The experience medical students gain during their hands-on training is key to overall success in their field. This is why EDU’s programmes are immersive and led by experts passionate about and dedicated to supporting students through their learning experience. But how can these skills be assessed?
We spoke with Matthew Rai, EDU’s Assessment Lead, to learn more about how EDU’s students’ clinical skills are evaluated as they go through the Bachelor and Master of Medicine. We will dive deep into one specific examination: the OSCE.
The use of the OSCE is integral to clinical skills training and is essentially a method of simulating practice to empower students to improve autonomy and develop complex understanding within a safe, controlled clinical environment (Aronowitz et al, 2017).
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What is an OSCE?
OSCE stands for “Objective Structured Clinical Examination.” An OSCE is a type of higher education assessment that is commonly used in health sciences – particularly in medical programmes, to test clinical skills performance and competencies (knowledge, skills and attitudes) such as clinical examination, medical procedures and techniques, medical knowledge, clinical decision making, and clinical thinking and reasoning.
All of these skills are integrated into specific, controlled scenarios, for students to perform. Thus, OSCEs present a fair and standardised manner of assessing competences, as well as identifying areas for improvement and practice.
Why have OSCEs?
OSCEs are a highly valuable and insightful tool in medical education because they allow a student to demonstrate their clinical skills in a standardised medical scenario. Furthermore, having OSCEs provides students with valuable feedback on clinical skills to allow for their ongoing improvement. OSCEs were first developed and implemented in the 1970’s by Professor Ronald M Harden and colleagues and over time, have become a reliable and accepted method of clinical skills assessment in medical education.
At EDU, there is a strong emphasis on various forms of assessment. Students take part in both formative and summative assessments throughout the Bachelor and Master of Medicine. The OSCEs serve as a major clinical assessment, while at the same time providing students with experience as well as thorough feedback on their performance. Thus, EDU OSCEs take place at strategic time points throughout the curriculum in order to enable students to incorporate the feedback received. EDU OSCEs additionally provide an opportunity for faculty, as well as students, to gain a deeper insight into areas of strength as well as areas of weakness, which can help to inform revisions to teaching, curriculum and assessments. OSCEs function as part of a symbiotic relationship within the EDU learning ecosystem. The level of precision, preparation, and knowledge obtained from each examination forms a feedback loop that impacts the future development of curriculum, assessments and teaching.
The feedback students receive from examiners (senior clinicians) during the OSCEs is particularly valuable as it is received in a setting similar to the clinical rotation. Given that the examination takes place in a clinical (or simulated clinical) setting where students are faced with a simulated scenario mimicking real-life scenarios encountered during clinical rotations, the OSCEs offer an opportunity for a practical application of knowledge and skills. To date, students report overall feelings of satisfaction with the OSCEs and enjoy the opportunity to receive feedback on areas for improvement from senior clinicians.
How are OSCEs held?
The content and format of each OSCE are selected to test skills and knowledge that students have already been exposed to in the classroom and during clinical rotations. In other words, what is evaluated in an OSCE is strongly related to the learning curriculum.
OSCEs take place at a designated hospital or simulation lab; to which students, relevant EDU faculty, and external examiners alike travel.
OSCEs work like a role-play scenario. The exam is set up as a circuit, meaning there are multiple stations through which students rotate to perform different skills and competencies on a standardised patient (or simulated patient). This can be either a trained expert actor (in health professions education), or a simulation device such as a ‘dummy’ or mannequin.
The examination day begins with a briefing session. Students are then taken into the “assessment area” where there are eight stations (in the case of the Bachelor’s programme) or 12 stations (for the master’s programme). Each student is then allocated to a different starting station and is assessed under exam conditions.
At each station, students are instructed to enter the room and perform the task(s) for that station in front of an examiner. Each station is allocated the same amount of time for completion, with students moving on to subsequent stations in accordance with the OSCE timetable prepared specifically for their examination day.
External examiners are often the same doctors from the clinical rotation hospitals, which means they already have interacted with EDU students on various occasions. This is especially valuable for EDU students, given that clinical teachers are able to learn from the OSCEs and can adjust their interactions and supervision of students accordingly.
Finally, when every student has rotated through each station, a feedback session is held where EDU students have the opportunity to provide feedback on the assessment to the EDU faculty and staff present, as well as provide feedback about their learning experience more generally. This session additionally serves as an opportunity for students to receive feedback on their performance in the OSCEs as a group or cohort(s). One final layer of feedback is provided through the audiovisual recording of each student’s performance at each station.
When are OSCEs held?
OSCEs take place at three different points during the Bachelor programme at EDU: toward the end of module 3, module 6 and module 9. These are the last modules of each academic year of the Bachelor of Medicine programme. These examinations take place in the final three days of the clinical rotation. During the masters, OSCEs will take place approximately once per year.
This particular setup means that students attend the assessment after completing their clinical rotation, which has been proven to have multiple benefits. Firstly, students often arrange accommodation together during their clinical rotations, therefore they see each other consistently for several weeks before the examination. This allows them to prepare collaboratively, by using their free time during the clinical rotation to roleplay the roles of the OSCE student, patient and examiner, for example. This is just one of many examples of the ways in which students engage with the collaborative learning component of EDU’s programmes in medicine and helps students to better prepare for their upcoming assessment.
Ultimately, OSCEs provide a multilayered learning experience for EDU students. Congruently, students are satisfied with the OSCEs and thoroughly appreciate and benefit from taking this specific examination. Finally, the OSCEs, especially those formative in nature, provide a true “assessment for learning” approach which enables ongoing professional development throughout a student’s medical studies.
