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Background: The Objective Structured Clinical Examination (OSCE) is a commonly used method for assessing clinical skills among nursing students. However, it often induces anxiety, which can impact student performance. This study aims to examine the effect of a simulated OSCE (MOCK OSCE) on reducing test anxiety and improving performance in nursing students during the OSCE.Method: This quasi-experimental study was conducted on 65 first-year nursing students at Aligudarz Nursing School during the 2023-2024 academic years. Using a census sampling method, students were randomly assigned to two groups: an intervention group, which participated in a MOCK OSCE program (including test scenarios, feedback, and practical exercises), and a control group, which continued with the regular curriculum. Test anxiety was measured before and after the intervention using the Sarason Test Anxiety Scale, and OSCE performance scores were evaluated with standardized checklists. Data were analyzed with paired t-tests, independent t-tests, and ANOVA using SPSS version 23.Results: The results showed a significant decrease in test anxiety scores within the intervention group before and after the simulated OSCE (p

To offset grade inflation, many clerkships combine faculty evaluations with objective assessments including the Medical Examiners Subject Examination (NBME-SE) or Objective Structured Clinical Examination (OSCE), however, standardized methods are not established. Following a curriculum transition removing faculty clinical evaluations from summative grading, final clerkship designations of fail (F), pass (P), and pass-with-distinction (PD) were determined by combined NBME-SE and OSCE performance, with overall PD for the clerkship requiring meeting this threshold in both. At the time, 90% of students achieved PD on the Internal Medicine (IM) OSCE resulting in overall clerkship grades primarily determined by the NBME-SE. The clerkship sought to enhance the OSCE to provide a more thorough objective clinical skills assessment, offset grade inflation, and reduce the NBME-SE primary determination of the final clerkship grade. The single-station 43-point OSCE was enhanced to a three-station 75-point OSCE using the Reporter-Interpreter-Manager-Educator (RIME) framework to align patient encounters with targeted assessments of progressive skills and competencies related to the clerkship rotation. Student performances were evaluated pre- and post-OSCE enhancement. Student surveys provided feedback about the clinical realism of the OSCE and the difficulty. Pre-intervention OSCE scores were more tightly clustered (SD = 5.65%) around a high average performance with scores being highly negatively skewed. Post-intervention OSCE scores were more dispersed (SD = 6.88%) around a lower average with scores being far less skewed resulting in an approximately normal distribution. This lowered the total number of students achieving PD on the OSCE and PD in the clerkship, thus reducing the relative weight of the NMBE-SE in the overall clerkship grade. Student response was positive, indicating the examination was fair and reflective of their clinical experiences. Through structured development, OSCE assessment can provide a realistic and objective measurement of clinical performance as part of the summative evaluation of students.

While objective clinical structured examination (OSCE) is a worldwide recognized and effective method to assess clinical skills of undergraduate medical students, the latest Ottawa conference on the assessment of competences raised vigorous debates regarding the future and innovations of OSCE. This study aimed to provide a comprehensive view of the global research activity on OSCE over the past decades and to identify clues for its improvement. We performed a bibliometric and scientometric analysis of OSCE papers published until March 2024. We included a description of the overall scientific productivity, as well as an unsupervised analysis of the main topics and the international scientific collaborations. A total of 3,224 items were identified from the Scopus database. There was a sudden spike in publications, especially related to virtual/remote OSCE, from 2020 to 2024. We identified leading journals and countries in terms of number of publications and citations. A co-occurrence term network identified three main clusters corresponding to different topics of research in OSCE. Two connected clusters related to OSCE performance and reliability, and a third cluster on student’s experience, mental health (anxiety), and perception with few connections to the two previous clusters. Finally, the United States, the United Kingdom, and Canada were identified as leading countries in terms of scientific publications and collaborations in an international scientific network involving other European countries (the Netherlands, Belgium, Italy) as well as Saudi Arabia and Australia, and revealed the lack of important collaboration with Asian countries. Various avenues for improving OSCE research have been identified: i) developing remote OSCE with comparative studies between live and remote OSCE and issuing international recommendations for sharing remote OSCE between universities and countries; ii) fostering international collaborative studies with the support of key collaborating countries; iii) investigating the relationships between student performance and anxiety.

Introduction: Objective structured clinical examinations have traditionally been used to assess clinical skills. However, these face-to-face clinical assessments were hindered by physical and social restrictions imposed during COVID-19. This created a need to develop novel approaches for reliable assessment of clinical skills. We explored and evaluated a virtual exercise teleconsultation assessment (VETA) to replicate a teleconsultation setting where physiotherapy students were assessed on exercise prescription and coaching skills. Methods: We conducted a cross-sectional mixed-methods study using convenience sampling. A VETA was implemented for 172 physiotherapy students via Zoom to allow synchronous interaction with standardised patients (SPs). 67 students and 9 SPs completed two separate post evaluation surveys on themes relating to administration, support, authenticity, effectiveness, and value of the VETA. Likert-type responses were categorised as positive, neutral, or negative while coded qualitative responses were consolidated into themes by inductive content analysis. Results: 76% of students agreed that the assessment was authentic while 93% felt that the SPs were realistic and believable. Responders also highlighted important challenges including the limited camera viewing angle, time and space constraint, adequacy of equipment and reliability of connectivity. Exploratory factor analysis of responses revealed three latent constructs: (1) clarity of assessment, (2) clinical relevance, and (3) value of assessment. Conclusion: Despite the technical challenges, VETA demonstrated clarity and value as an alternative assessment and showed relevance to future telehealth practice, which is increasingly pervasive in clinical settings. This paper demonstrates a feasible approach for the virtual assessment of clinical competencies.

Naireen Asim,* Ianna Alberto* Medical School, St George’s, University of London, London, UK*These authors contributed equally to this workCorrespondence: Naireen Asim, Email m1501540@sgul.ac.uk

This study aimed to investigate the experience of medical students assessing their cohort peers in formative clinical assessment. The exercise was designed to provide students with a formative experience prior to their summative assessment, and to determine what students could learn by being on the “other side of the mark sheet.” Students were grateful for the experience learning both from the assessment practice, and from the individual written feedback provided immediately afterwards. They also described how much they learnt from seeing the assessment from the assessor’s viewpoint, with many students commenting that they learnt more from being the “assessor” than from being the “student” in the process. Students were asked how they felt about being assessed by their peers, with some describing the experience as being more intimidating and stressful than when compared to assessment by clinicians. An interesting aspect of this study is that it also demonstrates some findings which suggest that the students’ current learning context appears to have an effect on their attitudes to their peers as assessors. It is possible the competitive cultural milieu of the teaching hospital environment may have a negative effect on medical student collegiality and peer support.

