Perception of Undergraduate Medical Students and Examiners Towards Grand Objective Structured Clinical Examination

doi:10.21203/rs.3.rs-4934773/v1

Background

The assessment of undergraduate medical students consists of a written component and an advanced clinical competency test that evaluates the students' skills. The Objective Structured Clinical Examinations (OSCE) was only implemented in most medical schools in the last ten years, similar in many developing countries. It was first used with other clinical assessment methods

This study was designed to investigate how medical students in the fourth and sixth grades and examiners perceived the unique format, features, and quality of the GRAND OSCE, a novel method for assessing students. The aim was to understand how this innovative method, distinct from traditional assessment methods, prepares students for real-world scenarios where they encounter different specialty cases.

Additionally, the study aimed to understand the significant role and challenges faced by the Faculty of General Medicine at Koya University in implementing this type of OSCE and to identify potential improvements to enhance the quality of the assessment process.

Method

Following the administration of two distinctGRAND OSCE examinations for the fourth and sixth stages, feedback forms were created using Google Forms and distributed to both students and examiners. The feedback forms covered all aspects of the examination process. The responses were then rigorously analyzed using the scientific tool SPSS, allowing for a comparison between students from both stages and the faculty and external examiners.

Results

In the survey of 104 undergraduate students (78% of attendants), the majority (84n,80%) rated the fairness of the assessment as good, which is the primary goal of this version of OSCE. A large percentage (89n,85.6%) agreed that the examination covered a wide range of clinical skills. Eighty students (76.85%) believed the patients cooperated and found the findings precise; on the other hand, The obtained responses from 24 out of 33 faculty staff members (75%) and 29 out of 35 external examiners (82%) strongly agreed that the examination adequately covered a wide variety of clinical abilities. Only two of 68 examiners (2.9%) believed the examination needed more to provide a learning opportunity.

Conclusion

With the insightful suggestions for improvement provided by the participants, this version of OSCE has a promising potential to evolve into a fair, objective clinical tool for assessing medical students, instilling a sense of optimism for its future development.

clinical

examiners

students

education

objective structured clinical exam (osce)

Traditional techniques for evaluating medical students' clinical competency (short and long cases) have several drawbacks, including a lack of uniformity and organization and biased reviews with low reliability and validity [1]. To address numerous shortcomings and enhance the clinical performance of medical students, the objective structured clinical examination (OSCE) was implemented in the 1970s [2, 3]. It is an evaluation technique created by Harden and his associates to measure the clinical performance of the

applicants precisely. Based on Miller's competency pyramid, competence is evaluated at the "show how" performance level [4, 5]. Since its launch, the OSCE has become a popular tool for assessing clinical competency [6–8].

The OSCE has played a significant role in evaluating clinical competency in health professions education worldwide. Its use is particularly important in experiential training, where students' performance in practice situations must be effectively assessed. The competencies examined at different OSCE stations may range significantly in complexity, making it a versatile tool for assessing a wide range of clinical skills [9].

Acceptability is a crucial part of an evaluation that considers several factors, including feasibility, time restrictions, cultural acceptability, and cost efficiency. The OSCE's global acceptance, involving educators, stakeholders, administrators, patients, and, most importantly, students, is a testament to its success and potential for further improvement. This widespread acceptance not only reassures us of the OSCE's effectiveness but also its potential for further refinement.

In Iraq, the assessment of senior medical students consists of a written component and an advanced clinical competency test that evaluates the students' skills. The Objective Structured Clinical Examinations (OSCE) was only implemented in most medical schools in the last ten years, similar in many developing countries. It was first used with other clinical assessment methods, It was done over several days, with various specialties participating (for example, separate OSCEs for pediatrics, obstetrics, gynecology, and medicine). Different formats have been tried in the Kurdistan region, Iraq, first introduced in 2007 at Hawler Medical University. These include incorporating a global rating system into the checklist, utilizing a blueprint to ensure content validity, and creating a comprehensive clinical exam that evaluates clinical competence in all specialties in a single day. [12–14]

Above all, OSCE is resource-dependent and fraught with pitfalls, mainly occurring concurrently at five sites. As a result, cautious planning and structuring are necessary to preserve equality and consistency in several areas, including testing supplies, setup, and apparatus [15].

