the OSCE show that it is a useful tool for assessing the development clinical skills related to the use of physical agents. Also, said correlation means that the tool allows students to identify their strengths and the aspects they need to improve, and provides them with an opportunity to reflect on their clinical skills acquisition process.

Finally, the fact that the majority of students reported a high level of satisfaction with this methodology supports its use in this context, since they acknowledge both its usefulness to assess the acquisition and development of their clinical skills and the importance of using similar tools to improve their training as physical therapists.

Also, future studies may include the assessment of the OSCE by instructors and standardized patients as part of the students' feedback process.