Hussein Alhawari,1 Sameeha Alshelleh,1 Osama Alzoubi,1 Asim N Khanfar,1 Reem Akiely,1 Bayan Abdallah,1 Nada Hajjaj,1 Saja Alkhalaileh,1 Yousef Khader2 1Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan; 2Department of Public Health, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Hussein Alhawari, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan, Email h.alhawari@ju.edu.joIntroduction: Objective Structured Clinical Examinations (OSCEs) are considered an integral part of the assessment process of many schools of medicine worldwide. Close monitoring by examiners, scrutinized interactions with patients, and fear of the unknown, among other factors have been reported to cause psychological stress among students during the examinations period. In this study, we aimed to assess changes in cardiovascular parameters, anxiety scores, and lifestyle patterns of medical students during their OSCEs as compared to their baseline.Materials and Methods: We recruited healthy medical students from our institution’s medical school. General demographics, academic, and baseline lifestyle characteristics were collected 1– 2 months before the OSCE day. The Generalized Anxiety Disorder 7-item (GAD-7) scale was used to measure anxiety symptoms. Data related to coffee consumption in addition to systolic, diastolic blood pressure and heart rate measurements were collected both at baseline and on OSCE day.Results: This study included 325 students (144 (44.3%) males and 181 (55.7%) females). The mean systolic blood pressure, diastolic blood pressure, and heart rate measurements were significantly higher on OSCE day as compared to the baseline. In addition, the daily consumption of coffee increased significantly during OSCE day as compared to the baseline. Although the anxiety score increased during OSCE day compared to the baseline, the difference was not statistically significant. However, the change in anxiety score (OSCE day – baseline) was significantly higher in females compared to males.Conclusion: In our study, we observed significant increases in blood pressure, heart rate, and coffee intake on the day of the test compared to baseline measurements. These findings underscore the significance of implementing measures to reduce the harmful effects of stress on students during exam preparations and medical school assessments.Keywords: blood pressure, anxiety, stress, objective structured clinical examination, OSCE

ABSTRACTIntroduction Objective structured clinical examination (OSCE) results could be affected by low homogeneity of examiners, non-retrospectiveness of test results, and examiner-cohort effect. In China, many students participate in medical qualification examinations, and this issue is particularly significant. This study aimed to develop a video recording, video-based rating method and compare the reliability of video and on-site ratings to enhance the quality assurance of OSCEs.Methods The subjects of this study were clinical students one year after graduation participating in the clinical skills portion of the National Medical Licensing Examination. The participants were from four cities in Jiangsu province. Participants were randomly allocated to on-site and video rating groups to evaluate the rating methods consistency. We verified the reliability of recording equipment and evaluability of video recording. Moreover, we compared the consistency and equivalence of the two rating methods and analyzed the impact of video recording on scores.Results The reliability of recording equipment and evaluability of video recording were high. Evaluation consistency between experts and examiners was acceptable, and there was no difference in evaluation results (P = 0.61). There was good consistency between video and on-site rating; however, a difference between the two rating methods was detected. The scores of video-based rating group students were lower than those of all students (P

Objective structured clinical examination (OSCE) is a well-known assessment method to evaluate clinical skills and competence in healthcare. Following the recently reformed National Competence-Based Catalog of Learning Objectives in Medicine, the implementation of this assessment method in the training program for medical students is now obligatory in Germany. This major change requires a reorganization not only of the training programs but also of the students themselves and the way they learn. We performed a poll evaluating the students’ opinions regarding these major changes and the implementation of the OSCE with a new training program. To implement this assessment method and to evaluate the OSCE, Kern’s six-step approach comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback was applied. To evaluate and gather feedback, a poll was used to analyze the student’s opinions regarding OSCE in gynecology and obstetrics and OSCE in general, in addition to the regular analysis of the students’ results. To reform the educational strategy, a two-step approach was developed: First, the students completed the regular training program and a written examination, and second, they participated in a 1-week clerkship, in small group teaching, and in the OSCE. The OSCE stations were developed primarily based on the National Competence-Based Catalog and the German Catalog of Learning Objectives in Medicine, as well as on the feedback of experts reflecting their expectations for physicians beginning their careers. The students performed well in the OSCE and gave positive feedback regarding this examination method. Furthermore, they welcomed the upcoming changes by considering OSCE a valuable assessment tool, and they showed appreciation for the two-step approach by supporting the combination of an OSCE and a written examination. Thus, this article presents the implementation of an OSCE and a strategy for the adaptation of the curriculum to fulfill the new OSCE requirements and—to our knowledge—reveals students’ primary opinions regarding the changes in their medical training program for the first time.

BackgroundThis study describes the program and learning outcomes of a telehealth skills curriculum based on the Association of American Medical Colleges (AAMC) telehealth competencies for clerkship-level medical students.MethodsA total of 133 third- and fourth-year medical students in a required family medicine clerkship at Stanford University School of Medicine participated in a telehealth curriculum, including a telehealth workshop, site-specific telehealth clinical encounters, and telemedicine objective structured clinical examinations (teleOSCEs) between July 2020 and August 2021. Their workshop communication and physical examination competencies were assessed in two teleOSCEs utilizing a novel telehealth assessment tool. Students' attitudes, skills, and self-efficacy were assessed through voluntary pre-clerkship, post-workshop, and post-OSCE surveys.DiscussionMost learners reported low confidence in their telehealth physical examinations [n = 79, mean = 1.6 (scale 0–5, 5 = very confident, SD = 1.0)], which improved post-workshop [n = 69, 3.3 (0.9), p < 0.001]; almost all (97%, 70/72) felt the workshop prepared them to see patients in the clinic. In formative OSCEs, learners demonstrated appropriate “webside manner” (communication scores 94–99%, four items) but did not confirm confidentiality (21%) or review limitations of the visit (35%). In a low back pain OSCE, most learners assessed pain location (90%) and range of motion (87%); nearly half (48%) omitted strength testing.ConclusionOur telehealth curriculum demonstrated that telehealth competencies can be taught and assessed in medical student education. Improvement in self-efficacy scores suggests that an 80-min workshop can prepare students to see patients in the clinical setting. Assessment of OSCE data informs opportunities for growth for further development in the curriculum, including addressing visit limitations and confidentiality in telehealth visits.

Healthcare educators are encouraged to provide both skill-based practical exams and interprofessional experiences to prepare students for clinical practice. With skill-based exams come increased student stress and anxiety. This article reports on the development, exploratory outcomes, and lessons learned from an ungraded objective structured clinical examinations (OSCEs) event involving doctoral-level occupational therapy and bachelor-level nursing students. The primary objective was to allow occupational therapy students to practice for an upcoming graded, comprehensive, skill-based exam. The secondary objective was to examine if the event changed students’ perceived interprofessional skills. The OSCE event included a large group pre-brief, three simulations with mini debriefs following each simulation, and a large group debrief. Students completed pre- and post- tests providing quantitative data to assess perceived attainment of interprofessional competencies. Qualitative data suggested significant value and worthiness of this learning event. Students reported the event improved their interprofessional skills, decreased exam stress and anxiety, and provided them adequate practice for the exam. Overall, the preliminary findings suggested the design of this interprofessional ungraded OSCE event prepared occupational therapy students for comprehensive skill-based exams, thereby decreasing test anxiety and stress levels while facilitating a beneficial interprofessional experience. Details of the OSCE design are shared to assist faculty in preparing future healthcare professionals for positive interprofessional collaborations and comprehensive skill-based curricular assessments.