The OSCE format was successfully introduced by the University of Koya's Faculty of General Medicine in 2020 for the clinical assessment of sixth-year students pursuing a Bachelor of Medicine and Surgery (MBChB). Moreover, the OSCE format was introduced for fourth-year students in the same year that it was, and third-year students began taking the same kind of evaluation in 2022. This successful implementation is a testament to the institution's progress. Until the integrated medical curriculum was implemented in 2023, the conventional test format was maintained for the remaining phases. Preclinical phase 1 (1–3 years) and clinical phase 2 (4–6 years) comprise the new curriculum's two phases. In years two through six of the training program, an OSCE will be given in addition to a summative exam.

The OSCE can be very important when assessing students' knowledge and abilities, reviewing the curriculum, and evaluating instruction. In light of the revised curriculum, This study was designed to investigate how medical students in the fourth and sixth grades and examiners perceived the format, features, and quality of the GRAND OSCE, a new method for assessing students. The aim was to understand how this method prepares students for real-world scenarios where they encounter different specialty cases. additionally, the study aimed to understand the challenges faced by the Faculty of General Medicine at Koya University in implementing this type of OSCE and to identify potential improvements to enhance the quality of the assessment process.

OSCE setting and participants

The total number of enrolled students for the OSCE was 132 (89 students from the fourth year and 43 from the sixth year), divided randomly as follows: 6th years (43 students) to two groups for grand OSCE (including all main branch examinations) and (89 students) 4th year to other two groups for final year grand OSCE. The exam was conducted on two days, one for 6th and the other for 4th year students. The exam was conducted on two floors of the hospital: ground floor for surgery and gynecology-obstetric OSCE and 1st floor for internal medicine and pediatric OSCE for 6th year; each floor involved 21 and 22 students and lasted about 110 minutes for each group (total time = 220 minutes), as each station took 5 minutes after finishing two mentioned branch OSCE in one of the floors the groups of the students exchanged to the other floor for completing the remaining parts of the examination. For 4th year, the time took around 135 minutes because student numbers were 44 -45 for each group (22 -23 for each subgroup), and the time for each station was 3 minutes. The required instruments were made available at each station. This detailed process ensures the fairness and objectivity of the examination, as well as the comprehensive coverage of clinical skills and knowledge.

The students of both grades underwent the assessment by OSCE at the same hospital (shaheed Dr. Khaled Hospital) in Koya Town, Erbil City; the hospital contains different and most significant general branches and specialties such as general surgery, internal medicine, pediatric and gynecology-obstetric department, 31 stations with 12 rest stations (total 43 stations for 43 students) Were present for 6th year as follows; 11 stations for surgery (general surgery and its branches and sub-specialties), ten stations for internal medicine and its branches, and five stations for each pediatric and gynecology-obstetric department. 4th-year students divide into four subgroups with the same questions for all sub-groups; when the two sub-groups finished the examination, the other two sub-groups started the examination; the stations for them were as

follows: surgery four stations, internal medicine four stations, pediatric three stations, and gynecology-- obstetric three stations in addition to 8 rest stations (a total of 22 stations for 89 students). One international examiner and 85 local examiners coming from inside the faculty and other cities (Erbil, Sulaymaniyah, and Kirkuk) assessed the 6th-year students, and 28 local examiners from the faculty assessed 4th-year students; most of the stations are supervised by more than one examiner.

The stations included completing several tasks, such as performing procedures and communicating. Twenty actual patients were present among the stations for the sixth stage, and eight cases were present for each group in the fourth stage. The examinee’s performance was calibrated using a checklist and global assessment. The checklist consists of 5 to 10 items of expected attitude, each with a corresponding score.

Study design

This qualitative study was based on an online open-ended questionnaire survey.

