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Objectives The organization of medical knowledge is reflected in language and can be studied from the viewpoints of semantics and prototype theory. The purpose of this study is to analyze student verbalizations during an Objective Structured Clinical Examination (OSCE) and correlate them with test scores and final medical degree (MD) scores. We hypothesize that students whose verbalizations are semantically richer and closer to the disease prototype will show better academic performance. Methods We conducted a single-center study during a year 6 (Y6) high-stakes OSCE where one probing intervention was included at the end of the exam to capture students’ reasoning about one of the clinical cases. Verbalizations were transcribed and coded. An assessment panel categorized verbalizations regarding their semantic value (Weak, Good, Strong). Semantic categories and prototypical elements were compared with OSCE, case-based exam and global MD scores. Results Students with Semantic ‘Strong’ verbalizations displayed higher OSCE, case-based exam and MD scores, while the use of prototypical elements was associated with higher OSCE and MD scores. Conclusions Semantic competence and verbalizations matching the disease prototype may identify students with better organization of medical knowledge. This work provides empirical groundwork for future research on language analysis to support assessment decisions.

Indiana University-Purdue University Indianapolis (IUPUI), Advances in technology, non-traditional students, and a new generation of elearners all challenge institutions of higher learning to support innovations that create relevant distance education opportunities for their students. Due to the COVID-19 pandemic dramatic shifts to education occurred, requiring schools of social work to consider new ways to prepare students for the field and new evaluation methods of students’ practice skills. Smoyer and colleagues explored this further in their study on BSW students’ experiences in distance education during the pandemic and found when students were unexpectedly thrust into online learning platforms most were able to learn online; however, substantive interactivity and synchronous engagement were factors that were necessary to maintain student overall satisfaction in the distance learning environment. In addition, they point out the need for interactive technology in online social work classrooms to simulate the human interaction that is essential to student learning and practice. The online objective, structured clinical examination (e-OSCE) is one form of online simulation-based learning that offers highly interactive and engaging HIP learning opportunities for social work students. The OSCE is a standardized, valid, and reliable assessment method that social work education programs use to ensure successful practice skills development. This study used a qualitative, exploratory embedded single-case method to investigate online MSW students’ experiences participating in an e-OSCE, their perspectives on the use of an e-OSCE in online social work education, and future practice considerations students identify upon completing the e-OSCE.

The objective structured clinical examination (OSCE) is becoming an increasingly established assessment test in dental schools. The use of simulated patients in the OSCE makes the stations more similar to clinical practice. Therefore, the student can show their technical and clinical knowledge, and certainly, their ability to manage the patient. These sorts of tests, in which simulated patients can be included, would be used before the student started clinical practice with patients and/or at the end of the degree. The objective of this work was to describe how the periodontology station was developed using a simulated patient for students of a fifth year dentistry degree taking an OSCE test. Furthermore, a questionnaire was created to learn the perception of the students about this station and its characteristics. The fifth year students at the European University of Madrid positively evaluated this station in their examination. In addition, it was recorded that they preferred a simulated patient in their tests, rather than stations with clinical cases, images, X-rays, and presentations. It is essential that once the OSCE has been completed, the student receives a feedback to learn where they have failed and, therefore, be able to improve any of the aspects evaluated in the station. Sin financiación 4.614 Q1 JCR 2021 0.828 Q2 SJR 2022 No data IDR 2021 UEM

Background and objectives: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. Materials and methods: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. Results: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-minutes time limit and ranged from six to 21 questions (mean: 1.1 minutes/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2,829 students in their sixth year of study. It was jointly held on two dates in June 2020. Conclusions: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.

John Blamoun,1– 3 Ahmad Hakemi,4 Teresa Armstead3 1Central Michigan University, College of Medicine, Mount Pleasant, MI, 48859, USA; 2MidMichigan Health, Midland, MI, 48670, USA; 3Central Michigan University, College of Health Professions, Physician Assistant Program, Mount Pleasant, MI, 48859, USA; 4Central Michigan University, College of Health Professions, Internal Medicine, Mount Pleasant, MI, 48859, USACorrespondence: Ahmad HakemiCentral Michigan University, College of Health Professions, Internal Medicine, 1280 East Campus Drive, Mailstop #2086, Mount Pleasant, MI, 48859, USATel +1 989-774-1273Email ahmad.hakemi@cmich.eduAbstract: The most important core competencies for medical learners to master are reviewing history, performing physical examination, communication skills and clinical reasoning. The Objective Structured Clinical Examination (OSCE) provides a consistent, reliable, and valid assessment of these integrated skills and is considered to be the gold standard. OSCEs are advantageous because they provide opportunities in evaluating skills that written tests cannot do (stage 3 of Miller’s Pyramid of Learning). In this article, we have provided tips and helpful pointers to medical students and residents, based on available literature and authors’ expertise in managing formative, summative, and virtual OSCE experiences. In virtual OSCEs, in-person learning objectives need to be modified to the virtual milieu and new competencies such as “webside manner” need to be introduced. Harmonizing the process and content of the OSCEs create operational challenges, thus learning the various moving parts of the OSCEs such as psychometrics, tasks of the standardized patients and checklists will ease optimal performance.Keywords: OSCE, checklist, virtual OSCE, assessment, reliability, validity

Background: The ongoing changes in learning and education towards digitalisation have been rapidly accelerated by the COVID-19 pandemic. Especially in dental education where contact to the oral cavity is an integral part of training the chosen digital examination methods and training formats must undergo high requirements to full fill the goal of a real alternative to face-to-face exams. Therefore, this study compared student performance in a newly developed Tele-OSCE with a prior OSCE examinations in presence within an oral- and maxillofacial surgery curriculum. Methods: Study participants were fourth-year (in a five year curriculum) dental students and board certified maxillofacial surgeons (examiners) that took part in a newly developed Tele-OSCE that comprised three five-minute stations (structured facial examination, management mandibular fracture and squamous cell carcinoma) using the zoom® software. Student performance was measured using validated OSCE-Checklists and compared to a previous OSCE examination from the winter term 2019 with the same OSCE stations that was conducted in presence. Significant differences were tested using the Mann-Whitney U test. Furthermore, the new Tele-OSCE was evaluated by students and examiners using previously developed questionnaires.Results: Sixty-six dental students (study group: n=34, summer term 2021, control group: n=32 winter term 2019) and nine examiners participated in the study. Compared to previous non-pandemic OSCEs, there were no significant (p=0.53) differences in overall student performance. Evaluation of the Tele-OSCE showed that the demonstration and rating of practical skills was limited due to missing standard patients or phantoms, however, students did not fear to be misjudged. The demonstration and rating of anamnestic and consultation competencies was seen as unproblematic by students and examiners. Discussion: This pilot-study showed the feasibility of a Tele-OSCE as a formative examination in dental education. However, both students and examiners felt that the demonstration and assessment of practical skills was limited due the new examination format. Nevertheless, Tele-OSCEs might offer an alternative to enable students to complete their dental training. Hintergrund: Der stetige Wandel hin zur Digitalisierung im Bildungswesen wurde durch die Covid-19 Pandemie rasant beschleunigt. In der zahnmedizinischen Ausbildung, wo der Kontakt zur Mundhöhle integraler Bestandteil der klinischen Lehre ist, müssen die gewählten digitalen Lehrformate jedoch hohen Anforderungen unterliegen, um eine sinnvolle Alternative zur Präsenzlehre darzustellen. Ziel dieser Pilotstudie war deshalb einen neu entwickelten Tele-OSCE in der Mund-, Kiefer- und Gesichtschirurgie mit vorherigen Präsenz-OSCE Prüfungen hinsichtlich Performanz und Zufriedenheit bei Studierenden und Prüfern zu evaluieren. Methoden: Die Studienteilnehmer waren Zahnmedizinstudierende im vierten Jahr und MKG-ChirurgInnen (Prüfer), die an einer neu entwickelten Tele-OSCE teilnahmen, welche drei fünfminütige Stationen umfasste (1. strukturierte Gesichtsuntersuchung, 2. Management von Unterkieferfrakturen, 3. Management des Plattenepithelkarzinoms). Der Kontakt zwischen Studierendem und Prüfer wurde mit der Zoom®-Software hergestellt. Die studentischen Leistungen wurden anhand validierter OSCE-Checklisten gemessen und mit einer vorangegangenen Präsenz-Kohorte aus dem Wintersemester 2019 verglichen. Die Leistung der Studierenden wurde mittels Mann-Whitney-U-Test auf signifikante Unterschiede getestet. Darüber hinaus wurde das neue Prüfungsformates durch Studierende und Prüfer anhand zuvor entwickelter Fragebögen evaluiert.Ergebnisse: An der Studie nahmen 66 Studierende der Zahnmedizin (Studiengruppe: n=34, Sommersemester 2021, Kontrollgruppe: n=32 Wintersemester 2019) und neun PrüferInnen teil. Im Vergleich zur Präsenz-Kohorte von 2019 gab es keine signifikanten (p=0,53) Unterschiede in der Gesamtleistung der Studierenden. Die Evaluation zeigte jedoch, dass die Demonstration und Bewertung praktischer Fertigkeiten im Tele-Setting nur eingeschränkt möglich waren. Eine Angst schlechter oder falsch bewertet zu werden bestand auf Studierendenseite nicht. Der Demonstration und Bewertung von anamnestischen und beratenden Kompetenzen wurden von Studierenden und Prüfern als unproblematisch eingeschätzt.Diskussion: Diese Pilotstudie konnte zeigen, dass eine Tele-OSCE in der zahnmedizinischen Ausbildung als Alternative zu Präsenzprüfungen problemlos implementierbar ist und zu keinen Leistungsunterschieden in Vergleich zu Präsenzprüfungen führt. Allerdings empfanden sowohl Studierende als auch PrüferInnen die Demonstration und Bewertung praktischer Fertigkeiten durch das neue Prüfungsformat als eingeschränkt. Dennoch könnten Tele-OSCEs eine sinnvolle Alternative darstellen und Studierenden die Möglichkeit zu geben, ihre zahnmedizinische Ausbildung in Zeiten von Kontaktrestriktionen fortzusetzen.

From September to December 2022 Belgium is chairing the OSCE Forum for Security Cooperation. Whilst political gridlock has plagued the organisation before, the ongoing Russian war against Ukraine has now plunged the OSCE in an existential crisis. This bodes badly for the European security architecture and the multilateral rules-based order in general. This Egmont Policy brief reviews the risk of a full breakdown in the functioning of the OSCE, analyses the multiple reasons for keeping the organization alive, and discusses several avenues by means of which the Belgian chairpersonship can contribute to such an outcome. Irrespective of the way in which the Russian-Ukraine war eventually concludes, the OSCE provides a unique framework for managing the post-war aftermath and reconstituting a novel arms control regime over the longer term.