Objectives: Objective structured clinical examinations (OSCEs) are used to assess clinical competence in medical education. Evaluations using video-recorded OSCEs are effective in reducing costs in terms of time and human resources. To improve inter-rater reliability, these evaluations undergo moderation in the form of a discussion between the raters to obtain consistency in grading according to the rubric criteria. We examined the effect of moderation related to the rubric criteria on the inter-rater reliability of a video-recorded OSCE with real patients. Methods: Forty OSCE videos in which students performed range-of-motion tests at shoulder abduction on real patients were assessed by two raters. The two raters scored videos 1 to 10 without moderation and videos 11 to 40 with moderation each time. The inter-rater reliability of the OSCE was calculated using the weighted kappa coefficient. Results: The mean scores of the weighted kappa coefficients were 0.49 for videos 1 to 10, 0.57 for videos 11 to 20, 0.66 for videos 21 to 30, and 0.82 for videos 31 to 40. Conclusions: An assessment of video-recorded OSCEs was conducted with real patients in a real clinical setting. Repeated moderation improved the inter-rater reliability. This study suggests the effectiveness of moderation in OSCEs with real patients.

Nabil Ansari,&ast; Ali Yalcinkaya,&ast; Akalya Ganeshamoorthy&ast; Faculty of Life Sciences and Medicine, King’s College London, London, UK&ast;These authors contributed equally to this workCorrespondence: Nabil Ansari, Faculty of Life Sciences and Medicine, King’s College London, Great Maze Pond, London, SE1 1UL, United Kingdom, Tel +44 7846175853, Email Nabil.ansari@kcl.ac.uk

LC Enoch,&ast; RM Abraham,&ast; VS Singaram&ast; School of Clinical Medicine, Clinical and Professional Practice, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa&ast;These authors contributed equally to this workCorrespondence: LC Enoch, Email Enochl@ukzn.ac.za

Abstract Background The need to engage adults, age 65 and older, in clinical trials of conditions typical in older populations, (e.g. hypertension, diabetes mellitus, Alzheimer’s disease and related dementia) is exponentially increasing. Older adults have been markedly underrepresented in clinical trials, often exacerbated by exclusionary study criteria as well as functional dependencies that preclude participation. Such dependencies may further exacerbate communication challenges. Consequently, the evidence of what works in subject recruitment is less generalizable to older populations, even more so for those from racial and ethnic minority and low-income communities. Methods To support capacity of research staff, we developed a virtual, three station simulation (Group Objective Structured Clinical Experience—GOSCE) to teach research staff communication skills. This 2-h course included a discussion of challenges in recruiting older adults; skills practice with Standardized Participants (SPs) and faculty observer who provided immediate feedback; and debrief to highlight best practices. Each learner had opportunities for active learning and observational learning. Learners completed a retrospective pre-post survey about the experience. SP completed an 11-item communication checklist evaluating the learner on a series of established behaviorally anchored communication skills (29). Results In the research staff survey, 92% reported the overall activity taught them something new; 98% reported it provided valuable feedback; 100% said they would like to participate again. In the SP evaluation there was significant variation: the percent well-done of items by case ranged from 25–85%. Conclusions Results from this pilot suggest that GOSCEs are a (1) acceptable; (2) low cost; and (3) differentiating mechanism for training and assessing research staff in communication skills and structural competency necessary for participant research recruitment.

Mona Arekat,1 Mohamed Hany Shehata,2,3 Abdelhalim Deifalla,4,5 Ahmed Al-Ansari,6 Archana Kumar,6 Mohamed Alsenbesy,1,7 Hamdi Alshenawi,8 Amgad El-Agroudy,1 Mariwan Husni,9,10 Diaa Rizk,11 Abdelaziz Elamin,12 Afif Ben Salah,2 Hani Atwa6,13 1Internal Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain; 2Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain; 3Family Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt; 4Anatomy Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; 5Human Anatomy and Embryology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; 6Medical Education Unit, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; 7Internal Medicine Department, Faculty of Medicine, South Valley University, Qena, Egypt; 8Surgery Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; 9Psychiatry Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; 10Psychiatry Department, Northern Ontario School of Medicine (NOSM), Ontario, Canada; 11Obstetrics and Gynecology Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; 12Pediatrics Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; 13Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, EgyptCorrespondence: Mohamed Hany Shehata, Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain, Tel +97333918183, Email mohamedhks@agu.edu.bhBackground: The COVID-19 pandemic led to profound restrictions on the face-to-face learning and assessment in all educational institutions, particularly the medical schools. The College of Medicine and Medical Sciences of the Arabian Gulf University (CMMS-AGU) conducted the final exams, both theoretical and clinical components, for its MD students online. This study was conducted to evaluate the utility of online clinical exams held at CMMS-AGU.Methods: This is a cross-sectional, mixed method study that included samples from final year medical students, examiners, and heads of clinical departments. Data were collected through surveys, structured interviews, documents’ review, and calculation of online examination’s psychometrics. Descriptive statistics were used. Quantitative data were presented in the form of means and standard deviations. Responses of heads of clinical departments in the structured interview were transcribed and analyzed thematically based on three pre-established themes.Results: Quantitative and qualitative data on the utility (validity, reliability, acceptability, educational impact, and cost and feasibility) of online objective structured clinical examination (OSCE) were collected. Content validity of the online clinical examination was established through high mean scores of content representativeness, which was confirmed by the heads of clinical departments regarding the proper coverage of clinical skills. Criterion validity was established through a high correlation between clinical and theoretical exam results (r = 0.75). Reliability of the exam was established through an acceptable Cronbach’s alpha value (0.70 to 0.78) over the four days of the examinations. The examinations were perceived as highly acceptable by both students and examiners. High educational impact was inferred from students’ responses and review of documents. The examination was found to be feasible and of reasonable cost.Conclusion: Online OSCE might be a good alternative of conventional clinical assessments in times of crises and impossibility of having in-person contact between students, examiners, and patients. An important major drawback is still present in such initiatives, which is the inability to assess students’ physical examination skills.Keywords: online clinical assessment, exam utility, OSCE, COVID-19

Introduction: As regards the novelty of the Clinical Competency Exam (CCE) in medical curriculum in Iran, lack of study about result of CCE and necessity for study about the relationship between result of CCE and other common exams in medical curriculum, this study was conducted. This study investigated the correlation between CCE and other exams in medical curriculum. Methods: This correlational study evaluated the CCE, comprehensive pre-internship exam (CPIE), Basic Science Grade Point Average (BSGPA), and Clinical Grade Point Average (CGPA) scores of the final year medical students admitted to Isfahan University of Medical Sciences in the academic years 2008-2013. The data were garnered by reviewing the relevant documentation provided by the Vice-Chancellery for educational and student affairs of Isfahan medical school. Results: The CPIE average score was 125±20.03 (out of 200), and the CCE average score was 16±1.38 (out of 20). The BSGPA score was 15.59±1.40 (out of 20) and the CGPA score was 16.62±0.90 (out of 20). Considering the effect of other variables, the CGPA scores were significantly correlated to the CCE average scores (p-value

