Objective Structured Clinical Examinations practices across Canadian medical schools: a national overview

Chris Gilchrist; Zia Bismilla

doi:10.36834/cmej.80144

Authors

Chris Gilchrist University of Toronto
Zia Bismilla University of Toronto

DOI:

https://doi.org/10.36834/cmej.80144

Abstract

Introduction: Objective Structured Clinical Examinations (OSCEs) are crucial in assessing clinical competencies, but their implementation varies widely across medical schools. This work examines OSCE practices across Canadian medical schools, focusing on frequency, type, and timing.

Methods: A survey was conducted among all 17 Canadian medical schools through the AFMC Clinical Skills Working Group. Data were collected during the 2023-2024 academic year. Details on OSCEs implementation during pre-clerkship and clerkship phases, categorized as formative or summative, and on the timing of final OSCEs was collected. Descriptive statistics were used to analyze the data.

Results: The median number of OSCEs per school was four, with one-third formative and two-thirds summative. Pre-clerkship assessments were split between formative and summative OSCEs, while 78% of clerkship OSCEs were summative. Timing of a program’s final OSCE varied: 35% occurred before the last year, while 65% took place in the final year, predominantly in the second half. All final OSCEs were summative.

Discussion and Conclusion: Variability in OSCE implementation likely reflects differing curricular approaches and institutional constraints. This work demonstrated a more balanced proportion of formative and summative assessments during pre-clerkship, indicating a desire to provide students with opportunities learn from feedback during their early training years. During clerkship, the focus shifted towards summative assessments. The later emphasis on summative OSCEs may highlight a focus on certifying competence at the cost of reduced opportunities for formative feedback. Medical schools may use these findings as guidance when building their programs of assessment.

References

1. Harden R, Stevenson M, Downie W, Wilson G. Assessment of clinical competence using objective structured examination. Br Med J. 1975 Feb 22;1(5955):447-51. https://doi.org/10.1136/bmj.1.5955.447

2. Harden RM. Revisiting “assessment of clinical competence using an objective structured clinical examination (OSCE).” Med Educ. 2016;50(4):376-9. https://doi.org/10.1111/medu.12801.

3. Patrício M, Julião M, Fareleira F, Young M. Is the OSCE a feasible tool to assess competencies in undergraduate medical education? Med Teach. 2013;35(6):503-14. https://doi.org/10.3109/0142159X.2013.774330.

4. Boursicot K, Kemp S, Wilkinson T, Findyartini A, Canning C, Cilliers F, Fuller R. Performance assessment: Consensus statement and recommendations from the 2020 Ottawa Conference. Med Teach. 2021;43(1):58-67. https://doi.org/10.1080/0142159X.2020.1830052.

5. Schuwirth LW, Van der Vleuten CP. Programmatic assessment: From assessment of learning to assessment for learning. Med Teach. 2011;33(6):478-85. https://doi.org/10.3109/0142159X.2011.565828.

6. Epstein RM. Assessment in medical education. N Engl J Med. 2007;356(4):387-96. https://doi.org/10.1056/NEJMra054784.

7. Touchie C, Ten Cate O. The promise, perils, problems, and progress of competency-based medical education. Med Educ. 2016;50(1):93-100. https://doi.org/10.1111/medu.12839.

8. Lin YH, Yang YY, Chen CH, et al. Can routine EPA-based assessments predict OSCE performances of undergraduate medical students? Med Teach. 2024 Oct 14. https://doi.org/10.1080/0142159X.2024.2413024.

9. Heal C, D’Souza K, Hall L, Smith J, Jones K, collaboration Accla. Changes to objective structured clinical examinations (OSCE) at Australian medical schools in response to the COVID-19 pandemic. Med Teach. 2021;44(4):418–24. https://doi.org/10.1080/0142159X.2021.1998404