Aim: Assessments of practical clinical competencies pose a challenge during the COVID-19 pandemic. Reports about OSCE stations administered online show that, despite technical feasibility and acceptance, there is a lingering desire for in-person assessments. Barriers and challenges must therefore also be identified in regard to the future integration of digital competencies into the curriculum. Based on a study investigating the feasibility and acceptance of an online OSCE anamnesis station and the descriptions given by students, simulated patients and examiners of the challenges and limitations, we make recommendations for necessary future adaptations to anamnesis training and testing in the context of telemedicine. Method: We surveyed students after completion of an OSCE anamnesis station, adapted to the telemedical setting, that was administered as an alternative assessment to 149 students via Zoom®. Using semi-structured interviews, we analyzed the resulting challenges and limitations as seen by all of the participants. Results: We confirm the existence of good technical and organizational feasibility, positive learning experiences through feedback, the acquisition of clinical competencies, and a high acceptance of this format as an alternative assessment during the pandemic. Using the semi-structured interviews, it was also possible to analyze additional categories that identify necessary adaptations of this type of format. Conclusion: Adaptation of the content-based training for all of the participants and a targeted revision of the checklists, e.g., regarding communication techniques in a telemedicine setting, is required due to the effects of the online format on communication and interactions between students and simulated patients., Zielsetzung: Leistungsüberprüfungen klinisch-praktischer Kompetenzen sind im Rahmen der COVID-19-Pandemie eine Herausforderung. Berichte über online durchgeführte OSCE-Stationen zeigen, trotz technischer Machbarkeit und Akzeptanz, den bleibenden Wunsch nach Präsenzprüfungen. Barrieren und Herausforderungen müssen daher auch im Hinblick auf die zukünftige Integration digitaler Kompetenzen in das Curriculum identifiziert werden. Mit Hilfe einer Untersuchung zur Machbarkeit und Akzeptanz bei der Durchführung einer Anamnese-OSCE-Station im Online-Format und Darstellung von Herausforderungen und Limitationen von Seiten der Studierende, der Simulationspatient*innen und der Prüfenden benennen wir Empfehlungen für zukünftig notwendige Anpassungen für Anamnese-Schulungen und Prüfungen unter telemedizinischen Aspekten. Methodik: Im Anschluss an eine als Prüfungsersatz mit 149 Studierenden via Zoom® durchgeführten und auf ein telemedizinisches Setting angepasste Anamnese-OSCE-Station, führten wir eine Fragebogenerhebung bei Studierenden durch. Mit Hilfe von semistrukturierten Interviews analysierten wir die sich daraus ergebenen Herausforderungen und Limitationen von Seiten aller Beteiligten. Ergebnisse: Wir konnten eine gute technische und organisatorische Machbarkeit, positive Lernerfahrungen durch Feedback und den Erwerb von klinischen Kompetenzen, sowie eine hohe Akzeptanz des Formates als Prüfungsersatz im Rahmen der Pandemie bestätigen. Mit Hilfe der semistrukturierten Interviews konnten zusätzlich Kategorien analysiert werden, die notwendige Anpassungen eines solchen Formates identifizieren. Schlussfolgerung: Eine durch das Online-Format veränderte Kommunikation und Interaktion zwischen Studierenden und Simulationspatient*innen bedarf einer Adaptation der inhaltlichen Schulung aller Beteiligten und einer gezielten Anpassung der Checklisten, z.B. bezüglich Kommunikations-Techniken für ein telemedizinisches Szenario

Objective: Assessment of skills is an important part of medical education. The objective was to find out how students perceive their learning after being assessed through OSCE. Methods: It was a mixed convergent parallel study. The study was carried out in the gynaecology department of a private medical college in Lahore. Five groups of final year students posted for rotation in gynae wards were included in this study. Each group comprised of 18 students. They were exposed to OSCE once daily. After completion of one month, students were given a feedback questionnaire (developed and validated by medical educationists) and a focus group discussion was carried out. Eight participants were selected from each group randomly and interviews were recorded. Interviews were transcribed verbatim. Results: Quantitative data calculated by SPSS 21 and results were calculated as frequencies. Qualitative analysis was based on word frequency count and thematic analysis was followed. Almost 65.2% of the student Shows agreement to the response that OSCE should be part of internal assessments. Whereas 15% shows disagreement and 9% remain neutral. The themes extracted after interviews were, better assessment tool, exam fear, knowledge, confidence and change learning style. thus, triangulating the data. The outcome measured was the result of the final professional of obstetrics and gynaecology year 2017-2018 batch. The success rate was 100% in gynae/obs and one student was able to get a distinction. Conclusion: Students perceived OSCE as a better assessment tool that increased their knowledge and confidence level. Thus, they were an opinion that OSCE should be part of examinations held in college. doi: https://doi.org/10.12669/pjms.37.4.4005 How to cite this:Yusuf L. Objective Structured Clinical Examination? How students perceive their learning after OSCE. Pak J Med Sci. 2021;37(4):1206-1210. doi: https://doi.org/10.12669/pjms.37.4.4005 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Objective Structured Clinical Exams (OSCEs) can assess professional competencies in a structured manner and facilitate objective evaluation of clinical performance. With limited data from the Eastern Mediterranean region, this study aims to describe the development, implementation, and evaluation of OSCEs for final year pharmacy students in Kuwait. The study also aims to compare students' performance in two academic years (2015–2016 and 2016–2017). Methods: The design, implementation, and evaluation of the competency-based OSCE followed a 3-phase systematic evidence-based approach. The development phase involved establishing an OSCE working group to develop a blueprint and scoring rubrics and to organise assessors and standardised patient/physician training. The implementation phase involved conducting formative and summative OSCEs. The evaluation phase involved undertaking student and staff perception surveys. Results: The overall students' OSCE scores for the academic years 2015–2016 and 2016–2017 were (median (interquartile range)) (71.6%, 32.2) and (60.0% (30.7)) and respectively (p

Background: Only a few studies with small sample sizes have compared electronic Objective Structured Clinical Examination (OSCE) rating checklists with traditional paper-based OSCE rating checklists. In this study, the examiner-perceived usability and preference for type of OSCE checklist (electronic vs. paper based) were compared, and the influence of OSCE checklist type on missed ratings was determined, for the Swiss Federal Licensing Examination in clinical skills for human medicine.Methods: All examiners in the Swiss Federal Licensing Examination in clinical skills for human medicine were invited over two subsequent years to evaluate the OSCE checklist type they had worked with during the examination. This was based on a questionnaire with 14 closed questions (i.e., demographic, checklist-type experience, perceived usability, checklist type preference). Furthermore, the numbers of missed ratings for the paper-based checklist were recorded.Results: The data from these examiners (n =377) with experience of both OSCE checklist types were analyzed. The electronic OSCE checklist was rated significantly higher on all usability aspects (i.e., ease of use, candidate rating and error correction, clarity, distraction using the checklist, overall satisfaction), except for the speed of registering comments (no significant difference). The majority of the examiners in both years (2014: 54.5%, n =60, 2015: 89.8%, n =230) reported preference for working with the electronic OSCE checklist in the future. Missed ratings were seen for 14.2% of the paper-based OSCE checklists, which were prevented with the electronic OSCE checklists.Conclusions: Electronic OSCE checklists were rated significantly more user-friendly and were preferred over paper-based OSCE checklists by a broad national sample of examiners, supporting previous results from faculty-level examinations. Furthermore, missed ratings were prevented with the electronic OSCE checklists. Overall, the use of electronic OSCE checklists is therefore advisable. Hintergrund: Nur wenige Studien mit kleinen Stichprobengrößen haben elektronische OSCE-Checklisten (Objective Structured Clinical Examination) mit traditionellen OSCE-Checklisten in Papierform verglichen. In dieser Studie wurden die von Prüfenden wahrgenommene Usability und Präferenz für den OSCE-Checklisten-Typ (elektronisch vs. papierbasiert) verglichen und der Einfluss des OSCE-Checklisten-Typs auf fehlende Bewertungen ermittelt für die Eidgenössische Clinical Skills-Prüfung Humanmedizin in der Schweiz.Methode: Die Prüfenden der Eidgenössischen Clinical Skills-Prüfung Humanmedizin wurden in zwei aufeinanderfolgenden Jahren gebeten, den OSCE-Checklisten-Typ zu bewerten, mit dem sie während der Prüfung gearbeitet hatten. Dies geschah anhand eines Fragebogens mit 14 geschlossenen Fragen (demographische Angaben, Erfahrung mit dem Checklisten-Typ, wahrgenommene Usability, Präferenz für den Checklisten-Typ). Außerdem wurde die Anzahl der fehlenden Bewertungen bei der papierbasierten Checkliste erfasst.Resultate: Die Daten derjenigen Prüfenden (n=377) mit Erfahrung mit beiden OSCE-Checklisten-Typen wurden ausgewertet. Die elektronische OSCE-Checkliste wurde bei allen Aspekten der Usability (einfache Benutzung, Kandidierendenbewertung und Fehlerkorrektur, Übersichtlichkeit, Ablenkung bei der Verwendung der Checkliste, Gesamtzufriedenheit) signifikant besser bewertet, mit Ausnahme der Geschwindigkeit des Erfassens von Kommentaren (kein signifikanter Unterschied). Die Mehrheit der Prüfenden in beiden Jahren (2014: 54.5%, n=60, 2015: 89.8%, n=230) gab an, in Zukunft lieber mit der elektronischen OSCE-Checkliste arbeiten zu wollen. Bei 14.2% der papierbasierten OSCE-Checklisten wurden fehlende Bewertungen festgestellt, welche mit elektronischen OSCE-Checklisten vermieden werden konnten.Schlussfolgerungen: Elektronische OSCE-Checklisten wurden von einer breiten nationalen Stichprobe von Prüfenden als deutlich benutzerfreundlicher eingestuft und gegenüber OSCE-Checklisten auf Papier bevorzugt, was frühere Ergebnisse von Prüfungen auf Fakultätsebene bestätigt. Außerdem wurden mit den elektronischen OSCE-Checklisten fehlende Bewertungen vermieden. Insgesamt ist die Verwendung elektronischer OSCE-Checklisten daher empfehlenswert.

Aim: Assessments of practical clinical competencies pose a challenge during the COVID-19 pandemic. Reports about OSCE stations administered online show that, despite technical feasibility and acceptance, there is a lingering desire for in-person assessments. Barriers and challenges must therefore also be identified in regard to the future integration of digital competencies into the curriculum. Based on a study investigating the feasibility and acceptance of an online OSCE anamnesis station and the descriptions given by students, simulated patients and examiners of the challenges and limitations, we make recommendations for necessary future adaptations to anamnesis training and testing in the context of telemedicine.Method: We surveyed students after completion of an OSCE anamnesis station, adapted to the telemedical setting, that was administered as an alternative assessment to 149 students via Zoom®. Using semi-structured interviews, we analyzed the resulting challenges and limitations as seen by all of the participants.Results: We confirm the existence of good technical and organizational feasibility, positive learning experiences through feedback, the acquisition of clinical competencies, and a high acceptance of this format as an alternative assessment during the pandemic. Using the semi-structured interviews, it was also possible to analyze additional categories that identify necessary adaptations of this type of format.Conclusion: Adaptation of the content-based training for all of the participants and a targeted revision of the checklists, e.g., regarding communication techniques in a telemedicine setting, is required due to the effects of the online format on communication and interactions between students and simulated patients. Zielsetzung: Leistungsüberprüfungen klinisch-praktischer Kompetenzen sind im Rahmen der COVID-19-Pandemie eine Herausforderung. Berichte über online durchgeführte OSCE-Stationen zeigen, trotz technischer Machbarkeit und Akzeptanz, den bleibenden Wunsch nach Präsenzprüfungen. Barrieren und Herausforderungen müssen daher auch im Hinblick auf die zukünftige Integration digitaler Kompetenzen in das Curriculum identifiziert werden. Mit Hilfe einer Untersuchung zur Machbarkeit und Akzeptanz bei der Durchführung einer Anamnese-OSCE-Station im Online-Format und Darstellung von Herausforderungen und Limitationen von Seiten der Studierende, der Simulationspatient*innen und der Prüfenden benennen wir Empfehlungen für zukünftig notwendige Anpassungen für Anamnese-Schulungen und Prüfungen unter telemedizinischen Aspekten.Methodik: Im Anschluss an eine als Prüfungsersatz mit 149 Studierenden via Zoom® durchgeführten und auf ein telemedizinisches Setting angepasste Anamnese-OSCE-Station, führten wir eine Fragebogenerhebung bei Studierenden durch. Mit Hilfe von semistrukturierten Interviews analysierten wir die sich daraus ergebenen Herausforderungen und Limitationen von Seiten aller Beteiligten. Ergebnisse: Wir konnten eine gute technische und organisatorische Machbarkeit, positive Lernerfahrungen durch Feedback und den Erwerb von klinischen Kompetenzen, sowie eine hohe Akzeptanz des Formates als Prüfungsersatz im Rahmen der Pandemie bestätigen. Mit Hilfe der semistrukturierten Interviews konnten zusätzlich Kategorien analysiert werden, die notwendige Anpassungen eines solchen Formates identifizieren. Schlussfolgerung: Eine durch das Online-Format veränderte Kommunikation und Interaktion zwischen Studierenden und Simulationspatient*innen bedarf einer Adaptation der inhaltlichen Schulung aller Beteiligten und einer gezielten Anpassung der Checklisten, z.B. bezüglich Kommunikations-Techniken für ein telemedizinisches Szenario