Nagwa N Hegazy,1 Noha M Elrafie,2 Nermine Saleh3 ,† Ilham Youssry,4 Samar A Ahmed,2,5 Mostafa Yosef,6 Marwa M Ahmed,7 Nagwan I Rashwan,8 Hany W Abdel Malak,5,9 Samia A Girgis,10 Gehane M Hamed,3 Howeida Hassan Abusalih11 1Family Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt; 2Forensic Medicine and Toxicology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 3Physiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 4Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 5Faculty of Medicine, Delta University for science and technology, Dakahlia, Mansoura, Egypt; 6Community Environmental and Occupational Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 7Family Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 8Pediatrics Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt; 9Anatomy & Embryology Department, Ain Shams University, Cairo, Egypt; 10Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 11College of Health and rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia†Nermine Saleh passed away on April 26, 2021Correspondence: Nagwa N Hegazy Email Nagwa.nashaat1@med.menofia.edu.egPurpose: Majority of the assessments, appraisals and placements have been disturbed, with some being cancelled, postponed, or modified in design. New approaches for assessment should be well-thought-out. This work attempts at capturing the collective wisdom of educators in the Middle East and North Africa region (MENA), providing an understanding of the online assessment conceptual framework in the era of COVID-19 that tells the story rather than determining cause and effect, and identifying the biggest gaps that derail the digital transformation.Methods: A qualitative inductive study using the grounded theory approach was implemented following a synchronous virtual online meeting, a summary of the reflections as well as experiences of medical education experts was prepared. Data for this qualitative study were collected from the meeting. The meeting was video-recorded and transcribed by the researchers. Thematic analysis was performed by three separate researcher coders. The authors then discussed together until they reached a consensus.Results: Three main thematic areas were identified: 1) feasibility, 2) exam fairness/equity and 3) acceptable graduate attributes, society/community acceptance.Conclusion: The COVID-19 era necessitated revisiting of our assessment strategies to cope with new changes within the available context. Rapid adaptation is required.Keywords: process assessment, educational technology, enhanced assessment, OSCE

Abdulrahman Alshaya,1– 3 Shuroug Alowais,1– 3 Shmeylan Alharbi,1– 3 Abdulkareem Albekairy1– 3 1College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi ArabiaCorrespondence: Abdulrahman Alshaya Email alshayaab@gmail.comPurpose: Objective structured clinical examination (OSCE) is an effective tool for learners’ assessment that require hands-on performance. During the COVID-era, many schools decided to minimize all forms of in-person communication between faculty members and students to mitigate the risk of COVID-19 transmission. We aimed to describe our experience in conducting physical OSCEs during the COVID-19 era. We also reported students’ satisfaction during this time.Materials and Methods: Descriptive cohort study by comparing the 2019– 2020 cohort to the 2020– 2021 cohort. Descriptive framework for the feasibility of conducting physical OSCEs in the college of pharmacy at King Saudi Bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia.Results: There were no reported cases of COVID-19 transmission among students and faculty members during the OSCE assessments. Overall, the 2020– 2021 cohort reported increased satisfaction compared to their peers in the 2019– 2020 cohort; p < 0.05. We observed an increased need for coordination to ensure students’ and staff safety while adopting machine learning applications as a public measure when possible.Conclusion: Owing to the implementation of clear and strong measures, it was feasible to conduct OSCEs, and there were no reported cases of COVID-19 transmission. Other universities may adopt a similar approach so as to provide an optimal educational experience while ensuring the safety of their staff and faculty.Keywords: OSCE, education, COVID-19, simulation, teaching

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

Letter To Editor

Fieldwork education is an integral part of the educational process in occupational therapy and assessing student competency at the end of fieldwork is important. The aim of this study was to design and conduct an Objective Structured Clinical Examination (OSCE) based on the Occupational Therapy Practice Framework (OTPF) for occupational therapy students on Level II fieldwork in Iran. A seven-station OSCE was designed and conducted with 13 students. Face and content validity of the exam scenarios and grading checklists was assessed via faculty review. The correlation between scores from each station and total OSCE scores were obtained to assess construct validity. Inter-rater reliability between two independent examiners at each OSCE station was determined. The participants’ (including both students and examiners) reactions to and learning from the exam was assessed using a self-report questionnaire that included participants' attitudes, satisfaction, and emotional response to the OSCE. Finally, a focus group of 12 examiners was conducted to examine the strengths and weaknesses of the exam. It was ascertained that the OSCE had good and acceptable face, content, and construct validity as well as inter-examiner reliability. All students reported that the exam was stressful, and most students (n=8, 61%) and examiners (n=5, 42%) reported there was not enough time for each station. Strength and weaknesses of the exam as related to the exam condition, exam content, students, and examiners were reported. Based on the qualitative and quantitative analysis of the results, in order to use OSCE as a method of evaluating occupational therapy students, some changes should be applied.

Abstract Patient‐dentist discourse is a core nonoperational competency in dental education. The skills of querying patients and responding to questions are noncognitive attributes, and their evaluation by the standardized patient objective structured clinical examination (OSCE) is particularly necessary. However, it is not clear whether students' test anxiety affects these attributes. This study aims to examine the relationship between dental students' state‐trait anxiety, noncognitive performance, and examination results during their first OSCE. A single dental school cohort (n = 226) of 5 year students attending their first clinical examination from 2014 to 2017 was studied. Participants completed the Chinese Mandarin Version State‐Trait Anxiety Inventory Y form before taking the OSCE. The difference between state and trait anxiety levels was compared by paired t test. Gender differences and the effect of age group in these anxiety levels were analyzed using multivariate analysis of variance. Moreover, gender, age group, state anxiety, and trait anxiety scores were compared with the OSCE items of noncognitive performance using a chi‐square test. Students showed significantly higher state anxiety than trait anxiety levels; moreover, women showed significantly higher state anxiety than men. Furthermore, gender, age group, state anxiety, and trait anxiety had no association with the noncognitive performance examination results. Most participants showed moderate state and trait anxiety levels during their first OSCE. Further, the state‐trait anxiety had no significant effect on their noncognitive performance. However, 26.5% of participants did not pass the examination; therefore, dental educators should increase communication skill training courses during clerkship training to improve students' noncognitive attributes.

