"You can do it late at night or in the morning. You can do it at home, I did it with my flatmate." The educational impact of an OSCE.

Background: The use of an objective structured clinical examination (OSCE) has been a powerful influence on doctor training but assessments do not always drive study behaviour in predictable ways.
Aims: To investigate the impact an OSCE has on study behaviours by exploring how 5th year medical students identify what to learn for a summative OSCE and the role of the clinical environment in their preparation.
Methods: A semi-structured questionnaire survey asked about strategies used by students to prepare for the OSCE. Focus group interviews explored successful methods of preparation for the OSCE. Themes were identified and classified.
Results: The questionnaire response rate was 84%. Topic identification was usually from the list of examinable problems, past OSCE papers and a booklet prepared by a previous student containing a series of OSCE checklists. The study behaviours of students preparing for the OSCE exam were predominantly to practise on each other, and to rehearse routines. Strategic and efficient study habits were favoured over conscious utilization of the clinical environment.
Conclusion: The expectation that an OSCE drives learning into the clinical workplace was not supported by this study. This suggests the role of clinical experience in helping students prepare for the exam may be more subliminal, or that an OSCE is more as a test of psychomotor skills than a marker of clinical experience. An unexpected benefit may be to drive more collaborative learning.