A realist evaluation of how, why and when objective structured clinical exams (OSCEs) are experienced as an authentic assessment of clinical preparedness

Yeates, Peter, Maluf, Adriano, Kinston, Ruth, Cope, Natalie, Cullen, Kathy, Cole, Aidan, O’Neill, Vikki, Chung, Ching-wa, Goodfellow, Rhian, Vallender, Rebecca, Ensaff, Sue, Goddard-Fuller, Rikki, McKinley, Robert and Wong, Geoff 2025. A realist evaluation of how, why and when objective structured clinical exams (OSCEs) are experienced as an authentic assessment of clinical preparedness. Medical Teacher 47 (3) , pp. 458-466. 10.1080/0142159x.2024.2339413

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Abstract

Introduction Whilst rarely researched, the authenticity with which Objective Structured Clinical Exams (OSCEs) simulate practice is arguably critical to making valid judgements about candidates’ preparedness to progress in their training. We studied how and why an OSCE gave rise to different experiences of authenticity for different participants under different circumstances. Methods We used Realist evaluation, collecting data through interviews/focus groups from participants across four UK medical schools who participated in an OSCE which aimed to enhance authenticity. Results Several features of OSCE stations (realistic, complex, complete cases, sufficient time, autonomy, props, guidelines, limited examiner interaction etc) combined to enable students to project into their future roles, judge and integrate information, consider their actions and act naturally. When this occurred, their performances felt like an authentic representation of their clinical practice. This didn’t work all the time: focusing on unavoidable differences with practice, incongruous features, anxiety and preoccupation with examiners’ expectations sometimes disrupted immersion, producing inauthenticity. Conclusions The perception of authenticity in OSCEs appears to originate from an interaction of station design with individual preferences and contextual expectations. Whilst tentatively suggesting ways to promote authenticity, more understanding is needed of candidates’ interaction with simulation and scenario immersion in summative assessment.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by-nc-nd/4.0/, Start Date: 2024-04-18
Publisher:	Taylor and Francis Group
ISSN:	0142-159X
Date of First Compliant Deposit:	5 March 2025
Date of Acceptance:	2 April 2024
Last Modified:	05 Mar 2025 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/176621

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