Setting and time. This study was carried out in the Faculty of Medicine, Koya University, Koya, Erbil, Kurdistan Region of Iraq, immediately after finishing the 2nd round examinations at the end of the 2023- 2024 academic year.

Participants. The population included students in the 4th and 6th year of study and faculty and external examiners.

Sampling method. Convenience sampling was used to select 132 students from the 4th and 6th years. The participants were invited electronically to fill out a Google form about their experiences and perceptions of the OSCE in the faculty of Medicine. A revised questionnaire was prepared using the Google form and sent via the students' representatives to all the students of the mentioned stages (132 students).

Another form was given to the examiners to see their feedback about the process.

Data collection. The questionnaire was designed by authors after extensive literature review [9,14,15] and comprised of three sections (29 questions), first section compose of two items related to demographic data from the respondents regarding their gender and place coming from for the OSCE examination either from other cities, dormitory or their home inside the town where the Faculty and the hospital located in, second section composed of 26 closed ended questions in which the Likert scale has been used for them in the following format: strongly agree, agree, neutral, disagree, strongly disagree, very bad, bad, neutral, good, very good, necessary and unnecessary, the closed ended questions were related to the students opinions and feedbacks regarding the OSCE which involved the following topics; stress level and sleeping night before exam, eating breakfast at exam day, opinion about necessity of the stress after finishing the exam, arrangement, number, and fair designation of the stations, OSCE covering wide range of skills, the exam minimized failing and cheating level, comparison of stress level of OSCE with other exam types such as multiple choice questions (MCQ) and case scenario, stations arrangement, pre examination instruction providing, enough times for stations, patients and organizing staff cooperation’s, lighting and set up of the station rooms, clearness of the questions and their relation to the curriculum, time before the OSCE for studying, clearness of directions between the stations, need for theoretical questions in combination with practical stations, preference of grand or separate OSCE, OSCE providing learning, dean role for relieving stress, arrangements and psychological supports, and result marks fairness with students anticipation , the last section of the questionnaire form composed of one open ended question regarding any suggestions, determining solid and weak points, time adequacy for task performance and recommendations for improvement and better arrangements of the exam.

104 Google forms were included in the study (those students who filled out the form and responded). Seventy-two students were 4th-year students, and the remaining 32 were 6th-year students. Students who did not fill out the form or did not respond were excluded from the study; on the other hand, 68 examiners' forms were collected out of 95 examiners who participated in the examinations.

Data analysis: Version 23.0 of the SPSS software was used to analyze the questions on the forms. The interpretable answers were compiled and arranged into groups. The authors examined the comments and identified their major themes to conduct a thematic analysis of the responses using standard coding procedures. This was part of the qualitative data analysis. These concepts were used to create an organized code classification. The data were electronically coded utilizing a sequence of iterative stages, and the coding structure was examined and adjusted several times as new understandings and connections between the themes found in the comments were discovered. Every open item underwent independent analysis and reporting. When required, multiple responses were programmed for every subject. Only one duplicate response was recorded. Missing data was assigned to illegible, blank, or off-topic replies. The results showed the total number of answers for each theme for every question.

Ethical consideration

This research was done under the Declarations of Helsinki. Ethical approval was obtained from the ethical committee of the Faculty of General Medicine, Koya University (Reference code 7/29/570 on 23/6/2024). Participation was voluntary and optional; participants could write their names or fill out the form without mentioning them. The participants were informed that the data with detailed information would be used for the study.

Seventy-two out of 89 students (80%) from the fourth stage and 32 out of 43 students (74%) from the sixth stage responded to the questionnaire, resulting in a combined response rate of 78% for those who attended two grand OSCE assessments. Regarding sociodemographic factors, 59 students (56.7%) identified as female, 45 students lived in dormitories, 29 were from the city, and the remaining came from outside the town on exam day. Of the 95 examiners who participated in both examinations, 68 completed the questionnaire, including 33 academic members and 35 visiting examiners. Please refer to Table 1 for more details.