Chemotherapy agents are cytotoxic materials. Thus, there is a need for the operators to be familiar with the knowledge and procedures before operation. We conducted a randomized controlled trial investigating the effectiveness of an immersive 3D VR teaching of chemotherapy administration operated in a smartphone coupled with a visual and audio device. We adopted a two-arm single-blind design and recruited 83 nurses, and they were randomized using a cluster approach. The VR group learned chemotherapy administration through VR, while the controlled group learned through document reading. The Knowledge and Attitude of Chemotherapy Administration (KACA) was administrated before the intervention, while the Objective Structured Clinical Examination (OSCE) and the Checklist of Action Accomplishment (CAA) were administrated one month after the intervention. The VR group scored higher than the controlled group in the CAA (95.69 ± 5.37 vs. 91.98 ± 9.31, p = 0.02) and the OSCE (73.07 ± 10.99 vs. 67.44 ±10.65, p = 0.02). Stepwise regression demonstrated that service years, an education level of undergraduate or above, and VR exposure contributed positively to the OSCE score (adjusted R2 = 0.194, p = 0.028). The use of VR improves the learning efficacy of chemotherapy administration in non-oncology nurses. We recommend using VR as a teaching tool for chemotherapy administration and other chemotherapy-related skills in a VR learning group with senior nurses with higher education levels as advisors. The study provides an approach to online training, especially during the COVID-19 pandemic. (CONSORT 2010 guidelines, registry number: NCT 04840732).

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.

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

Introduction Although menopause is a common condition, trainees still express high levels of discomfort with managing climacteric symptoms. Trainees also receive little preparation for conducting telemedicine visits, which have become increasingly important in clinical care. We present a formative standardized patient (SP) encounter to introduce medical students to the diagnosis and treatment of menopausal symptoms and the process of conducting a telemedicine visit. Methods We designed a virtual telemedicine encounter with an SP for medical students. Students received feedback via a post-encounter note on history taking, differential diagnosis, and diagnostics/management and an SP debrief. We collected student input on the experience at the midpoint and end of clerkship and analyzed it for recurring themes. We calculated summary statistics from student post-encounter notes. Results Thirty-two OB/GYN students completed the menopause telemedicine SP encounter between April and June 2020. Students scored a median of 20 out of 45 (interquartile range: 18, 22) on the post-encounter note. All students correctly provided a diagnosis of perimenopause/menopause; however, 50% did not offer any strategy for counseling or managing menopausal symptoms. Students expressed discomfort with using a telehealth format (78%) but found it a useful skill to practice (47%). A majority (66%) found the educational encounter to be of excellent or above-average educational value. Discussion While medical students demonstrated discomfort with both managing menopause and utilizing a telemedicine format, this SP case provided an opportunity for them to practice both skills in a safe learning environment. The majority of participants rated the learning experience highly.

This study aimed to report the specific methods and investigate the educational effects of diagnostic musculoskeletal ultrasound training and the Objective Structured Clinical Examination (OSCE) for traditional medicine students. Scanning volar wrist and diagnosing carpal tunnel syndrome were selected for musculoskeletal ultrasound to train students to use the basic functions of the ultrasound device and scan various structures including tendons, nerves, and arteries. The students were divided into two groups: one group had 8 weeks of training with mock OSCE experience and received feedback about their scan images, and the other group had 3 weeks of training with flipped learning. The OSCE was implemented on the last day of the training. The subjective learning outcomes were analyzed as students’ evaluation with a 5-point scale, and the objective learning outcomes were analyzed using OSCE scores evaluated with a pre-validated checklist. Of the 111 students, 60 (54.1%) responded to the questionnaire. Overall satisfaction with this ultrasound training was high (4.5 ± 0.60). The average OSCE score in the 8-week group was significantly higher than that in the 3-week group. The students’ self-assessment showed no significant differences between the two groups. Proficiency in using ultrasound is affected by the practice time and feedback. Ultrasound training should be further expanded as a required curriculum to meet students’ needs and achieve learning objectives in the clinical skills education of Korean medicine colleges. Further studies are needed on ultrasound education, especially guided interventions for traditional medicine students.

Introduction Child neurology has unique challenges in communication due to complex disorders with a wide array of prognoses and treatments. Effective communication is teachable through deliberate practice and coaching. Objective structured clinical exams (OSCEs) are one method of providing practice while assessing communication skills. Yet OSCEs have not been reported for child neurology residents. Methods We developed simulated clinical cases centering on communication skills for child neurology residents, all with challenging clinical scenarios (e.g., disclosure of a medical error, psychogenic nonepileptic events). Standardized patients (SPs) portrayed the parents of pediatric patients and, in some scenarios, an adolescent patient. We used a modified Gap-Kalamazoo Communication Skills Assessment Form to assess communication skills. The assessment was completed by faculty, SPs, and the resident, and we measured agreement among raters. Residents were surveyed afterward regarding their experience. Results Nine cases were developed and piloted. A total of 27 unique resident-case encounters with 16 individual trainees occurred over three annual implementations. Scores on the 360-degree assessment of communication skills showed that residents overwhelmingly underassessed their skills compared to other rater groups. Among 18 responses on the post-OSCE survey, the majority (77%) found the experience useful to their education and felt that the feedback from the SPs was helpful (61%) and the case portrayals were realistic (89%). Discussion We implemented simulated cases for assessment and formative feedback on communication skills for child neurology residents. We provide a blueprint to develop this educational activity in other programs.

Introduction Residents have been known to report a lack of self-efficacy in their ability to provide care for limited English proficiency (LEP) patients. Interpreters must be utilized to help navigate these patient encounters, but many institutions do not have a curriculum focused on utilizing interpreters effectively. Methods We created a 3-hour workshop for physician learners working with the pediatric population. It included a panel discussion, best-practices presentation, video demonstration, observing scenarios, and pre- and postworkshop objective structured clinical exams (OSCEs). The first OSCE introduced learners to a scenario (4-day-old with jaundice with an LEP parent) where interpreter use was imperative. The second OSCE allowed learners to perform another case (12-year-old with an abscess with an LEP parent) and practice newly obtained skills from the workshop. Both OSCEs were scored using a 16-item yes/no checklist. All pediatric residents filled out an eight-item survey to evaluate the workshop; a subset of that group performed the pre- and postworkshop OSCEs. Results Forty pediatric residents attended the workshop and completed the survey. The workshop was well received, with the majority of residents stating they would change their current interpreter usage practices. Ten pediatric residents performed the pre- and postworkshop OSCEs; all improved their scores. Discussion The workshop was effective in improving how residents navigated LEP encounters. It is applicable to learners of all levels who want to improve their communication skills to provide better care for LEP patients and can be tailored to fit the needs of a specific institution.

Abstract: Introduction: The inclusion of new methodologies and assessments in the medical education area has indicated the need to understand teachers’ perception of their own ability to use them adequately. Objective: Thus, the present study aimed to investigate possible associations between teacher self-efficacy and the use of OSCE. Method: The Teacher Self-efficacy Scale and Self-Efficacy Sources Scale and a characterization questionnaire were used. Forty-seven medical teachers from a private university, of both genders, aged between 31 and 78 years, participated in the study. Results: The results indicated that the factors Social Persuasion and Vicarious Learning were the most endorsed, suggesting that these sources are the ones that interfere the most in the formation of the participants’ beliefs. There was only one positive and statistically significant correlation, with a weak magnitude, established between the Intentionality of Action Efficacy and Vicarious Learning. The other identified correlations were statistically negative and of moderate magnitude. Conclusions: The teachers who agreed with some important characteristics about the OSCE method also showed higher levels of self-efficacy. Therefore, professionals with greater perseverance, resilience and confidence, have also been more committed to teaching, research and student assistance.

