Abstract:

Introduction:
University of Medicine and Pharmacy at Ho Chi Minh City (UMP HCMC) in Vietnam is on progress of reform curriculum program based on Health System Reforms Project of Vietnam Ministry of Health and its integral component is the Center for Advanced Training in Clinical Simulation (ATCS). ATCS has developed a clinical skill training program based on standards of Society for Simulation in Healthcare (SSH). In a simulation-based medical education (SBME) environment, there are best practices to maximum educational benefit and formative Objective Structured Clinical Examination (FOSCE) is an important feature of powerful SBME used to enhance student’s knowledge, skills and attitudes. In 2018, a FOSCE was introduced for medical students in the second year of their degree programme to enhance clinical education and assessment. The FOSCE was designed to allow students to experience OSCE conditions and to receive constructive feedback. As a basis for expanded implementation, this study was aimed to assess an educational effect of a FOSCE on the clinical performance of the second year medical students.

Methods:
408 second-year medical students, school year 2018-2019 of reform curriculum program, performed an individual FOSCE and debriefing session on history taking and head-neck examination after they finished the end of rotation assessment of these skills. At the end of the school year, a summative OSCE was designed including two stations of these skills. Scores were recorded based on a 10-point scale and a mean score of two stations were calculated. The objective of this study was to determine the effectiveness of incorporating an individualized formative assessment into 2 medical skills session by comparing OSCE performance before and after the intervention.

Results:
Mean score of the summative OSCE of both skills was 8.54 ± 0.64, higher than mean score of the end of rotation assessment (7.98 ± 0.82), p < 0.001 (Wilcoxon Signed Ranks Test). The percentage of students receiving a mean score >= 8.0 increased from 54.9% to 80.2% after the intervention. Mean score of an individual station also increased: head-neck examination station from 7.54 ± 1.29 to 8.33 ± 0.98 (p < 0.001) and history taking station from 8.43 ± 0.97 to 8.76 ± 0.71 (p < 0.001). The mean elevated score of clinical examination was 0.79 ± 1.60, higher than the mean elevated score of history taking (0.33 ± 1.13), p < 0.001.

Discussion:
The initial results show that a single individual FOSCE could improved students’ clinical competence and marks. Especially, the quality of clinical skill training will be robustly elevated with deliberate practice by using standardized FOSCEs. But there are some biases maybe influence to OSCE examiners’ assessment scores, such as examination context, examinee characteristics, examinee-examiner interactions, and examiner characteristics. Moreover, the quality of debriefing during FOSCE is also an important element that need to be improved to get better results.

Conclusion:
These finding suggest that a single individual FOSCE benefits students in both history taking and clinical examination. In next years, ATCS will continue to increase both quantity and quality of FOSCE, not only for the second year medical students. Our future researches should focus on effect of an expanded implementation of FOSCE and resolve obstacles.

Keywords:

ATCS, UMP HCMC, OSCE, Formative, Debriefing, Objective Structured Clinical Examination, Reform Curriculum Program.