With Europe’s security order becoming ever more fragile, the EU and the OSCE face verydifferent political and structural challenges. While the EU’s new Strategic Compass emphasizesits aspirations to become a genuine security actor, the OSCE faces erosion of the participatingStates’ consensus on values and weakened executive structures and institutions. Can the OSCEbe regenerated through enhanced cooperation with the EU, and if yes, how? In this article,we argue that the accelerated rise of the EU as a security actor should not be achieved at theexpense of the OSCE. Rather, cooperation between both organizations should focus on (1)strengthening the OSCE as an autonomous security organization, (2) using the OSCE as agenuine forum for dialogue and mutual assurance, and (3) capitalizing on the main strengths ofboth organizations while avoiding duplication.

The Organisation for Security and Co-operation in Europe (OSCE) has been givenlittle attention in International Relations scholarship. Against this background, 2001 was a bumper year for (English) books on the institution withfour major contributions emerging. Yet, if one turns from quantity to quality, one returns to normality. All but one of the books is descriptive, which is indicative of the state of the art. OSCE studies mostly eschew any explicit reference to analytical frameworks or theories. Such a descriptive orientation limits what can be said about the institution. This essay brings three theoretical frameworks into focus in order to illustrate the argument that research on the OSCE would benefit from a theoretical turn. It is shown how these three approaches - constructivist security studies, the Copenhagen school and Foucauldian power analysis - extend OSCE studies in previously unexplored directions, thereby opening new windows on the institution to reveal aspects of what it is and what it does that have not been brought to light before. While these three approaches do not exhaust the possibilities for theoretically informed research on the OSCE, they do point out the need for going beyond the state of the art of OSCE studies. V mednarodnih odnosih kot znanstveni disciplini je bila Organizacija za varnost in sodelovanje v Evropi (OVSE) deležna le malo pozornosti. Zato je bilo leto 2001 izjemno za (angleško) literaturo o njej, saj so izšle kar štiri študije. Vendar ko se od količine ozremo h kvaliteti, lahko zopet opazimo normalno stanje. Razen ene od študij so vse druge opisne, kar je sicer značilno za to področje proučevanja. Študije o OVSE se večinoma izogibajo vsakršnega neposrednega nanašanja na analitične okvire in teorije. Taka opisna naravnanost nujno omejuje tisto, kar je o OVSE mogoče povedati. Zato se članek osredotoča na tri teoretične okvire, da bi ponazoril trditev, koliko bi proučevanje OVSE pridobilo s teoretično osmislitvijo. Kaže, kako trije takšni pristopi - konstruktivistične varnostne študije, kopenhagenska šola in foucaujevska analiza moči - bogatijo proučevanje OVSE v še neraziskani smeri. Tako odkriva tudi nove, še nerazumljene vidike tega, kaj ta institucija je in kaj počne. Čeprav ti trije pristopi ne izčrpajo možnosti za teoretično osmišljeno proučevanje OVSE, pa poudarjajo potrebo po preseganju sedanje opisne metode pri njenem proučevanju.

In an interview about two and a half years ago, French President Emmanuel Macron arrogantly claimed that NATO was brain dead and Europe was on the edge of the precipice, and he assertively questioned NATO's very future. Macron's prediction turned up false. NATO is not brain-dead. Today even most wealthy Nordic EU member countries are willing to join NATO. For example, according to a Deutsche Welle (DW) report, Sweden and Finland have stayed out of NATO due to their military nonalignment policy supported in the past by majorities of both Finns and Swedes now seem to change their policy due to war in Ukraine and are desirious of joining NATO. It seems possible that the EU will become much more in need of the NATO security umbrella in the coming period. On the other hand, these days, when a serious war situation is taking place right next to Turkey, it is believed that it would be beneficial to go back to the past and to remember the principle of "indivisibility of security" developed by the Conference/Organization for Security and Cooperation in Europe (CSCE/OSCE) and to explain the essence of this principle to the younger generations. In the 1975 Helsinki Final Act of the CSCE, the participating States recognized the indivisibility of security in Europe. At the OSCE Istanbul summit in November 1999, the leaders of fifty-four states participating in the OSCE signed the Charter for European Security called the "İstanbul Document." Paragraph eight of the Charter for European Security involves one of the crucial principles for the security and stability of Europe in the twenty-first century. The reason for the war situation that Europe is facing in Ukraine today is that the Russian Federation and some countries in the Western bloc consider this paragraph in terms of their priorities. In order to find a solution to the war situation we face today in Ukraine, the constructive negotiation spirit of the period when the 1999 Istanbul Document was prepared must be returned. In our judgment, Turkey, in current circumstances, is one of the most appropriate OSCE countries that can best prepare the suitable ground for a revival of such constructive spirit in the new negotiations.

Objective Structured Clinical Examinations (OSCEs) are routinely used in healthcare education programs. Traditionally, students undertake OSCEs as face-to-face interactions to assess competency in soft skills. Due to physical distancing restrictions during COVID-19, alternative methods were required. This study utilized a mixed-method design (online survey and interviews) to evaluate second-year pharmacy students’ and examiners’ experiences of their first virtual OSCEs in Australia. A total of 196 students completed their first virtual OSCE in June 2020 of which 190 students completed the online survey. However, out of the 190 students, only 88% (n = 167) consented to the use of the data from their online survey. A further 10 students and 12 examiners were interviewed. Fifty-five students (33%) who participated in the online survey strongly agreed or agreed that they preferred the virtual experience to face-to-face OSCEs while 44% (n = 73) neither agreed nor disagreed. Only 20% (n = 33) felt more anxious with the virtual OSCEs. Additionally, thematic analysis found non-verbal communication as a barrier during the OSCE. Positive aspects about virtual OSCEs included flexibility, decreased levels of anxiety and relevance with emerging telehealth practice. The need for remote online delivery of assessments saw innovative ways of undertaking OSCEs and an opportunity to mimic telehealth. While students and examiners embraced the virtual OSCE process, face-to-face OSCEs were still considered important and irreplaceable. Future opportunities for OSCEs to be delivered both face-to-face and virtually should be considered.

ObjectivesObjective structured clinical examinations (OSCEs) are common for formative assessment. We developed an Online Smart Communicative Education System and aimed to explore the factors that affect the perceptions of both teachers and students for teaching and learning.Methods and AnalysisA two-year cross-sectional cohort study was undertaken. The program includes three parts. Part I Pre-OSCE: an online flipped class in preparation for task-related knowledge and skills. Part II OSCE-day: 10 tasks in one track formative OSCE. Part III Post-OSCE: extended online feedback for participants with further questions after the exam and raters with more feedback after reviewing their performance online. Principal component analysis with varimax rotation was performed to analyze the perceptions of students and teachers to the Online System by means of questionnaires.ResultsSeventy-six pharmacy students (male 32.9%) took the exam and 24 raters (male, 25%) participated in the scoring during the OSCEs. The mean G coefficient was 0.88. Seventy-six questionnaires from the students were obtained for the analysis. Results explained the cumulative variance of 73.9% for component (1) “Effects of extended online feedback”: 40% and (2) “Facilitation of learning”: 33.9%. Thirty-nine questionnaires from the raters who experienced the Online System were obtained for the analysis (male 23.1%). Results explained a cumulative variance of 77.3% for component (1) “Effects of extended online feedback”: 36.6%, (2) “Facilitation of scoring and feedback”: 24.5%, and (3) “Feasibility of online platform”: 16.2%, respectively.ConclusionWe demonstrated good reliability for digitizing the scoring system with educational support to facilitate teaching. “Effects of extended online feedback” was the major aspect in explaining the variance from the perceptions of students and raters by factor analysis. In comparison with traditional formative OSCEs, extended online feedback is a novel approach, which extends the process of learning and teaching among the learners and raters and overcomes the barriers of time limitation and distance.

Background The year 2013 marks a watershed in the history of medical education in Taiwan. Following Taiwan’s Taskforce of Medical School Curriculum Reform recommendations, the medical school curriculum was reduced from 7 to 6 years. This study aimed to analyze the impact of medical school curriculum reform on medical students’ performance in objective structured clinical examinations (OSCEs). Methods We retrospectively analyzed the OSCE records at Taipei Veterans General Hospital (Taipei VGH), one of Taiwan’s largest tertiary medical centers, between November 2016 and July 2020. The eligibility criteria were medical students receiving a full one-year clinical sub-internship training at Taipei VGH and in their last year of medical school. All medical students received a mock OSCE-1 at the beginning of their sub-internship, a mock OSCE-2 after six months of training, and a national OSCE at the end of their sub-internship. The parameters for performance in OSCEs included “percentage of scores above the qualification standard” and “percentage of qualified stations.” Results Between November 2016 and July 2020, 361 undergraduates underwent clinical sub-internship training at Taipei VGH. Among them, 218 were taught under the 7-year curriculum, and 143 were instructed under the 6-year curriculum. Based on baseline-adjusted ANCOVA results, medical students under the 7-year curriculum had a higher percentage of scores above the qualification standard than those under the 6-year curriculum at the mock OSCE-1 (7-year curriculum vs. 6-year curriculum: 33.8% [95% CI 32.0–35.7] vs. 28.2% [95% CI 25.9–30.4], p p = 0.001). Moreover, medical students in the 7-year curriculum had a higher percentage of qualified stations in mock OSCE-1 (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 87.4–91.4] vs. 84.0% [95% CI 81.5–86.4], p = 0.001) and mock OSCE-2 (7-year curriculum vs. 6-year curriculum: 91.9% [95% CI 90.1–93.8] vs. 86.1% [95% CI 83.8–88.3], p = 0.001). After clinical sub-internship training, there were no differences in the percentage of scores above the qualification standard (7-year curriculum vs. 6-year curriculum: 33.5% [95% CI 32.2–34.9] vs. 34.6 [95% CI 32.9–36.3], p = 0.328) and percentage of qualified stations (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 88.1–90.7] vs. 90.2% [95% CI 88.6–91.8], p = 0.492). Conclusions At the beginning of the sub-internship, medical students under the 7-year curriculum had better OSCE performance than those under the 6-year curriculum. After the clinical sub-internship training in Taipei VGH, there was no difference in the national OSCE score between the 6- and 7-year curricula. Our study suggests that clinical sub-internship is crucial for the development of clinical skills and performance in the national OSCE.