Table 1 Demographic distribution

aspects	Variable	Frequency	Percentage
Stage	Fourth	72	80
Stage	Sixth	32	74
Gender	Male	45	43.3
Gender	Female	59	56.7
Place	Dormitories	45	43.3
	Inside koya	29	27.9
	Travel day of the exam	30	28.8
Examiners	Faculty staff	33	48
Examiners	External examiners	35	52

In the survey of 104 undergraduate students, the majority (84n,80%) rated the fairness of the assessment as good. A large percentage (89n,85.6%) agreed that the examination covered a wide range of clinical skills. 80 students (76.85%) believed the patients cooperated and found the findings precise. These results are outlined in Table 2

Table 2 students perception regarding scientific base of OSCE

Aspects	Stage	Strongly disagree(%)	Disagree (%)	Neutral (%)	Agree (%)	Strongly agree(%)	total	P value
Osce's examination was fair	Fourth	4(5.6)	4(5.6	9(12.5)	27(37.5)	28(38.8)	72	0.71
	Sixth	2(6.2)	1(3.12)	0	8(25)	21(65.6)	32
	Total	6(5.7)	5(4.8)	9(8.6)	36(33.6)	49(47.11)	104
The exam covered a wide range of clinical skills	Fourth	0	2(2.7)	5(6.94)	38(52.7)	27(37.5)	72	0.71
	Sixth	0	2(3.8)	6(18.7)	9(28.1)	15(46.8)	32
	Total	0	4(3.8)	11(10.5)	47(45.1)	42(40.3)	104
The exam minimizes the chance of failure	Fourth	3(4.1)	12(16.6)	17(23.6)	22(30.5)	18(25)	72	0.57
	Sixth	2(6.2)	0(0)	6(18.7)	9(28.1)	15(46.8)	32
	Total	5(4.8)	12(11.5)	23(22.11)	31(29.8)	33(31)	104
Enough time to demonstrate the required skills for each station	Fourth	4(5.5)	9(12.5)	12(16.6)	34(47.2)	13(18)	72
	Sixth	3(9.37)	5(15.62)	8(25)	6(18.7)	10(31.25)	32
	Total	7(6.7)	14(13.4)	20(19.2)	40(38.3)	23(22.11)	104
Patients were cooperative, and the findings were clear	Fourth	1(1.3)	3(4.1)	10(13.8)	32(44.4)	26(36.11)	72	0.63
	Sixth	1(3.12)	1(3.12)	8(25)	11(34.3)	11(34.3)	32
	Total	2(4.1)	4(3.8)	18(17.3)	43(41.3)	37(35.5)	104
Questions were clear and part of the curriculum	Fourth	3(4.1)	1(1.3)	8(11.1)	32(44.44)	26(36.11)	72	0.57
	Sixth	0	1(3.12)	5(15.62)	11(34.37)	15(46.87)	32
	Total	3(2.88)	2(1.9)	13(12.5)	43(41.3)	41(39.4)	104
Exams provide the opportunity to learn	Fourth	0	3(4.1)	7(9.72)	26(36.11)	36(50)	72
	Sixth	1(3.12)	2(6.2)	2(6.2)	9(28.1)	18(56.2)	32
	Total	1(0.9)	5(4.8)	9(8.6_	35(33.4)	54(51.9)	104

The evaluation of the fourth and sixth stages took place on separate days, with modifications in some assessment arrangements. The responses to these aspects were examined individually for the two groups. Nevertheless, both groups conveyed significant contentment with the rest of the stations. Specifically, 47 students (65%) from the fourth stage and 28 (87%) from the sixth stage strongly concurred that the rest stations were satisfactory and provided psychological assistance. The examination preparation duration varied, with the sixth stage having only five days and the fourth stage having eight days. Among the students in the sixth stage, 12 (32%) strongly disagreed with the adequacy of the preparation time before the examination, while 30 students (41%) in the fourth stage were delighted with the time. Please refer to Table 3 for more details.