Hesham Khalid,* Shiffa Shahid,* Nikita Punjabi,* Nikhil Sahdev* Faculty of Medicine, St George’s Hospital Medical School, London, UK *These authors contributed equally to this work Background: Several benefits of peer tutoring in medical school teaching have been described. However, there is a lack of research on the perceptions of peer tutoring, particularly from tutees who partake in a long-term clinical skills scheme integrated into the medical school curriculum. This study evaluates the opinions of preclinical tutees at the end of a 2-year peer-tutored clinical skills program and peer tutors themselves.Methods: A cross-sectional study was conducted in a UK-based medical school that primarily utilizes peer tutoring for clinical skills teaching. A questionnaire was designed to assess the views of preclinical tutees and peer tutors. Likert scales were used to grade responses and comment boxes to collect qualitative data.Results: Sixty-five questionnaires were collected (52 tutees, 13 peer tutors). Seventy-nine percent of students felt satisfied with their teaching, and 70% felt adequately prepared for clinical placements. Furthermore, 79% believed that peer tutoring is the most effective method for clinical skills teaching. When compared to faculty teaching, tutees preferred being taught by peer tutors (63%), felt more confident (73%), and were more willing to engage (77%). All peer tutors felt that teaching made them more confident in their Objective Structured Clinical Examination performance, and 91% agreed that being a tutor made them consider pursuing teaching in the future. Thematic analysis of qualitative data identified 3 themes regarding peer tutoring: a more comfortable environment (69%), a more personalized teaching approach (34%), and variation in content taught (14%).Conclusion: Preclinical tutees prefer being taught clinical skills by peer tutors compared to faculty, with the peer tutors also benefitting. Studies such as this, looking at long-term schemes, further validate peer tutoring and may encourage more medical schools to adopt this method as an effective way of clinical skills teaching. Keywords: peer-assisted, near-peer, teaching, learning, curriculum, OSCE

Jasim Alabbad,1,2 Fawaz Abdul Raheem,2 Ahmad Almusaileem,1 Sulaiman Almusaileem,1 Saba Alsaddah,2 Abdulaziz Almubarak2 1Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait; 2Department of Surgery, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait Purpose: To investigate the reliability of medical student logbook data in assessing student performance and predicting outcomes in an objective standardized clinical exam and a multiple-choice exam during surgery rotation. In addition, we examined the relationship between exam performance and the number of clinical tutors per student.Materials and methods: A retrospective review of the logbooks of first and third clinical year medical students at the Faculty of Medicine, Kuwait University, was undertaken during their surgery rotation during the academic year 2012–2013.Results: Logbooks of 184 students were reviewed and analyzed. There were 92 and 93 students in the first and third clinical years, respectively. We did not identify any correlation between the number of clinical encounters and clinical exam or multiple-choice exam scores; however, there was an inverse relationship between the number of clinical tutors encountered during a rotation and clinical exam scores.Conclusion: Overall, there was no correlation between the volume of self-reported clinical encounters and exam scores. Furthermore, an inverse correlation between the number of clinical tutors encountered and clinical exam scores was detected. These findings indicate a need for reevaluation of the way logbook data are entered and used as an assessment tool. Keywords: OSCE, assessment, Kuwait, universities, rotation

Introduction: Objective Structured Clinical Examination (OSCE) is one of the evaluation methods which has been widely used in medical and paramedical majors in the recent years. Since various studies have provided varying results about the effects of this method, there is still a question that how does the evaluation of nursing students using the OSCE method would influence their learning, satisfaction and test anxiety? Therefore, the current study aimed to review the literature and examine the effects of the OSCE method on the learning, satisfaction and test anxiety of nursing students. Methods:This systematic review was conducted by searching through Google scholar, SID, Iranmedex, PubMed, and ERIC databases. Articles published from 2008 to 2017 were searched using the key terms “nursing students, assessment, evaluation, OSCE test, OSCE evaluation, learning, test stress, test anxiety and test satisfaction”. Based on the inclusion criteria, 15 articles were finally selected out of 110 publications found. Results:The results were categorized in three categories namely “the effect of OSCE on the students’ satisfaction with the exam”, “the OSCE as an anxiety-inducing method compared to traditional methods”, and “the effect of OSCE on the nursing students’ learning”. The results indicated that due to the procedure of implementation, OSCE satisfies the students and thereby, will enhance their learning. However, results about the anxiety-inducing nature of the OSCE are conflicting. Conclusion:It is possible to perform accurate OSCE evaluations by meticulously designing the stations, appropriately preparing the students and faculty members during the academic semesters, providing an appropriate environment and all the necessary facilities and human resources, and allocating adequate time to the exams

Shayaan Akhtar, Musab Hasan, Haseeb Iqbal Faculty of Medicine, Department of Medicine, Imperial College School of Medicine, London, UKCorrespondence: Shayaan AkhtarFaculty of Medicine, Imperial College London, Sir Alexander Fleming Building, Imperial College Road, London, SW7 2AZ, UKEmail shayaan.akhtar16@imperial.ac.uk View the original paper by Dr Ganesananthan and colleagues

Objective: The Objective Structured Clinical Examination (OSCE) is an assessment tool used to objectively evaluate clinical competence in medical schools and, more recently, in the nursing profession as well. However, few studies have been conducted to elicit the views of dental students in KSA regarding the OSCE. The present study was designed to explore, evaluate, and analyse students' perceptions of the OSCE and to explore the strengths and weaknesses of this assessment tool as perceived by dental students. Methods: This was a cross-sectional analytical observational study using a survey design. It took place in the College of Dentistry, Taibah University, KSA. The study sample consisted of third, fourth, and fifth-year students who took the OSCE assessment during their studies. Results: Of 138 invited students, 119 responded (response rate of 86.2%). Almost half the students (47.1%) agreed that the OSCE exam was fair, while 19.3% agreed that a broad range of clinical skills were included in the OSCE exam. A low percentage of students believed to a great extent that the scores were standardised; however, the practicality and usefulness of the OSCE was questioned. Students perceived that issues pertaining to personality, ethnicity, and gender would not impact the scores. Conclusion: The findings of this study indicated that the OSCE is a meaningful and fair assessment tool for clinical skills.

Background: The national board exam for residents in Iran is held in two parts: Multiple-choice and Objective Structured Clinical Examination (OSCE). The OSCE is a suitable method for evaluation of residents' clinical qualifications. However, it requires experienced human resources, accurate planning, facilities and reliable evaluation tools. Objective: To determine the challenges of the OSCE National Board Exam in Iran. Methods: This cross-sectional study was conducted on all the final-year pediatrics and gynecology residents of Mashhad University of Medical Science, who participated in the board exam in September 2014. A questionnaire was designed to evaluate the residents’ opinion on challenges of the OSCE. Data was analyzed with SPSS16. We used U Mann–Whitney test independent t-test, and Pearson correlation coefficient. Results: Fourteen pediatrics and eleven gynecology residents participated. In the gynecology group, there was no significant statistical correlation between the individual marks and questionnaire scores. However, in the pediatrics group, there was a significant correlation (p=0.046, r=-0.763). Based on pediatrics residents’ perspective, the main challenge of the OSCE part of the exam was the imbalance and disproportion between the allowed time and the task load in each exam stage. In other words, they believed that the tasks could not be fulfilled in the given time. In the gynecology group, the main challenge reported was the delay in announcing the exam results. In the pediatrics group, the main complaint was the disproportion of the allowed time and the task load in the exam stages. Conclusion: Some of the challenges of the board exam were associated with the examiners and the exam environment, and some of them were related to the home university where the candidates had studied. To solve the problems, both aspects should be considered.