Movin Peramuna Gamage,1 Ravanth Baskaran,1 Srinjay Mukhopadhyay,1 Nishaanth Dalavaye,1 Becky Leveridge,1 Sashiananthan Ganesananthan,2 Robert Spencer,3,4 Susruta Manivannan,5 Malik Zaben3,4 1School of Medicine, Cardiff University, Heath Park Campus, Cardiff, CF14 4YS, UK; 2Department of Digestion, Metabolism and Reproduction, Imperial College London, London, UK; 3Neuroscience and Mental Health Innovation Institute (NMHII), Cardiff University, Cardiff, UK; 4Department of Neurosurgery, University Hospital of Wales, Cardiff, UK; 5Division of Psychological Medicine and Clinical Neurosciences, University Hospital of Wales, Cardiff, UKCorrespondence: Malik Zaben, Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK, Tel +442920748153, Email ZabenM@cardiff.ac.ukPurpose: Objective Structured Clinical Examination (OSCE) is a vital examination that must be passed to graduate as a qualified doctor. The delivery of OSCE teaching was changed to an online format to accommodate COVID-19 restrictions. Therefore, this study evaluates factors that students perceive to affect their virtual learning of clinical skills for OSCE.Methods: In this cross-sectional study, all medical students from across the world who attended “The Respiratory Station” session delivered by OSCEazy (a medical student organization providing free online medical education) in the academic year 2020– 2021 received an online questionnaire about their perceptions of this learning opportunity. The survey was created on Google™ forms and consisted of 5-point Likert scales as well as free-text boxes.Results: A total of 556 responses were received (mean age: 24, female: 76.6%). Most students agreed that online OSCE teaching offers more flexibility and convenience (median: 5, IQR: 4– 5) but their likeliness to ask questions in either format was similar (median: 4, IQR: 3– 5 vs median: 4, IQR: 3– 4, p value: 0.94). The use of visual aids (median: 5, IQR: 4– 5) and breakout rooms (median: 3, IQR: 2– 4) were thought to enhance the quality of virtual OSCE teaching. The biggest concern about online teaching was access to a stable internet connection (69.1%).Conclusion: The flexibility and convenience of virtual OSCE teaching enables the sharing of knowledge and skills to a wider audience and thus may be a very useful adjunct to face-to-face OSCE teaching in the future.Keywords: medical education, COVID-19, online learning, student perceptions

Background/Aims: To avoid the negative impacts of the COVID-19 pandemic on clinical clerkship, supplemental teachings such as digital materials in the scenario-based distal simulations were implemented. This study utilized the OSCE (objective-structured clinical examination) to evaluate the impact of COVID-19 pandemic on the learning outcome of medical students from the regular group (class of 2020) and pandemic-impacted group (class of 2021). Methods: All medical students serially took, firstly, the mock-OSCE, secondly, the mock-OSCE, and the national OSCE. Then, the serial OSCE scores were compared between groups. Results: Although with similar scores in the first mock OSCE, the regular group (n = 78) had a higher average score in the national OSCE than the pandemic-impacted group (n = 80) (872.18 vs. 834.96, p = 0.003). In terms of improvement, the performances of the regular group were also better than the pandemic-impacted group between the second mock OSCE and the national OSCE (79.10 vs. 38.14, p = 0.014), and between the second mock OSCE and the national OSCE (125.11 vs. 77.52, p = 0.003). While separating distinct genres, the regular group had more of a score increment in standardized patient-based stations between the second mock OSCE and the national OSCE (regular vs. pandemic-impacted: 57.03 vs. 18.95, p = 0.003), as well as between the first mock OSCE and the national OSCE (75.97 vs. 26.36, p < 0.001), but there was no significant difference among the skill-based stations. In particular, the scores of the emergency medicine associated station in the national OSCE of the pandemic-impacted group was lower. Conclusions: Our study implies that the pandemic significantly hampered the learning outcomes of final year medical students in their clinical participation. Especially facing the COVID-19 pandemic, more supplemental teachings are needed to compensate the decreasing emergency medicine exposure.

Aim: The aims were to describe the development of a modified national online OSCE during COVID-19 and assess related student feedback. Material and methods: The modified online OSCE comprising of eight question entities was organised simultaneously in all four dental institutes of Finland using the Moodle virtual learning environment. All fourth-year students (n = 179) attended the examination online at home. Student feedback was collected via an anonymous questionnaire with multiple-choice questions and open-ended questions concerning attitudes towards the modified online OSCE, as well as content and usability of the question entities in the examination. Means and standard deviations were calculated for multiple-choice questions. Content analysis was used for open-ended questions. Results: Of 179 students, 119 (66%) consented to the study. Students experienced they had received adequate information (mean 3.8; SD 1.2), had a positive attitude before the examination (4.0; 1.0) and found the practice test useful (3.7; 1.1) (range 1–5). Technical implementation (2.7; 0.7) and the difficulty of the questions (2.9; 0.6) (range 1–4) were found to be good. The teaching students received during their studies was sufficient (3.2; 0.5) (range 1–4). Content (mean 3.2; 0.4) and usability (2.9; 0.4) of the question entities were good (range 1–4). The themes arising from open-ended questions were importance and practicality of the topic (in questions) in relation to the work of a dentist and gratitude for the rapid conversion of the OSCE into an online examination despite COVID-19. The themes arising from negative experiences included difficulties in completing the examination within the time allocated, and dissatisfaction with the model answers provided after the examination. Conclusion: The positive student feedback towards the modified online OSCE encourages including an online examination to complement the traditional OSCE.

John Blamoun,1– 3 Ahmad Hakemi,4 Teresa Armstead3 1Central Michigan University, College of Medicine, Mount Pleasant, MI, 48859, USA; 2MidMichigan Health, Midland, MI, 48670, USA; 3Central Michigan University, College of Health Professions, Physician Assistant Program, Mount Pleasant, MI, 48859, USA; 4Central Michigan University, College of Health Professions, Internal Medicine, Mount Pleasant, MI, 48859, USACorrespondence: Ahmad HakemiCentral Michigan University, College of Health Professions, Internal Medicine, 1280 East Campus Drive, Mailstop #2086, Mount Pleasant, MI, 48859, USATel +1 989-774-1273Email ahmad.hakemi@cmich.eduAbstract: The most important core competencies for medical learners to master are reviewing history, performing physical examination, communication skills and clinical reasoning. The Objective Structured Clinical Examination (OSCE) provides a consistent, reliable, and valid assessment of these integrated skills and is considered to be the gold standard. OSCEs are advantageous because they provide opportunities in evaluating skills that written tests cannot do (stage 3 of Miller’s Pyramid of Learning). In this article, we have provided tips and helpful pointers to medical students and residents, based on available literature and authors’ expertise in managing formative, summative, and virtual OSCE experiences. In virtual OSCEs, in-person learning objectives need to be modified to the virtual milieu and new competencies such as “webside manner” need to be introduced. Harmonizing the process and content of the OSCEs create operational challenges, thus learning the various moving parts of the OSCEs such as psychometrics, tasks of the standardized patients and checklists will ease optimal performance.Keywords: OSCE, checklist, virtual OSCE, assessment, reliability, validity

Md Anwarul Azim Majumder,1 Alok Kumar,1,2 Kandamaran Krishnamurthy,1,2 Nkemcho Ojeh,1 Oswald Peter Adams,1 Bidyadhar Sa31Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados; 2Department of Pediatrics, The Queen Elizabeth Hospital, Bridgetown, Barbados; 3Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and TobagoBackground: The objective structured clinical examination (OSCE) is the gold standard and universal format to assess the clinical competence of medical students in a comprehensive, reliable and valid manner. The clinical competence is assessed by a team of many examiners on various stations of the examination. Therefore, it is found to be a more complex, resource- and time-intensive assessment exercise compared to the traditional examinations.Purpose: The objective of this study was to determine the final year MBBS students’ and OSCE examiners’ perception on the attributes, quality, validity, reliability and organization of the Medicine and Therapeutics exit OSCE held at the University of the West Indies (Cave Hill) in June 2017.Methods: At the end of the OSCE, students and examiners were provided with a questionnaire to obtain their views and comments about the OSCE. Due to the ordinal level of data produced by the Likert scale survey, statistical analysis was performed using the median, IQR and chi-square.Results: A total of 52 students and 22 examiners completed the questionnaire. The majority of the students provided positive views regarding the attributes (eg, fairness, administration, structure, sequence, and coverage of knowledge/clinical skills), quality (eg, awareness, instructions, tasks, and sequence of stations), validity and reliability (eg, true measure of essential clinical skills, standardized, practical and useful experiences), and organization (eg, orientation, timetable, announcements and quality of examination rooms) of the OSCE. Similarly, majority of the examiners expressed their satisfaction with organization, administration and process of OSCE. However, students expressed certain concerns such as stressful environment and difficulty level of OSCE.Conclusion: Overall, the OSCE was perceived very positively and welcomed by both the students and examiners. The concerns and challenges regarding OSCE can be overcome through better orientation of the faculty and preparation of the students for the OSCE.Keywords: OSCE, undergraduate medical education, students’ perception, examiners’ perception, medicine and therapeutics, Barbados

Assessment during pre registration in midwifery school is one of the necessary process which need to be concerned as it would strengthen the quality of the graduation. It also could become a tool to evaluate ability and competency of the pre registration midwifery student. There is an evaluation which applied in Indonesian midwifery school as national standard i.e. OSCE in which is considered could fulfil the validity, reliability and feasibility within Indonesian context. This study aimed to evaluate the implementation of OSCE among midwifery school in Yogyakarta. This research was a mixed methods study used sequential explanatory design method i.e. quantitative phase and qualitative phase. Analytic descriptive study was applied in quantitative phase, whilst a case study was applied in qualitative phase. Quantitative data collection was conducted by using a checklist sheet and analyzed by using descriptive analysis, whilst qualitative data by using in-depth interviews and analyzed by using content analysis. The quantitative result show that the implementation of OSCE among midwifery schools in Yogyakarta has score 68 out of 92. The qualitative analysis showed that OSCE was challenging to be implemented due to technical problems such as broken media of assessment, different phantom model in delivery stages, assessor has been late, assessment rooms were not conducive and there were limited model who skilled as OSCE model. Conclusion: Standardized OSCE implementation has not been carried out properly in midwifery school. Therefore there is a need of national evaluation of the OSCE itself in order to understand the real condition across Indonesian midwifery school.

Background: Objective Structured Clinical Examination (OSCE) is one of the final assessment components for nursing students. OSCE assessment uses the ON-OSCE (Online Nursing OSCE) application to fulfill the need and overcome the manual OSCE assessment challenges using papers. The manual OSCE assessment with multiple checklists is very detailed and takes a long time in scoring. Besides, the evaluation using papers tends to cause a miscalculation in scoring a total of ratings that can harm the student.Method: This research is a non-experimental study with a descriptive design and cross-sectional approach. The samples were 480 respondents of nursing students. The instrument of assessment of satisfaction was analyzed based on the score accuracy, time to retrieve score, and examiner's attention. Data analysis used descriptive frequency and percentage distributions. Results: Students' satisfaction based on the time to retrieve score revealed that 365 students (76%) were satisfied. Two hundred eighty-five students (59,4 %) were also satisfied with ON-OSCE related to the score accuracy. Regarding the examiners' attention, 273 students (56,9 %) felt the examiners ignored the students' actions. They focused on the laptop to provide an assessment. It could be due to the new ON-OSCE application for the examiners and their unfamiliarity with operating the application.Conclusion: Most students were satisfied with the assessment using the ON-OSCE application to retrieve scores and the score accuracy. However, they were less satisfied with the examiners' attention. The examiners should be more familiar with the ON-OSCE.

