Abstract:

Background:
From their inception in 1979, the Objective Structured Clinical Examination (OSCE) has become a staple of medical school examinations (Harden and Gleeson, 1979). They have offered institutions the ability to examine the practical skills required by a medical graduate through mock patient encounters and the assessment of clinical skills.
As Clinical Teaching Fellows (CTFs) at University Hospitals Birmingham (UHB), we have seen the anguish medical students feel towards their OSCE examinations, driven by a lack of understanding of what OSCEs entail and how they will be assessed.
It has been shown that the introduction of OSCEs has influenced medical student’s learning, shifting them from books towards practical knowledge acquisition (Müller et al, 2019 and Harden and Laidlaw, 2016). Given their impact on study, it is crucial that medical students understand the OSCE process and feel comfortable with the logistics and practicalities of the examination.

Aims and Objectives:
Our objectives were:
1. To assess a third year medical student’s confidence and knowledge of OSCEs
2. To design a series of interventions to improve a third year medical student’s confidence and knowledge of OSCEs and evaluate their impact

Methods:
Our sample was third year medical students from Aston Medical School (AMS) on placement at UHB. These were the first cohort of students undertaking their third year at AMS and the first cohort on placement at UHB. There are a total of twenty-five students on placement, twenty-two students participated in our study (one student dropped out after the first intervention).
Qualitative and quantitative data was collected through a questionnaire which asked students to rate their confidence and preparedness for an OSCE including station types using a Likert scale (1-10) and free text questions. The same questionnaire was used after each intervention.
The first intervention was a one-hour lecture delivered by CTFs covering the structure of an OSCE, how to prepare, the types of stations, what to expect on the day and our top tips to maximise performance. The second intervention was a four-station mock OSCE designed to cover the main station types students may encounter, followed by feedback from the mock examiner (CTF).
Data was then collated and analysed using a paired T-test to assess for quantifiable improvements in the student’s confidence.

Results:
95% of the students had not sat a summative OSCE before, however 100% of the students have sat formative face to face OSCEs. These included formative OSCEs run by AMS (86%), Hospital Trust (55%) or an external course (9%).
Prior to any interventions, students’ mean confidence to undertake a summative OSCE was 4.91; rising to 7.62 (p=0.0001) after the lecture and formative OSCE. Their mean preparedness to undertake a summative OSCE also increased from 4.96 to 7.24 (p=0.0002) after the OSCE preparation course. Their understanding of the structure improved from 5.86 to 8.38 (p=0.0001). The station type students were least confident in involved presenting radiological imaging (e.g. chest x-ray); after both interventions the mean score increased from 5.36 to 7.38 (p=0.0004).

Conclusion:
The OSCE preparation course demonstrated a self-rated improvement in student’s confidence and preparedness for summative OSCEs. Further evaluation of this cohort’s summative OSCE results would be pertinent to understand whether these findings translate into improved final examination performance.

Keywords:

Medical education, OSCE, formative assessment.