Table 3 students perception about arrangement of OSC|E

Aspects	stage	Strongly disagree(%)	Disagree (%)	Neutral (%)	Agree (%)	Strongly agree(%)	Total	P value
Grand is better than separate osce	Fourth	17(23.6)	9(12.5)	0	0	55(76.3)	72	0.89
	sixth	3(9.33)	8(25)	0	0	29(90.6)	32
	total	20(19.2)	17(16.3)	0	0	84(80.7)	104
The time for studying for OSCE was good	Fourth	3(1.3)	2(2.7)	9(12.5)	28(38.8)	30(41.6)	72	<0.001
	sixth	12(37.5)	12(37.5)	4(12.5)	1(3.12)	3(9.375)	32
	Total	15(14.4)	14(13.4)	13(12.5)	29(27.8)	33(31.7)	104
The direction of movement between stations was clear	Fourth	1(1.3)	3(1.3)	3(1.3)	12(16.6)	53(73.6)	72	0.678
	sixth	0	0	2(6.2)	7(21.8)	23(71.8)	32
	total	1(0.9)	3(2.8)	5(4.8)	19(18.2)	76(73)	104
OSCE is less stressful than other examinations.	Fourth	18(25)	22(30.5)	16(22.2)	9(12.5)	7(9.7)	72	0.375
	sixth	11(34)	5(15.6)	7(21.8)	3(9.3)	6(18.7)	32
	total	29(28.4)	27(25.9)	23(22.1)	12(11.5)	13(12.5)	104
The place and rooms regarding setup and lighting were good.	Fourth	0	1(1.3)	5(4.8)	24(33.3)	42(58.3)	72	0.29
	sixth	0	2(6.2)	1(3.12)	7(21.8)	22(68.75)	32
	total	0	3(2.8)	6(5.7)	31(29.8)	64(61.5)	104
Rest stations	Fourth	0	1(1.3)	6(8.3)	18(25)	47(65.2)	72	0.20
	sixth	0	1(3.12)	3(9.3)	0	28(87.5)	32
	total	0	2(1.9)	9(8.6)	49(47.11)	75(72.1)	104
The number of stations was adequate.	Fourth	0	9(12.5)	0	0	63(87.5)	72	0.162
	sixth	0	8(25)	0	0	24(75)	32
	total	0	17(16.3)	0	0	87(83.6)	104
Organizing staff was helpful.	Fourth	0	0	4(5.55)	12(16.6)	56(77.77)	72	0.319
	sixth	0	0	0	4(12.5)	28(87.5)	32
	total	0	0	4(3.8)	16(15.3)	84(80.7)	104
Dean was helpful regarding the arrangement and psychological support.	Fourth	1(1.3)	1(1.3)	7(9.72)	24(33.3)	40(55.5)	72	0.24
	sixth	1(3.12)	0	0	2(6.25)	29(90.6)	32
	total	2(1.9)	1(0.96)	7(6.6)	26(25)	69(66)	104

Examiner perception

Table 4 presents the examiner's feedback on the entire operation. It is essential to mention that most of the examiners and respondents were external examiners.

The leading queries were related to the structure of the examination. The obtained responses from 24 out of 33 faculty staff members (75%) and 29 out of 35 external examiners (82%) strongly agreed that the examination adequately covered a wide variety of clinical abilities. Only two of 68 examiners (2.9%) believed the examination needed more to provide a learning opportunity.

