Impact of Formative OSCE on Students' Summative Clinical Performance
Condition: Objective Structured Clinical Examination; Clinical Performance
Study type: Interventional

Summary: 
      Assessment is now seen as a learning experience. there is little literature on objective
      structured clinical examination role for formative assessment especially in developing world
      Many studies showed that formative-OSCE contributes positively to final summative examination
      performance though most studies address this point through the students' perception toward
      the formative-OSCE.

      Having research that evaluates the effect of formative-OSCE introduction on a subsequent
      summative-OSCE in randomised controlled design may be of benefit for institutions considering
      the establishment of their own formative-OSCEs particularly in low resource countries.
    

Detailed description: 
      Formative assessments are systematically designed instructional interventions to assess and
      provide feedback on students' strengths and weaknesses in the course of teaching and learning
      and educational experts recommend its use in addition to summative assessment. Moreover, it
      is a requirement in undergraduate medical education and must be at the heart of student
      training not just included to satisfy accreditation requirement, yet unlike other
      professional training culture such as music in which feedback is expected, respected and
      given regularly to all learners, the investigators haven't cultivated a true feedback culture
      in medical education.

      In a performance-based assessment, the Objective Structured Clinical Examination (OSCE) has
      gained importance because of its reliability and could be in a summative or formative manner
      to measure clinical competence. Clinical skills development requires time and practice at a
      rate that can accelerated by feedback to optimize experiential learning and improve future
      performance for which a learner should enter a reflection period during which available
      feedback is examined.

      There are some medical schools where formative assessments are institutionalized and carried
      out systematically, unfortunately, this kind of assessment is not very frequent in
      Mediterranean countries.

      Undergraduate medical education in Iraq is currently going through a transitional period. The
      Medical college of Hawler medical university (HMU) which provides a 6-year MBChB program, has
      started the process of changing its curriculum to competency-based medical education (CBME)
      and formative assessment is a requirement in this process. In the traditional curriculum
      training in pediatric is introduced in 5th year with summative assessment composed of 50%
      written test, 30% OSCE, 10% logbook, 10% history taking skills. Students should be competent
      to record case history, examine children, make a provisional diagnosis, interpret
      investigations and communicate with children and their families given that at the allotted
      time end, students present the case findings and evaluated by the faculty. However, a faculty
      member doesn't actively observe the students' actual performance of these skills or
      competencies so the purpose of formative assessment is not fully met. Use of OSCE as
      formative assessment can overcome this problem.

      Attempts have been made in OSCE implementation for summative assessment, however,
      formative-OSCEs introduction and evaluation in Iraqi medical colleges is lacking. Iraqi
      medical schools are facing challenges in staff recruitment and adequate resource provision.
      The latter is one of the numerous concerns and challenges to the CBME implementation.

      Many studies showed that formative-OSCE contributes positively to final summative examination
      performance though most studies address this point through the students' perception toward
      the formative-OSCE.
    

Intervention name(s): Formative objective structured clinical examination (OSCE)
Intervention type(s): Other
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Students in the intervention group (first-arm) attended a formative-OSCE on the first day of their pediatric module to assess the competencies they gained from previous modules. The formative-OSCE design involved a blueprint development which served as a guideline for the development and face-validation of the 8 stations, which were both interactive and static.
The formative-OSCE examiners consisted of 2 teaching staff and 11 postgraduate pediatric board trainees, who were trained by the researcher using role model and audiovisual aids. The formative-OSCE was carried out following the exact same process of the summative-OSCE. It composed of stations assessing same competencies with standardized mark sheets and feedback. Students received feedback on their performance in the formative-OSCE on the day the results were released on a one-to-one basis.
at the end of pediatric module both groups undergo summative OSCEassessment
Masking: Single (Outcomes Assessor)
Primary purpose: Other
Keywords: formative assessment; objective structured clinical examination (OSCE); Iraq; impact; feedback