Objective: Simulated patients play a significant role in OSCE (Objective Standardized Clinical Examination) settings. Does the understanding of one's own role or task lead to more clarity for all protagonists involved in an OSCE? Methodology: Based on the range of professional experiences and qualifications of the training team it was possible to bundle medical, acting and didactic knowledge. It was against this background that the individual understanding of one’s role was examined from its respective points of view. Result: As a result, the authors have developed the so-called Case Space Model, which encourages critical exchange and discussion. It is a visualization of the relationships between the simulated patients, examiners and candidates. During the course of the model’s development a preference for the term believability instead of authenticity became clear. Conclusion: The Case Space Model can help to clarify the positions and provide certainty in the respective roles., Zielsetzung: Simulationspersonen spielen bei OSCE-Prüfungen (Objectiv Standardized Clinical Examination) eine tragende Rolle. Führt das Verständnis der eigenen Rolle oder Aufgabe der an einem OSCE beteiligten ProtagonistInnen zu mehr Klarheit? Methodik: Aus der Mischung der beruflichen Herkunft und Qualifikationen des TrainerInnenteams war es möglich, medizinisches, schauspielerisches und didaktisches Wissen zu bündeln. Ausgehend von diesem Hintergrund wurden die einzelnen Rollenverständnisse aus ihrer jeweiligen Sicht betrachtet. Ergebnis: Das Ergebnis ist das von den AutorInnen so genannte Rollenraum-Modell, welches zum Austausch und diskutieren anregen soll. Es macht die Beziehungen zwischen Simulationspersonen, PrüferInnen und KandidatInnen sichtbar. Im Verlauf der Entwicklung des Modells zeigte sich die Präferenz des Begriffs Glaubhaftigkeit anstelle von Authentizität. Schlussfolgerung: Das Rollenraum-Modell hilft dabei, die Positionen zu klären und gibt Sicherheit in der jeweiligen Rolle.

The spread of COVID-19 and social-distancing rules have increased the need for alternative learning environments with a focus on e-learning platforms. The objective of this study was to assess whether and to what extent the transition from traditional learning and assessment environment to the e-setting impacts the knowledge and skills acquired by students and their satisfaction with new e-solutions of taking the OSCE test. The study compared the results of three face-to-face (2018–2019) and one electronically conducted (2021) OSCE tests, as well as students’ feedback on the content and organization of the tests. For data analysis the one-way ANOVA test and post hoc multiple comparisons were used. The results demonstrated the feasibility and effectiveness of and students’ satisfaction with OSCE tests in the Zoom environment. However, more focus on communication techniques is required in a remote communication environment to better cover all patient health-related and drug communication aspects. There were identified differences between undergraduate students and practicing assistant pharmacists in assessing patients’ health problems and providing corresponding counseling. This result points to the need to implement the continuous development of patient-centered counseling techniques in the lifelong learning of pharmacists and the need to use innovative digital solutions, if applicable.

Background: The educational process in different medical schools has been negatively affected by the COVID-19 pandemic worldwide. As a part of the Saudi government’s attempts to contain the spread of the virus, schools’ and universities’ educational activities and face-to-face lectures have been modified to virtual classrooms. The purpose of this study was to explore the perceptions of the faculty and the students of an electronic objective structured clinical examination (E-OSCE) activity that took place during the COVID-19 pandemic in the oldest medical school in Saudi Arabia. Methods: An e-OSCE style examination was designed for the final-year medical students by the pediatrics department, College of Medicine at King Saud University in Riyadh, Saudi Arabia. The examination was administered by Zoom™ video conferencing where both students and faculty participated through their laptop or desktop computers. In order to explore the students’ and the faculty’s perceptions about this experience, a newly designed 13-item online questionnaire was administered at the end of the e-OSCE. Results: Out of 136 participants (23 faculty and 112 students), 73 respondents (e.g., 54% response rate) filled out the questionnaire. Most of the respondents (69.8%) were very comfortable with this new virtual experience. Most participants (53.4%) preferred the e-OSCE compared to the classic face-to-face clinical OSCE during the pandemic. Regarding the e-OSCE assessment student tool, 46.6% reported that it is similar to the classic face-to-face OSCE, however, 38.4% felt it was worse. Conclusions: The e-OSCE can be a very effective alternative to the classic face-to-face OSCE due to the current circumstances that still pose a significant risk of infection transmission. Future studies should examine different virtual strategies to ensure effective OSCE delivery from the perspective of both faculty and students.

Background: Patient-centredness (PCN) is an increasingly demanded objective in health care and has gained importance for the care situation, for research, and the education of healthcare professions. The literature shows that the term PCN is not uniformly defined. Key aspects for the concept of PCN can be found in the integrative model and its dimensions by Scholl and colleagues (2014), which are incorporated into the acquisition of competencies in Objective Structured Clinical Examination (OSCE) examination formats. The inclusion of subjective experiences of persons directly affected in health-related situations is recognized as an important factor for continuous improvement in health care. In the interprofessional education of healthcare professions, subjective experiences serve as a starting point in relation to OSCE exams. In this context, the project “DIPEx” “Database of Individual Patients’ Experiences” stands for the systematic collection and evaluation of subjective experiences of illness using scientific methods. Aim: The aim of this interprofessional training workshop was to show how PCN can support the writing of case vignettes based on real experiences from systematically collected narratives within the DIPEx project, as well as the preparation of simulation subjects for OSCE examinations in the healthcare professions. Methods: Interactive, moderated workshop with two theory-based input presentations on the systematic development of interprofessional case vignettes based on four steps, group work with synthesis in the form of statements, and a concluding outlook. Results: With regard to the aims of the workshop, the synthesis included results at two levels: exemplary results on aims not explicitly addressed: Interprofessional teaching is full of presuppositions and requires clarification of four different perspectives in advance to be included in case development; exemplary results on explicitly addressed aims: Listening to and incorporating the real-life experiences and narratives of persons directly affected in health-related situations and their families was seen as an important learning aspect for PCN in relation to the practitioner-patient relationship. Five key statements on explicit aims for case development involving PCN emerged from the group work. Conclusion: Competency-based interprofessional education of health professionals and PCN can benefit from real patient narratives of health and illness as simulated patients can portray roles in OSCE formats in a realistic and convincing manner., Hintergrund: Patient*innenorientierung (PO) ist in der Gesundheitsversorgung ein zunehmend gefordertes Ziel und hat für die Versorgungssituation, Forschungslage und für die Ausbildung von Gesundheitsberufen an Bedeutung gewonnen. In der Literatur zeigt sich, dass der Begriff PO nicht einheitlich definiert ist. Zentrale Aspekte für das Konzept der PO finden sich im integrativen Modell und seinen Dimensionen von Scholl und Kollegen aus 2014, die in den Kompetenzerwerb bei Objective Structured Clinical Examination (OSCE) Prüfungsformaten Eingang finden. Der Einbezug subjektiver Erfahrungen von Betroffenen wird als wichtiger Faktor für die kontinuierliche Verbesserung der Gesundheitsversorgung anerkannt. In der interprofessionellen Ausbildung der Gesundheitsberufe dienen sie als Ausgangspunkt in Bezug auf OSCE Prüfungen. Das Projekt „DIPEx“ „Database of Individual Patients’ Experiences“ steht dabei für die systematische Erhebung und Auswertung subjektiver Krankheitserfahrungen anhand wissenschaftlicher Methoden. Ziel des Beitrags: Ziel des Interprofessionellen Ausbildungs-Workshops war es aufzuzeigen, wie PO anhand realer Erfahrungen aus systematisch erhobenen Narrativen im Rahmen des DIPEx-Projektes das Verfassen von Fallvignetten unterstützen kann, wie auch die Vorbereitung von Simulationspersonen für OSCE Prüfungen in den Gesundheitsberufen. Methode: Interaktiver, moderierter Workshop mit zwei theoriegeleiteten Inputpräsentationen zur systematischen Entwicklung interprofessioneller Fallvignetten anhand von vier Schritten in Gruppenarbeit mit Synthesebildung in Form von Statements und abschliessendem Ausblick. Ergebnisse: Mit Bezug auf die Ziele des Workshops umfasste die Synthese Ergebnisse auf zwei Ebenen: exemplarische Ergebnisse zu nicht explizit adressierten Zielen: Interprofessionelle Lehre ist voraussetzungsreich und verlangt vorab die Klärung von vier verschiedenen Perspektiven, die in die Fallentwicklung einbezogen werden; exemplarische Ergebnisse zu explizit adressierten Zielen: Das Zuhören und der Einbezug der realen Erfahrungen und Erzählungen von Betroffenen und ihren Angehörigen wurde als wichtiger Lernaspekt für PO in Bezug auf die Behandler*innen-Patienten-Beziehung gesehen. Aus der Gruppenarbeit gingen fünf zentrale Statements zu expliziten Zielen für die Fallentwicklung unter Einbezug der PO hervor. Fazit: Die kompetenzorientierte interprofessionelle Ausbildung der Gesundheitsberufe und PO kann von realen Patient*innennarrativen zu Gesundheit und Krankheit profitieren, indem Simulationspersonen in OSCE-Formaten Rollen realitätsnah und überzeugend darstellen können., GMS Journal for Medical Education; 38(5):Doc91

Latar Belakang: Kebijakan Study from Home (SfH) dan Work from Home (WfH) selama pandemi Coronavirus Disease-19 (Covid-19) berdampak pada proses pendidikan mahasiswa kedokteran, salah satunya dalam penyelenggaraan evaluasi keterampilan klinis atau Objective Structured Clinical Examination (OSCE). Diperlukan sebuah model OSCE berbasis dalam jaringan (daring) agar uji kompetensi tetap berjalan dengan optimal. Tujuan: Mengembangkan model OSCE berbasis daring yang disesuaikan pada kondisi pandemi Covid-19. Metode: Metode observasional deskriptif digunakan melalui dua tahapan. Tahapan pertama meliputi proses pelaksanaan OSCE berbasis daring. Tahap kedua adalah evaluasi pelaksanaan melalui survei kuesioner online kepada 149 mahasiswa Fakultas Kedokteran Universitas Wahid Hasyim yang mengikuti OSCE berbasis daring pada periode Agustus 2020. Hasil: Proses pelaksanaan OSCE berbasis daring meliputi tahap pra-OSCE, OSCE, dan pasca-OSCE. Pada evaluasi selama pra-OSCE, 79,5% mahasiswa menyebutkan bahwa sarana telah dipersiapkan dengan baik dan 46,1% menyebutkan bahwa informasi yang disampaikan saat technical meeting jelas. Pada tahap pelaksanaan, 91,3% mahasiswa menyebutkan soal OSCE jelas, 65,9% memiliki koneksi internet dan komunikasi berjalan lancar, 53% menyebutkan dukungan technical support baik, dan 88% menyatakan waktu pengerjaan cukup. Kesimpulan: Pelaksanaan OSCE berbasis daring dapat diimplementasikan. Meskipun demikian, dukungan teknis dan persiapan yang matang diperlukan sehingga dalam pelaksanaannya tetap berlangsung secara efektif.

