Harnessing insights from an activity system – OSCEs past and present expanding future assessments

Abstract

Objective Structured Clinical Examinations (OSCEs) are a dominant, yet problematic, assessment tool across health professions education (HPE). OSCEs’ standardised approach aligns with regulatory accountability, allowing learners to exchange exam success for the right to practice. We offer a sociohistorical account of OSCEs’ development to support an interpretation of present assessment practices. OSCEs create tensions. Preparing for OSCE success diverts students away from the complexity of authentic clinical environments. Students will not qualify and will, therefore, be of no use to patients without getting marks providing evidence of competence. Performing in a formulaic and often non patient-centred way is the price to pay for a qualification. Acknowledging the stultifying effect of standardising human behaviour for OSCEs opens up possibilities to release latent energy for change in medical education. In this imagined future, the overall object of education is refocused on patient care.

Keywords:

• OSCE
• assessment
• standardised patients
• clinical
• undergraduate

Acknowledgements

Thanks to Dr. Mairead Corrigan, Professor Pascal McKeown, and Professor Peter Cantillon for supporting the research on which this article draws.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Helen Reid

Helen Reid, BM, PhD, is a GP. Her research interests concern assessment and healthcare workplace learning (particularly in community contexts), drawing on a range of critical methodologies.

Gerard J. Gormley

Gerard J. Gormley, MB, MD, is a GP and Professor in Simulation. He has a particular interest in education scholarship – especially relating to simulation.

Tim Dornan

Tim Dornan, BM, PhD, is Professor of Medical Education at QUB and Emeritus Professor, Maastricht University, The Netherlands. He is an internist and endocrinologist, whose main interest is workplace learning. His methodological interests include dialogic discourse analysis and a range of qualitative methodologies inspired by sociocultural theory and phenomenology.

Jennifer L. Johnston

Jennifer L. Johnston, BM, PhD, is a critical educationalist and practising GP. Her interests lie in uncovering implicit power dynamics, addressing inequalities through education, and raising critical consciousness.