Aspects	examiners	Strongly disagree (%)	Disagree (%)	Neutral (%)	Agree (%)	Strongly agree (%)	total	P value
OSCE examination was fair	Faculty	0	1(3)	6(18.18)	13(39.3)	13(39.3)	33	0.74
	External	0	0	6(17.1)	16(45.7)	13(37.1)	35
	Total		1(1.4)	12(17.4)	29(42.4)	26(38.2)	68
The exam covered a wide range of clinical skills	Faculty	1(3)	0	8(24.2)	12(36.3)	12(36.3)	33	0.535
	External	1(2.8)	1(2.8)	4(11.4)	17(48.5)	12(34.2)	35
	Total	2(2.9)	1(1.4)	12(17.4)	29(42.4)	24(35.2)	68
The exam minimized the chance of failure.	Faculty	0	2(6)	9(27.2)	14(42.4)	8(24.2)	33	0.365
	External	2	1(2.8)	13(37.1)	9(25.7)	10(28.5)	35
	Total	2(2.9)	3(4.4)	21(30.8)	23(33.8)	12(17.4)	68
Enough time to demonstrate requires skills for stations.	Faculty	3(9)	3(9)	8(24.2)	12(36.3)	7(21.2)	33	0.20
	external	0	1(2.8)	6(17.1)	7(20)	11(31.42)	35
	Total	3(4.4)	4(5.8)	14(20.5)	19(27.9)	18(26.4)	68
Patients were cooperative, and the findings were clear	Faculty	0	2(6.8)	6(18)	12(36.3)	13(39.3)		0.741
	External	0	1(2.8)	4(11.4)	13(37.1)	17(48.5)
	Total	0	3(4.4)	10(14.7)	25(36.7)	30(44.1)
Questions were clear and part of the curriculum	Faculty	3(9)	1(3)	8(24.2)	5(15.15)	16(48.5)	33	0.57
	external	0	1(2.8)	5(14.2)	11(31.4)	15(42.8)	35
	Total	3(4.4)	2(2.9)	13(19.1)	16(23.5)	31(45.5)	68
Exams provide opportunity to learn	Faculty	2(6)	0	3(9)	17(51.5)	11(33.33)	33	0.502
	external	0	0	4(11.4)	15(42.8)	16(45.7)	35
	Total	2(2.9)	0	7(10.2)	32(47)	27(39.7)	68

In order to address the issue of fairness among students, which is a significant concern in terms of patients' conditions and the selection of teachers in most OSCE examinations, particularly in our faculty located in a small town with a limited number of patients and a majority of external examiners as teachers, we have made the decision to conduct all examinations on a single day instead of having separate OSCE assessments.

Compared to Sediq et al. and al-Khateeb et al [13, 16], which are done in Sulaymaniyah and hawler colleges, respectively, our students' satisfaction with all aspects of arrangement and the scientific base is better, although all examinations done together, the difference may be due to the small number of students in comparing with them, Out of our region, we compared our results with Ansari T et al, Alghamdi KS et al [17, 18] Students were less satisfied with the fairness of examination and other aspects of osce arrangement and scientific bases.

In other universities, the OSCE examination was conducted separately. We implemented a new and challenging method of conducting the OSCE for all branches together. We made sure to gather feedback from our students regarding their preference for either separate or grand OSCEs. Of the 84 respondents, 80.7% strongly agreed that the grand OSCE format is superior to separate OSCEs.

Another objective of doing all examinations on the same day is to ensure that when younger doctors graduate, they are capable of simultaneously managing various specialties in the casualty room, opposite of a study done by al-Khateeb et al [13] at Hawler Medical University, which regarded uncooperative patients as another problem raised by the students as a weakness of their OSCE examination. Most students in both stages rated patient cooperation as good. In contrast, only 5% rated it as bad, this is considered a strength of our faculty that may be attributed to a hospital and faculty in a small town.

Although a five-minute time frame is standard for demonstrating a specific clinical skill, which was time for each station of the sixth stage, exactly half of the students, 16 out of 32, agreed or strongly agreed about that, while the time allowed for each station of the fourth stage was three minutes and only 13 students (18%) of them saw the time limit required to be increased with no significant difference in P value, which nearly same to Ansari T et al [18] and opposite to sediq et al and Alghamdi KS et al[16, 17]

One criticism we have encountered is the limited time available for studying all courses before the examination. Therefore, we have asked our participants for their feedback on this matter, there is a statistically significant difference in the P value between the results of the fourth and sixth stages, approximately 80% of fourth-stage students agree or strongly agree that the time required to prepare for the OSCE exam was satisfactory for studying before the examination. In comparison, only four students (4%) in the sixth year agree. This difference can be attributed to the difference in technical preparation time, with the sixth-year students having five days after theory examinations compared to 8 days for the fourth-stage students.