Background Assessment of emergent, rare or complex medical conditions in Endocrinology and Metabolism (E&M) is an integral component of training. However, data is lacking on how this could be best achieved. The purpose of this study was to develop and administer an Objective Structured Clinical Examination (OSCE) for E&M residents, and to gather validity evidence for its use. Methods A needs assessment survey was distributed to all Canadian E&M Program Directors and recent graduates to determine which topics to include in the OSCE. The top 5 topics were selected using a modified Delphi technique. OSCE cases based on these topics were subsequently developed. Five E&M residents (PGY4-5) and five junior Internal Medicine (IM) residents participated in the OSCE. Performance of E&M and IM residents was compared and results were analyzed using a Generalizability study. Examiners and candidates completed a survey following the OSCE to evaluate their experiences. Results The mean score of IM and E&M residents was 41.7 and 69.3 % (p 2 = 0.75). Overall reliability of the OSCE was 0.74. Standard setting using a borderline regression method resulted in a pass rate of 100 % of E&M residents and 0 % of IM residents. All residents felt the OSCE had high value for learning as a formative exam. Conclusions The E&M OSCE is a feasible method for assessing emergent, rare and complex medical conditions and this study provides validity evidence to support its use in a competency-based curriculum.

The aim of the present research was to analyze the autonomic stress response of nursing students in a nursing Objective Structured Clinical Evaluation (OSCE). We analyzed, in 41 s-year nursing degree students (20.1 ± 2.3 years), modifications in heart rate variability (HRV) to monitor the autonomic stress response before, during and after the 18 different scenarios of a complete OSCE. Heart rate mean response of nurse students was consistent with an anticipatory anxiety response at the beginning of the OSCE, showing a sympathetic nervous system activation, but HRV parameters show contradictory results. The most stressful OSCE station was the CPR maneuver, the stress response varying according to the station’s demands.

Background Feedback is an essential element of learning. Despite this, students complain about receiving too little feedback in medical examinations, e.g., in an objective structured clinical examination (OSCE). This study aims to implement a written structured feedback tool for use in OSCEs and to analyse the attitudes of students and examiners towards this kind of feedback. Methods The participants were OSCE examiners and third-year medical students. This prospective study was conducted using a multistage design. In the first step, an unstructured interrogation of the examiners formed the basis for developing a feedback tool, which was evaluated and then adopted in the next steps. Results In total, 351 students and 51 examiners participated in this study. A baseline was created for each category of OSCE station and was supplemented with station-specific items. Each of these items was rated on a three-point scale. In addition to the preformulated answer options, each domain had space for individual comments. A total of 87.5% of the students and 91.6% of the examiners agreed or rather agreed that written feedback should continue to be used in upcoming OSCEs. Conclusion The implementation of structured, written feedback in a curricular, summative examination is possible, and examiners and students would like the feedback to be constant.

In the wake of the Covid-19 pandemic, people over 65 or suffering from certain conditions were deemed at high risk and asked to isolate themselves. This led to the simulated patient (SP) program at the University of Bern being depleted of middle-aged and elderly SP. Meanwhile, an OSCE had to be delivered using adapted cases that minimized physical contact between candidates and SP. Short of suitable cases at such short notice, the case of an elderly patient with postural instability had to be added to the exam blueprint. With elderly SP off the roster, it was decided to use makeup effects to achieve visual authenticity. A combination of wigs (grey hair, hairdo), 3D Probondo transfers (forehead wrinkles), old age stipple (crow’s feet), and colouring (age spots) were used to achieve the old-age effects, while SPs wore scarves to cover their neckline. The lower face was covered with protective face masks in accordance with the exam’s Covid-19 hygiene protocol. Case-related feedback from candidates and examiners was analysed for any direct or indirect remark attributable to the ageing effects. As no comment touched upon the subject of the appearance of age, this was interpreted as success, as any distracting effect from the SPs’ appearance in this regard would surely have prompted remarks or even complaints. The SPs’ feedback revealed how applying the ageing effects helped them adopt the octogenarian’s role. This report explains how SP in their fifties were made fit for an octogenarian’s case in an OSCE using makeup effects. The effort required for the ageing simulation was considerable, but it is hoped that in future, with more planning time, the amount of effort required can be reduced. The feedback obtained from the candidates suggest the appearance of SPs was not experienced as a distraction, which was the primary objective of this exercise. Adapting our approach to their own contexts allows educators to include cases with elderly patients in their OSCE that cannot be re-written for younger SP, so long as Covid-19 prevents elderly SP from participating., In der Covid-19-Pandemie wurden ein Lebensalter über 65 oder das Vorliegen bestimmter Gesundheitszustände als Risikofaktoren definiert und Betroffene entsprechend zur Selbstisolation aufgefordert. Dies führte auch dazu, dass das Simulationspersonenprogramm der Universität Bern auf den Einsatz vieler SP v.a. mittleren und vorgerückten Alters verzichten musste. Für eine unaufschiebbare OSCE-Prüfung wurden die Stationen derart angepasst, dass physische Nähe zwischen Kandidat*innen und SP minimiert war. Da sich in der kurzen zur Verfügung stehenden Zeit nur wenige Stationen derart anpassen liessen, musste der Fall einer älteren Patientin mit Haltungsinstabilität in den Prüfungsplan aufgenommen werden. Da ältere SP jedoch nicht aufgeboten werden konnten, wurde beschlossen, die visuelle Authentizität an dieser Station mittels Make-up-Effekten zu erzielen. Die Alterungseffekte wurden mithilfe von Perücken (graues Haar, Frisur), 3D-Probondo-Transfers (Stirnfalten), Old Age Stipple (Krähenfüsse) und Schminke (Altersflecken) bewirkt. Schals bedeckten die Dekolletés und gemäss Covid-19-Schutzreglement wurden chirurgische Masken getragen. Das stationsbezogene Feedback der Kandidat*innen und Prüfer*innen wurde auf direkte oder indirekte Bemerkungen zu den Alterungseffekten überprüft. Dass keine Äusserung bezüglich der altersgerechten Erscheinung der SP identifiziert werden konnte, wurde als Erfolg interpretiert, da jede ablenkende Wirkung des dargestellten Alters sicherlich zu Bemerkungen oder sogar Beschwerden geführt hätte. Das Feedback der SP zeigte ausserdem, wie die Alterungseffekte halfen, die Rolle der Achtzigjährigen anzunehmen. Dieser Bericht erläutert, wie SP in ihren Fünfzigern mithilfe von Make-up-Effekten für die Rolle einer Achtzigjährigen in einem OSCE vorbereitet wurden. Der Aufwand für die Alterungssimulation war beträchtlich, aber mit mehr Planungszeit könnte dieser bei zukünftigen Anwendungen reduziert werden. Die Rückmeldungen der Kandidat*innen deuten darauf hin, dass die Erscheinung dieser SP nicht als Ablenkung empfunden wurde, was Hauptziel der Intervention war. Der beschriebene Ansatz lässt sich adaptieren, sodass auch andernorts Stationen mit älteren Patient*innen in OSCE aufgenommen werden können, wo eine Verjüngung der Rolle nicht infrage kommt, zumindest solange Covid-19 die Teilnahme älterer SP verhindert.

Abdullah A Yousef,1,2 Bassam H Awary,1 Faisal O AlQurashi,1 Waleed H Albuali,1 Mohammad H Al-Qahtani,1 Syed I Husain,2 Omair Sharif2 1Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Vice Deanship for e-learning, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Faisal O AlQurashiDepartment of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O Box: 11286, Dammam, 31453, Saudi Arabia, Tel +966555078804, Fax +966138955088, Email Faisal.alqurashi@yahoo.comPurpose: The Objective Structured Clinical Examination (OSCE) is a standard academic assessment tool in the field of medical education. This study presents an innovative method for digitizing OSCE evaluation system for medical students and explores its efficacy compared to the traditional paper-based system, through the analysis of a User Satisfaction Survey.Methods: A cross-sectional, questionnaire-based study involving a User Satisfaction Survey to evaluate assessors’ attitudes toward and acceptance of the Computerized Web-based OSCE Evaluation System (COES) was used. Fifth-year medical students at a College of Medicine were assessed clinically through their 2019 end-of-year OSCE examination by 30 examiners in five different OSCE stations. The traditional paper-based stations were converted into an online electronic version using QuestionPro software. Answers were filled in using smart tablets (iPads). QR codes were used for students’ identification at each station to fully digitize the process and save time. After the completion of the exam, a User Satisfaction Survey was sent electronically to all examiners to evaluate their experiences with the new system.Results: The response rate for the survey was 100% with an internal consistency of 0.83. Almost all the examiners (29, 97%) were satisfied with the application of the COES. Further, 72% of the examiners indicated that the electronic system facilitated the evaluation of the students’ skills, and 84% found using a smart device (iPad) was easier than using a paper form. All examiners expressed their preference for using the electronic system in the future.Conclusion: Users were satisfied with the utilization of the customized COES. This concept of fully digitizing the OSCE assessment process shortened the time needed for both the analysis of results and providing students with feedback. Further observational studies are needed to assess examiners’ behaviors when using this methodology.Keywords: academic performance, clinical competency, clinical skills, medical education, undergraduate, Saudi Arabia

Background The Covid pandemic and associated lockdown forced medical schools globally not only to deliver emergency remote teaching, but to consider alternative methods of high stakes assessment. Here we outline our approach to the resit virtual OSCE (“VOSCE”) for final year medical students that we undertook during “lockdown” in the current pandemic. Methods The original ‘pre Covid’ examination blueprint was reviewed and modified for the virtual environment in both format and content. In anticipation of the new format delivery, a number of pre-training sessions took place for all parties, and standardised templates were developed. Results A total of 9 students undertook the VOSCE, which took the form of a two-part exam (a communication and clinical examination component, and a practical procedures component). The VOSCE was completed by all students, examiners, simulated patients and invigilators on an online digital platform with no issues with regards to technical problems. Conclusions A total of 6 students passed the VOSCE and as such progressed to graduation. The limitation of assessing some particular types of skills across the remote format (such as practical procedures) was recognised. The training and the templates developed were helpful in case the VOSCE format needs to be adopted in future at short notice and/or expanded in future.

During the wake of the COVID-19 pandemic, many schools quickly transitioned their teaching and assessment strategies to online formats. In Spring 2020, a 3-station remote Objective Structured Clinical Examination (OSCE) was implemented for first-year pharmacy students. The day following the remote OSCEs students answered three open-text prompts about the remote OSCE experience: (1) “I liked...”, (2) “I learned…”, and (3) “I suggest…”. Responses were open-coded and frequency counts were calculated to determine the most prevalent codes. Concept maps were created to visualize and explore connections between the codes. Out of 157 students, 156 students completed the reflection assignment, a 99.36% response rate. The three major themes in the Liked data were: Logistics (n = 65, 41.7%), Differences In-person Versus Remote (n = 59, 37.8%), and Skill Development (n = 43, 27.6%). The three major themes in the Learned data were: Technology (n = 66, 42.3%), Communication (n = 58, 37.2%), and Skill Development (n = 56, 35.9%). The three major themes in the Suggest data were: Logistics (n = 89, 57.1%), Technology (n = 31, 19.9%), and Continuation of Remote OSCE (n = 31, 19.9%). Overall, the remote OSCE experience was well-received, and students described it as applicable to their future pharmacy practice. Future work should explore the design, implementation, and outcomes of remote OSCEs.