Introduction The ethical skills fundamental to medical practice encompass a large portion of the Accreditation Council for Graduate Medical Education (ACGME) professionalism milestones. Yet many ethical practices are difficult to reduce to milestone frameworks given the variety of traditions of moral reasoning that clinician-trainees and their colleagues might properly employ. Methods We developed an observed standardized clinical examination (OSCE) simulation with standardized patients to assess the ethical skills captured in professionalism milestones in pediatrics. The OSCE included four vignettes based on actual cases that presented problems without a correct answer. Residents discussed ethically challenging issues with standardized patients and were evaluated on specific ethical tenets contained in the professionalism milestones. Our assessment guide for preceptors offered content for debriefing and assessment. We piloted this OSCE with seven preceptors and 17 pediatric residents in two different medical settings. Results Residents all agreed that the four cases were realistic. All but two residents agreed that OSCEs like this one are an appropriate or objective way of assessing the ACGME professionalism milestones. All preceptors reported that they strongly agreed the assessment improved their ability to assess the professionalism milestones. Discussion This OSCE offers a structured method to assess professionalism milestones and a forum to discuss ethical problem solving. It can also be used solely as a training exercise in ethical decision making and having difficult conversations.

Mohammed Abdul Shafi, Mohamed Rimzy Mohamed Riza, Muhammed Shaan RiazFaculty of Medicine, St George’s Hospital Medical School, London, UKWe have read with great interest the article by Kumar et al,1 which correlates the performance of physician associates in a multiple mini-interview (MMI) to performances in objective structured clinical examinations (OSCEs). As senior medical students, we share many similarities with physician associate students as we were assessed through MMIs for entrance into medical school and are constantly assessed via OSCEs throughout our training. We would therefore like to share our perspective on the topic.Authors' responseWe thank Shafi et al for their interest in our recently published paper1 and for sharing their perspective as medical students who have gone through multiple mini-interview (MMI) and objective structured clinical examinations (OSCE). Having read their response in detail, we feel it warrants several clarifications.View the original paper by Kumar and colleagues.

Introduction Telemedicine is a growing practice with minimal training in US medical schools. Telemedicine OSCE (TeleOSCE) simulations allow students to practice this type of patient interaction in a standardized way. Methods The Insomnia–Rural TeleOSCE was implemented as part of a required clinical clerkship for students in their second, third, or fourth year of medical school. This case addressed a patient with depression in a medically underserved area. Students performed it as a formative experience and received immediate feedback. They then completed a survey to evaluate the experience. Results Students (n = 287) rated the quality of the experience 7.59 out of 10. Comments showed that 61 learners thought the TeleOSCE was a positive experience, 35 wanted more teaching about telemedicine, 28 improved their understanding of barriers to care, 25 expressed concern over minimal other training, 23 found the TeleOSCE important and challenging, 16 appreciated the differences between in-person and remote visits, and 15 wanted fewer distractions. Eight students worried about how they would be judged, five learned from the technical limitations, five requested more time, five were skeptical of the utility, and five saw telemedicine as triage. Discussion The TeleOSCE allows learners to gain exposure to telemedicine in a safe simulated teaching environment and assesses learner competencies. The TeleOSCE also improves students’ understanding of barriers to care and the utility of telemedicine. It logistically allows faculty to directly assess distance students on their clinical reasoning and patient communication skills.

Introduction Common variable immunodeficiency (CVID) is the most common symptomatic antibody deficiency, with a prevalence of 0.6-6.9 depending on the population studied. In contrast to other primary immunodeficiency diseases (PIDDs), symptoms may not appear until the third decade of life. Lack of recognition of CVID is a persistent problem. Myriad confounding clinical phenotypes and frequent infections, including autoimmunity, malignancy, chronic lung disease, granulomatous disease, and gastrointestinal disease, complicate the diagnosis. Often it is years before a diagnosis is made, leading to irreversible morbidities and mortality. Methods Second-year medical students are introduced to CVID during their session on PIDDs that occurs during the immunology/rheumatology course. To assess students’ recognition of CVID, a 15-minute OSCE encounter was created that included a simulation of lung sounds (rhonchi), physical exam cards (clubbing, otitis media with effusion), and moulage of skin (petechiae). A standardized patient (SP) portrayed a patient requesting antibiotics for a sinus infection. Students were tasked to both interview the patient and perform a hypothesis-driven physical exam. A postencounter exercise queried the students on their differential diagnosis and their rationale. Results Item analysis of the case showed high levels of difficulty and strong discrimination between high- and low-performing students in both communication skills and clinical reasoning in CVID. Discussion This SP encounter can be used in both formative and summative assessments to measure the recognition of CVID.

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Introduction As the number of patients with limited English proficiency grows, there is increasing awareness in the medical community about disparities in health outcomes for this population. The proper use of professional medical interpreters improves communication between physicians and patients with limited English proficiency. Typically, however, little curricular time in medical training is devoted to this competency. Methods We developed a two-station objective structured clinical examination (OSCE) in which learners worked with interpreters to conduct medical interviews with Spanish-speaking standardized patients (SPs). Cases were designed for use with residents from any medical specialty and to have personal and emotional richness in keeping with the real-life circumstances of many patients. Twelve residents from six medical specialties completed a session evaluation and were assessed by faculty, SPs, and interpreters using existing validated instruments and case-specific checklists. Results All residents reported that the cases mimicked real patient encounters. The checklists were well received and easy to use. While scores varied between residents, deficiencies were identified in basic communication skills for interacting with a non-English-speaking SP through an interpreter, including maintaining proper eye contact and open body posture with patients and introducing and clearly articulating the role of the interpreter. Discussion A two-station OSCE utilizing professional medical interpreters and Spanish-speaking SPs was well received by all participants. Residents’ scores helped identify common skill gaps in their work with interpreters. Based on the success of the pilot deployment, we plan to target educational interventions at these common deficiencies and offer the OSCE to more trainees.