Regarding all other technical preparation and scientific base of examination, there was no significant difference between the fourth and sixth stages, While two-thirds of students rated the examination in general as good, in contrast, less than half of sediq et al and only 36.9% of Alghamdi KS et al [16, 17] rated their examination as the same, It is a satisfactory outcome, and we can consider using this sort of assessment in the coming years, taking into account all the facts and note.

Teachers play a crucial role in achieving scientific outcomes, especially when faculty councils decide on new assessment models. We take this into account by considering examiners' feedback. The results are reliable because a majority of the respondents are external examiners with extensive experience in teaching and examination.

In the present study, the examiners exhibited considerable satisfaction with OSCE attributes, quality, and organization following international papers [19, 20]. The OSCE examiners involved in the current study were from multi-specialty, and most of them had previous experience in OSCE, using the checklist and global assessment. Most examiners accepted that the OSCE assessment was fair and that the tasks were interesting and educative. They believe the test covered multiple clinical skills, minimized the chance of failing, and delivered enough time for task demonstration, and as more than half of responders were external examiners from other local medical colleges with a long history of student assessment with no statistically significant difference between local and external examiners that also give strength to our evaluation as most of our external examiners were with a long history of process of medical education and examination, comparing with local faculties, our faculty examiners agreement and strongly agreement about fairness, coverage of a wide range of clinical skills, minimizing the chance of failing to have opportunity to learn was 80.4%, 66.6% 50.1% and 86.7% respectively while in Sulaymaniyah university was 82.8, 79.7%, 73.5 and 85.9% respectively[16]

The strength of the current study is that it was the first study in our university to be conducted, aiming to assess students' and examiners' perceptions of new style of OSCE. In addition, self-administered questionnaires filled after the exam and before the release of the results could minimize interviewer bias and self-report-related issues. The sample size was comparatively large, the response rate was high in both groups. Our study had a few limitations as it was a questionnaire-based observational study without interviewing the participants, and our evaluation was a multi-specialty examination. We may need to go into more detail about each station and each specialty.

the opinions of the 4th and 6th-year medical students and their examiners regarding Grand OSCE, organization, and performance quality were evaluated,

Most students believed that the OSCE was tolerably designed and well organized, and they agreed that the supporting staff were helpful and that good facilities were available during the exam. However, the majority of the students rated the assessment's fairness as good, the examiner's perceptions showed greater satisfaction with all the aspects of the OSCE, and they offered few suggestions for future evaluations.

We can schedule this type of OSCE for the upcoming academic years, as the majority of participants are in agreement regarding the organization and specifics of this examination format. However, it will require additional preparation for future exams, and every aspect of feedback should be given due consideration, even if it comes from a small number of students. This includes paying particular attention to the duration of time allotted for studying.

Ethical approval and consent to participate: All participants in this study gave consent or waived it. The ethical committee of the Faculty of General Medicine, Koya University, issued approval (Reference code 7/29/570 on 23/6/2024).

All authors agreed to participate, and the ethical committee agreed about their participation

Consent for publication: all authors are agreed to publish the article

Availability of data and material The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interest, no competing interest

Funding All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work

Author contribution: DJH has contributed substantially to the conception and design of the work, the acquisition and analysis of the data, and the manuscript drafting. STB acquired, analyzed, and interpreted the data. Others contributed to the conception and design of the work, analyzed the data, and drafted the manuscript. All authors had full access to the data, contributed to the study, approved the final version of the manuscript for publication, and took responsibility for its accuracy and integrity.

Acknowledgments: Special thanks to examiners and students for their contribution to the examination and feedback

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No competing interests reported.

Perception of Undergraduate Medical Students and Examiners Towards Grand Objective Structured Clinical Examination

Status:

Version 1

Abstract

Introduction

Materials and Methods

Results

Discussion

Conclusions

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1