Introduction Peer assessments are increasingly prevalent in medical education, including student-led mock Objective Structured Clinical Examinations (OSCE). While there is some evidence to suggest that examiner training may improve OSCE assessments, few students undergo training before becoming examiners. We sought to evaluate an examiner training programme in the setting of a student-led mock OSCE. Methods A year‑2 mock OSCE comprised of history taking (Hx) and physical examination (PE) stations was conducted involving 35 year‑3 (Y3) student examiners and 21 year‑5 (Y5) student examiners who acted as reference examiners. Twelve Y3 student-examiners attended an OSCE examiner training programme conducted by senior faculty. During the OSCE, Y3 and Y5 student examiners were randomly paired to grade the same candidates and scores were compared. Scores for checklist rating (CR) and global rating (GR) domains were assigned for both Hx and PE stations. Results There was moderate to excellent correlation between Y3 and Y5 student examiners for both Hx (ICC 0.71–0.96) and PE stations (ICC 0.71–0.88) across all domains. For both Hx and PE stations, GR domain had poorer correlation than CR domains. Examiner training resulted in better correlations for PE but not Hx stations. Effect sizes were lower than the minimum detectible effect (MDE) sizes for all comparisons made. Discussion Y3 student examiners are effective substitutes for Y5 student examiners in a Y2 mock OSCE. Our findings suggest that examiner training may further improve marking behaviour especially for PE stations. Further studies with larger sample sizes are required to further evaluate the effects of dedicated examiner training.

Background Physicians’ communication skills (CS) are known to significantly affect the quality of health care. Communication skills training programs are part of most undergraduate medical curricula and are usually assessed in Objective Structured Clinical Examinations (OSCE) throughout the curriculum. The adoption of reliable measurement instruments is thus essential to evaluate such skills. Methods Using Exploratory Factor Analysis (EFA), Multi-Group Confirmatory Factor Analysis (MGCFA) and Item Response Theory analysis (IRT) the current retrospective study tested the factorial validity and reliability of a four-item global rating scale developed by Hodges and McIlroy to measure CS among 296 third- and fourth-year medical students at the Faculty of Medicine in Geneva, Switzerland, during OSCEs. Results EFA results at each station showed good reliability scores. However, measurement invariance assessments through MGCFA across different stations (i.e., same students undergoing six or three stations) and across different groups of stations (i.e., different students undergoing groups of six or three stations) were not satisfactory, failing to meet the minimum requirements to establish measurement invariance and thus possibly affecting reliable comparisons between students’ communication scores across stations. IRT revealed that the four communication items provided overlapping information focusing especially on high levels of the communication spectrum. Conclusions Using this four-item set in its current form it may be difficult to adequately differentiate between students who are poor in CS from those who perform better. Future directions in best-practices to assess CS among medical students in the context of OSCE may thus focus on (1) training examiners so to obtain scores that are more coherent across stations; and (2) evaluating items in terms of their ability to cover a wider spectrum of medical students’ CS. In this respect, IRT can prove to be very useful for the continuous evaluation of CS measurement instruments in performance-based assessments.

This CSS Study examines the challenges that the broad context of the global crisis of multilateralism and increased geopolitical polarization poses for the OSCE and how it has responded to them. It also highlights the opportunities that have emerged. First-hand insights into the challenges faced by Swiss Ambassador Thomas Greminger, who acted as the OSCE Secretary General from 2017–2020, and how he sought to navigate the organization through stormy waters form the heart of this study, flanked by analyses of the OSCE’s responses “on the ground” to the conflicts in Ukraine and Transnistria. It also looks toward the OSCE’s possible future development., Diese CSS-Studie untersucht die Herausforderungen, die der breite Kontext des Hintergrunds der globalen Krise des Multilateralismus und der zunehmenden geopolitischen Polarisierung für die OSZE darstellt, und wie sie darauf reagiert hat. Es zeigt auch die Möglichkeiten auf, die sich ergeben haben. Einblicke aus erster Hand in die Herausforderungen des Schweizer Botschafters Thomas Greminger, der von 2017 bis 2020 als OSZE-Generalsekretär fungierte, und wie er die Organisation durch stürmische Gewässer bemühte, bilden den Kern dieser Studie, flankiert von Analysen der OSZE- Reaktionen „vor Ort“ auf die Konflikte in der Ukraine und Transnistrien. Sie befasst sich auch mit der möglichen zukünftigen Entwicklung der OSZE., CSS Studies, ISBN:978-3-905696-78-3

Background: There is an active strategy to recruit international nurses and midwives to help manage vacancy gaps in the United Kingdom’s healthcare system. However, there is little evidence detailing how recruiting organisations prepare new recruits for the Objective Structured Clinical Exam (OSCE) they are required to pass. Aims and objectives: To gather and analyse feedback from recruiting organisations on the preparation offered to international nurses and midwives on arrival in the United Kingdom, prior to undertaking an OSCE in order to gain Nursing and Midwifery Council professional registration. Design and methods: An online cross-sectional questionnaire. The data was analysed using thematic analysis. Results: Four main themes were generated from thematic analysis of the qualitative data: SAME IDEAS DIFFERENT PRACTICE; PASSING THE OSCE; INDIVIDUALISED SUPPORT; SUPPORT NETWORKS. Conclusion: Differences in how organisations prepare and support international nurses and midwives to undertake the OSCE suggest standardised approaches could benefit new recruits. Impact statement: Addressing an evidence gap, this research suggests recruits may benefit from standardised support around working and living in the UK.

In the wake of the Covid-19 pandemic, people over 65 or suffering from certain conditions were deemed at high risk and asked to isolate themselves. This led to the simulated patient (SP) program at the University of Bern being depleted of middle-aged and elderly SP. Meanwhile, an OSCE had to be delivered using adapted cases that minimized physical contact between candidates and SP. Short of suitable cases at such short notice, the case of an elderly patient with postural instability had to be added to the exam blueprint. With elderly SP off the roster, it was decided to use makeup effects to achieve visual authenticity. A combination of wigs (grey hair, hairdo), 3D Probondo transfers (forehead wrinkles), old age stipple (crow’s feet), and colouring (age spots) were used to achieve the old-age effects, while SPs wore scarves to cover their neckline. The lower face was covered with protective face masks in accordance with the exam’s Covid-19 hygiene protocol. Case-related feedback from candidates and examiners was analysed for any direct or indirect remark attributable to the ageing effects. As no comment touched upon the subject of the appearance of age, this was interpreted as success, as any distracting effect from the SPs’ appearance in this regard would surely have prompted remarks or even complaints. The SPs’ feedback revealed how applying the ageing effects helped them adopt the octogenarian’s role. This report explains how SP in their fifties were made fit for an octogenarian’s case in an OSCE using makeup effects. The effort required for the ageing simulation was considerable, but it is hoped that in future, with more planning time, the amount of effort required can be reduced. The feedback obtained from the candidates suggest the appearance of SPs was not experienced as a distraction, which was the primary objective of this exercise. Adapting our approach to their own contexts allows educators to include cases with elderly patients in their OSCE that cannot be re-written for younger SP, so long as Covid-19 prevents elderly SP from participating., In der Covid-19-Pandemie wurden ein Lebensalter über 65 oder das Vorliegen bestimmter Gesundheitszustände als Risikofaktoren definiert und Betroffene entsprechend zur Selbstisolation aufgefordert. Dies führte auch dazu, dass das Simulationspersonenprogramm der Universität Bern auf den Einsatz vieler SP v.a. mittleren und vorgerückten Alters verzichten musste. Für eine unaufschiebbare OSCE-Prüfung wurden die Stationen derart angepasst, dass physische Nähe zwischen Kandidat*innen und SP minimiert war. Da sich in der kurzen zur Verfügung stehenden Zeit nur wenige Stationen derart anpassen liessen, musste der Fall einer älteren Patientin mit Haltungsinstabilität in den Prüfungsplan aufgenommen werden. Da ältere SP jedoch nicht aufgeboten werden konnten, wurde beschlossen, die visuelle Authentizität an dieser Station mittels Make-up-Effekten zu erzielen. Die Alterungseffekte wurden mithilfe von Perücken (graues Haar, Frisur), 3D-Probondo-Transfers (Stirnfalten), Old Age Stipple (Krähenfüsse) und Schminke (Altersflecken) bewirkt. Schals bedeckten die Dekolletés und gemäss Covid-19-Schutzreglement wurden chirurgische Masken getragen. Das stationsbezogene Feedback der Kandidat*innen und Prüfer*innen wurde auf direkte oder indirekte Bemerkungen zu den Alterungseffekten überprüft. Dass keine Äusserung bezüglich der altersgerechten Erscheinung der SP identifiziert werden konnte, wurde als Erfolg interpretiert, da jede ablenkende Wirkung des dargestellten Alters sicherlich zu Bemerkungen oder sogar Beschwerden geführt hätte. Das Feedback der SP zeigte ausserdem, wie die Alterungseffekte halfen, die Rolle der Achtzigjährigen anzunehmen. Dieser Bericht erläutert, wie SP in ihren Fünfzigern mithilfe von Make-up-Effekten für die Rolle einer Achtzigjährigen in einem OSCE vorbereitet wurden. Der Aufwand für die Alterungssimulation war beträchtlich, aber mit mehr Planungszeit könnte dieser bei zukünftigen Anwendungen reduziert werden. Die Rückmeldungen der Kandidat*innen deuten darauf hin, dass die Erscheinung dieser SP nicht als Ablenkung empfunden wurde, was Hauptziel der Intervention war. Der beschriebene Ansatz lässt sich adaptieren, sodass auch andernorts Stationen mit älteren Patient*innen in OSCE aufgenommen werden können, wo eine Verjüngung der Rolle nicht infrage kommt, zumindest solange Covid-19 die Teilnahme älterer SP verhindert., GMS Journal for Medical Education; 37(7):Doc89

The 2020 Covid19 pandemic has caused significant disruption to medical education across the world. At the University of Sheffield final year medical students undertook a virtual OSCE via technology in order to graduate however for our Physician Associate course this was more problematic as following completion of the assessments at the university students are also required to pass a national examination with a formal Objective Structured Clinical Examination (OSCE). Due to this it was felt that it was crucial to run an OSCE examination for our students on a face to face basis but within the context of managing the potential safety and risks inherent in doing so. \ud \ud \ud \ud This piece of work describes the process of running the examination including detail which we feel will be useful to others who may seek to undertake examinations for the same reason within the current health emergency or any future such events. It is important to note that some innovations we put in place with respect to technology enhancing safety will remain for future OSCE examinations in any circumstances.