Introduction To assess communication and professionalism, as well as technical skills related to patient care, the American Board of Anesthesiology (ABA) has begun administering an Objective Structured Clinical Examination (OSCE) portion of the APPLIED Examination in addition to the Standard Oral Examination component. Methods We created video modules and a curriculum for anesthesiology resident OSCE preparation for the Interpretation of Monitors and Interpretation of Echocardiography components. The modules can be used individually by trainees or included as part of an OSCE workshop led by faculty educators with seven individual stations matching the content of the actual ABA examination. These modules are recommended for all levels of anesthesiology trainees so that they can gain exposure to the format and the fast pace of the examination. Results Sixty-six junior and senior anesthesiology residents, fellows, and junior faculty successfully participated in these modules. Seventy-three percent of the participants agreed that after completing these modules, they now had a good understanding of the Interpretation of Monitors and Interpretation of Echocardiography technical skills stations. More than 90% of participants reported that the modules were useful, and more than 70% reported that they now felt prepared for these stations of the OSCE. Discussion Developing technical skills stations for deliberate practice and preparation for the ABA OSCE is resource intensive. Finding time and faculty to facilitate OSCE preparation is also challenging. With the video modules and scripts included in this publication, residents can practice independently or as part of larger preparation course.

Abstrak Objective structured clinical examination (OSCE) adalah cara penilaian kompetensi klinik mahasiswa secara komprehensif dan konsisten serta dapat dijadikan media untuk meningkatkan hasil belajar. Feedback dapat dilakukan oleh mahasiswa itu sendiri (self assessment) maupun mahasiswa lain yang satu level (peer assessment). Self dan peer assessment diharapkan akan meningkatkan kemampuan mahasiswa dalam melihat tujuan pembelajaran, meningkatkan rasa percaya diri, kemampuan berpikir kritis, dan bertindak tepat dalam menghadapi ujian. Tujuan penelitian ini melihat hubungan self assessment dan peer assessment dengan nilai kelulusan OSCE mahasiswa tingkat dua dan empat FK Unisba tahun akademik 2012/2013. Nilai hasil ujian OSCE yang dipergunakan adalah pada periode Desember 2012–Juni 2013. Self dan peer assessment dilaksanakan setelah ujian OSCE. Self assessment dilakukan oleh mahasiswa itu sendiri, sedangkan peer assessment didapatkan dari lima orang mahasiswa lain yang pernah berada dalam satu kelompok dengan subjek. Hasil penelitian menunjukkan untuk mahasiswa tingkat dua terdapat korelasi bermakna self assessment dan peer assessment dengan nilai OSCE (p

Background: The objective structured clinical examination (OSCE) is a widely used method for assessing clinical competence in health sciences education. Studies using this method have shown evidence of validity and reliability. There are no published studies of OSCE reliability measurement with generalizability theory (G-theory) in Latin America. The aims of this study were to assess the reliability of an OSCE in medical students using G-theory and explore its usefulness for quality improvement. Methods: An observational cross-sectional study was conducted at National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City. A total of 278 fifth-year medical students were assessed with an 18-station OSCE in a summative end-of-career final examination. There were four exam versions. G-theory with a crossover random effects design was used to identify the main sources of variance. Examiners, standardized patients, and cases were considered as a single facet of analysis. Results: The exam was applied to 278 medical students. The OSCE had a generalizability coefficient of 0.93. The major components of variance were stations, students, and residual error. The sites and the versions of the tests had minimum variance. Conclusions: Our study achieved a G coefficient similar to that found in other reports, which is acceptable for summative tests. G-theory allows the estimation of the magnitude of multiple sources of error and helps decision makers to determine the number of stations, test versions, and examiners needed to obtain reliable measurements.

Introduction: Implementation of skills evaluation in the laboratory is necessary to see how far the ability has been achieved. Objective structured clinical examination (OSCE) becomes one of the evaluation techniques used. the purpose of this study is to know prevalence of the anxiety and the factors that cause anxiety before following the OSCE in first-degree nursing students. Methodology: This research is a descriptive research, as many as 89 respondents selected by using simple random sampling. The questionnaire used was Nursing Skills Anxiety Scale Test (NSTAS). Results: 65 respondents (73%) experienced anxiety with most of the sexes were women (89,9%), and 56 respondents (62.9%) were 18 years old. Factor’s related to anxiety included environment (50,5%), exam it self (44,9%) and observer (44,9%). Discussion: there is a need for further research on the impact of anxiety before taking the OSCE examination with graduation rates on each skill performed

Background: Although options counseling is a fundamental skill for medical providers, previous research has identified gaps in medical school reproductive health education. Purpose: To determine if a 1-h novel patient interaction (NPI) improves student performance when caring for a standardized patient with an unintended pregnancy. Methods: From September 2012 to June 2013 we randomized third-year medical students at the University of Colorado School of Medicine to the standard curriculum plus an NPI, or the standard curriculum only. The NPI consisted of a 1-h small-group session with a patient who discussed her experiences with options counseling and her decision to terminate her pregnancy. Students completed an Objective Structured Clinical Examination (OSCE) at the rotation's end, which included options counseling. The primary outcome was the proportion of participants achieving ‘excellence’ on the OSCE checklist. ‘Excellence’ was defined as a score ≥90%. Examinations were flagged as ‘unsatisfactory encounters’ if core competencies were not addressed. OSCE standardized patients and evaluators were blinded to group assignment. Results: In total, 135 students were eligible and randomized: 75 to NPI; 60 to control. During the OSCE, few students achieved ‘excellence’ (24% NPI vs. 28% control, p=0.57).There were no differences between scores for components of options counseling. More students in the control group ‘appeared somewhat uncomfortable’ delivering the pregnancy test results (5% NPI vs. 18% control, p=0.006). More than half (54%) of the intervention group and 67% of controls had ‘unsatisfactory encounters’ (p=0.16), almost exclusively due to omission of adoption. Most students addressed abortion (96% NPI vs. 92% control, p=0.29). Conclusions: A 1-h NPI does not improve medical students’ performance of pregnancy options counseling and the option of adoption is routinely omitted. Adoption is clearly an area that needs greater attention when designing comprehensive reproductive health curriculum for medical students.

Purpose: The Objective Structured Clinical Examination (OSCE) is a widely employed tool for measuring clinical competence. In the drive toward comprehensive assessment, OSCE stations and checklists may become increasingly complex. The objective of this study was to probe inter-observer reliability and observer accuracy as a function of OSCE checklist length. Method: Study participants included emergency physicians and senior residents in Emergency Medicine at Dalhousie University. Participants watched an identical series of four, scripted, standardized videos enacting 10-min OSCE stations and completed corresponding assessment checklists. Each participating observer was provided with a random combination of two 40-item and two 20-item checklists. A panel of physicians scored the scenarios through repeated video review to determine the ‘gold standard’ checklist scores. Results: Fifty-seven observers completed 228 assessment checklists. Mean observer accuracy ranged from 73 to 93% (14.6–18.7/20), with an overall accuracy of 86% (17.2/20), and inter-rater reliability range of 58–78%. After controlling for station and individual variation, no effect was observed regarding the number of checklist items on overall accuracy (p=0.2305). Consistency in ratings was calculated using intraclass correlation coefficient and demonstrated no significant difference in consistency between the 20- and 40-item checklists (ranged from 0.432 to 0.781, p-values from 0.56 to 0.73). Conclusions: The addition of 20 checklist items to a core list of 20 items in an OSCE assessment checklist does not appear to impact observer accuracy or inter-rater reliability.