Introduction: The Objective Structured Clinical Examination (OSCE) is an established format for practical clinical assessments at most medical schools and discussion is underway in Germany to make it part of future state medical exams. Examiner behavior that influences assessment results is described. Erroneous assessments of student performance can result, for instance, from systematic leniency, inconsistent grading, halo effects, and even a lack of differentiation between the tasks to be performed over the entire grading scale. The aim of this study was to develop a quality assurance tool that can monitor factors influencing grading in a real OSCE and enable targeted training of examiners.Material, Methods and Students: Twelve students at the Medical Faculty of the University of Heidelberg were each trained to perform a defined task for a particular surgical OSCE station. Definitions were set and operationalized for an excellent and a borderline performance. In a simulated OSCE during the first part of the study, the standardized student performances were assessed and graded by different examiners three times in succession; video recordings were made. Quantitative and qualitative analysis of the videos was also undertaken by the study coordinator.In the second part of the study, the videos were used to investigate the examiners' acceptance of standardized examinees and to analyze potential influences on scoring that stemmed from the examiners' experience.Results: In the first part of the study, the OSCE scores and subsequent video analysis showed that standardization for defined performance levels at different OSCE stations is generally possible. Individual deviations from the prescribed examinee responses were observed and occurred primarily with increased complexity of OSCE station content.In the second part of the study, inexperienced examiners assessed a borderline performance significantly lower than their experienced colleagues (13.50 vs. 15.15, p=0.035). No difference was seen in the evaluation of the excellent examinees. Both groups of examiners graded the item "ocial competence" - despite identical standardization - significantly lower for examinees with borderline performances than for excellent examinees (4.13 vs. 4.80, p

Background: Objective Structured Clinical Examinations (OSCEs) have become an established examination format at German medical faculties. Medical experts routinely use a summative assessment to evaluate practical and communicative skills, while the use of the OSCE format by student examiners, as a formative examination, remains rather limited. Objective: The formative OSCE program of the Department of General Practice and Implementation Research at the Heidelberg Medical Faculty, which is conducted and evaluated by peer tutors, is examined with regard to its quality criteria and compared with summative OSCEs from other departments. Methods: Difficulties and discriminatory power of individual testing stations were determined for the summative, as well as the formative OSCE, and compared with each other. To assess the reliability of the measurements, an analysis of the data was carried out using the Generalizability theory. In addition, a comparison is made between the assessments of student examiners and second assessments by medical experts. Results: The stations of the formative OSCE show similar difficulties as those of the summative comparison OSCEs (Pform=0.882; Psum=0.845 – 0.902). With respect to measurement reliability, there are no differences between the OSCE in General Medicine and the other subjects. The assessments of student examiners and medical experts correlate highly (r=0.888). Conclusion: The formative OSCE in General Medicine is comparable to the summative comparison formats in terms of its quality criteria. The use of student examiners can be a reliable alternative to medical experts in formative OSCEs., Hintergrund: Objective Structured Clinical Examinations (OSCEs) sind mittlerweile ein etabliertes Prüfungsformat an deutschen medizinischen Fakultäten. Üblicherweise werden darin praktische und kommunikative Fertigkeiten von medizinischen Experten summativ bewertet. Der Einsatz des OSCEs als formatives Prüfungsformat mit studentischen Prüfern findet bislang eher wenig Anwendung. Zielsetzung: Der an der Medizinischen Fakultät Heidelberg im Fach Allgemeinmedizin durchgeführte formative OSCE, der von Peer-Tutoren durchgeführt und bewertet wird, soll hinsichtlich seiner Gütekriterien untersucht und mit denen summativer OSCEs aus anderen Fachbereichen verglichen werden. Methodik: Schwierigkeiten und Trennschärfen der einzelnen Stationen werden für die summativen sowie den formativen OSCE bestimmt und einander gegenübergestellt. Zur Beurteilung der Messzuverlässigkeit wird eine Analyse der Daten mittels der Generalisierbarkeitstheorie durchgeführt. Zusätzlich findet ein Vergleich zwischen den Bewertungen der studentischen Prüfer und Zweitbewertungen medizinischer Experten statt. Ergebnisse: Die Stationen des formativen OSCEs weisen ähnliche Schwierigkeiten wie die der summativen Vergleichs-OSCEs auf (Pform=0.882; Psum=0.845 – 0.902). Bezüglich der Messzuverlässigkeit zeigen sich keine Unterschiede zwischen dem OSCE Allgemeinmedizin und denen der anderen Fächer. Die Bewertungen der studentischen Prüfer und der medizinischen Experten korrelieren hoch (r=0.888). Schlussfolgerung: Der formative OSCE Allgemeinmedizin ist hinsichtlich seiner Qualitätskriterien vergleichbar mit denen der summativen Vergleichsformate. Der Einsatz studentischer Prüfer kann bei formativen OSCEs eine verlässliche Alternative zu medizinischen Experten darstellen., GMS Journal for Medical Education; 37(4):Doc42

Introduction: The Objective Structured Clinical Examination (OSCE) is an established format for practical clinical assessments at most medical schools and discussion is underway in Germany to make it part of future state medical exams. Examiner behavior that influences assessment results is described. Erroneous assessments of student performance can result, for instance, from systematic leniency, inconsistent grading, halo effects, and even a lack of differentiation between the tasks to be performed over the entire grading scale. The aim of this study was to develop a quality assurance tool that can monitor factors influencing grading in a real OSCE and enable targeted training of examiners. Material, Methods and Students: Twelve students at the Medical Faculty of the University of Heidelberg were each trained to perform a defined task for a particular surgical OSCE station. Definitions were set and operationalized for an excellent and a borderline performance. In a simulated OSCE during the first part of the study, the standardized student performances were assessed and graded by different examiners three times in succession; video recordings were made. Quantitative and qualitative analysis of the videos was also undertaken by the study coordinator. In the second part of the study, the videos were used to investigate the examiners’ acceptance of standardized examinees and to analyze potential influences on scoring that stemmed from the examiners’ experience. Results: In the first part of the study, the OSCE scores and subsequent video analysis showed that standardization for defined performance levels at different OSCE stations is generally possible. Individual deviations from the prescribed examinee responses were observed and occurred primarily with increased complexity of OSCE station content. In the second part of the study, inexperienced examiners assessed a borderline performance significantly lower than their experienced colleagues (13.50 vs. 15.15, p=0.035). No difference was seen in the evaluation of the excellent examinees. Both groups of examiners graded the item “ocial competence” – despite identical standardization – significantly lower for examinees with borderline performances than for excellent examinees (4.13 vs. 4.80, p, Einleitung: Objective Structured Clinical Examinations (OSCE) sind als Format für klinisch-praktische Prüfungen an den meisten medizinischen Fakultäten etabliert und sollen in Zukunft auch in die humanmedizinischen Staatsprüfungen integriert werden. Einflüsse auf die Prüfungsergebnisse durch Prüferverhalten sind beschrieben. Fehlbeurteilungen der studentischen Leistungen resultieren beispielsweise durch systematische Nachsicht, durch Inkonsistenz in der Beurteilung, durch Halo-Effekte oder auch durch fehlende Differenzierung von Leistungen über die gesamte Bewertungsskala. Ziel der vorliegenden Arbeit war es ein Qualitätssicherungsinstrument zu entwickeln, das zukünftig die Überprüfung von Einflussfaktoren auf Bewertungen in einem realen OSCE ebenso wie eine gezielte Prüfer-Schulung ermöglicht. Material, Methoden und Studierende: Zwölf Studierende der Medizinischen Fakultät Heidelberg wurden trainiert, eine definierte Leistung für jeweils eine chirurgische OSCE-Station zu erbringen. Es wurde ein Niveau für eine exzellente und eine Borderline-Leistung festgelegt und operationalisiert. Im ersten Teil der Studie wurde in einem Überprüfungs-OSCE die standardisierte Leistung dreimal hintereinander mit unterschiedlichen Prüfern/innen überprüft, bewertet und auf Video aufgenommen. Eine zusätzliche quantitative und qualitative Bewertung erfolgte durch die Studienleiterin anhand der Videoanalyse. Im zweiten Teil der Studie wurden die Videoaufnahmen genutzt um die Akzeptanz für Standardisierte Prüflinge bei Prüfern/innen zu erheben und potentielle Einflüsse auf die Leistungsbewertung durch die Prüfererfahrung zu analysieren. Ergebnisse: Im ersten Teil der Studie zeigten die Bewertungen im OSCE und die nachfolgende Videoanalyse, dass eine Standardisierung für definierte Leistungsniveaus an verschiedenen OSCE-Stationen grundsätzlich möglich ist. Einzelne Abweichungen von den erwarteten Antworten wurden beobachtet und traten vor allem mit zunehmender inhaltlicher Komplexität der OSCE-Station auf. Im zweiten Studienteil bewerteten unerfahrene Prüfer/innen eine Borderline-Leistung signifikant schlechter als ihre erfahrenen Kolleg/innen (13,50 vs. 15,15, p=0,035). In der Bewertung der „Exzellenten Prüflinge“ zeigte sich kein Unterschied. Beide Prüfergruppen bewerteten das Item „Soziale Kompetenz“ – trotz identischer Standardisierung - bei Prüflingen mit einer Borderline-Leistung signifikant schlechter im Vergleich zu den „Exzellenten Prüflingen“ (4,13 vs. 4,80, p, GMS Journal for Medical Education; 37(4):Doc40

Web-Objective Structured Clinical Examination (OSCEs) were piloted for the Clinical Skills Assessment (CSA) exams in the USA two decades ago and were shown to be an acceptable way to conduct OSCEs remotely. The learners valued the process yet expressed numerous limitations.1 In response to the COVID-19 outbreak in Qatar, medical schools stopped in-person teaching creating a hiatus in clinical instruction. The Clinical Skills and Simulation Lab (CSSL) team devised and piloted a Web-OSCE to determine its feasibility in this setting, and to evaluate stakeholders’ experiences. We describe the steps taken to create a Web-OSCE built on women’s reproductive and sexual health which is part of the third year Obstetrics and Gynecology Clerkship curriculum, using Zoom teleconferencing. It mirrored the steps taken when conducting this activity in person; however, all communication relied on emails before the event, Zoom during the event with WhatsApp as a backup for connectivity between learners, Zoom hosts and faculty. ### Pre-Web-OSCE steps #### Preparing students CSSL provided by email a step-by-step instruction guide plus a pre-OSCE task for students to complete to ensure that they could access the OSCE on the day of the activity. A live Zoom session led by faculty reviewed the learning objectives, expectations and assessment and served as an open forum for students to ask questions in order to mitigate any anxiety surrounding the new modality. #### Preparing simulated patients Simulated patients (SP) were surveyed to assess their interest and technology capabilities to participate in Zoom activities. Interested SPs joined a Zoom meeting with staff members, who ensured they had adequate technical capability. SPs were selected and confirmed according to requirements of the case. Training notes and checklists were sent …

IntroductionObjective structured clinical exams (OSCEs) are a cornerstone of assessing the competence of trainee healthcare professionals, but have been criticised for (1) lacking authenticity, (2) variability in examiners’ judgements which can challenge assessment equivalence and (3) for limited diagnosticity of trainees’ focal strengths and weaknesses. In response, this study aims to investigate whether (1) sharing integrated-task OSCE stations across institutions can increase perceived authenticity, while (2) enhancing assessment equivalence by enabling comparison of the standard of examiners’ judgements between institutions using a novel methodology (video-based score comparison and adjustment (VESCA)) and (3) exploring the potential to develop more diagnostic signals from data on students’ performances.Methods and analysisThe study will use a complex intervention design, developing, implementing and sharing an integrated-task (research) OSCE across four UK medical schools. It will use VESCA to compare examiner scoring differences between groups of examiners and different sites, while studying how, why and for whom the shared OSCE and VESCA operate across participating schools. Quantitative analysis will use Many Facet Rasch Modelling to compare the influence of different examiners groups and sites on students’ scores, while the operation of the two interventions (shared integrated task OSCEs; VESCA) will be studied through the theory-driven method of Realist evaluation. Further exploratory analyses will examine diagnostic performance signals within data.Ethics and disseminationThe study will be extra to usual course requirements and all participation will be voluntary. We will uphold principles of informed consent, the right to withdraw, confidentiality with pseudonymity and strict data security. The study has received ethical approval from Keele University Research Ethics Committee. Findings will be academically published and will contribute to good practice guidance on (1) the use of VESCA and (2) sharing and use of integrated-task OSCE stations.

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