Attitudes Towards Introduction of Multiple Modalities of Simulation in Objective Structured Clinical Examination (OSCE) of Emergency Medicine (EM) Final Board Examination: A Cross-Sectional Study

Figures & data

Table 1 Descriptive Statistics of Demographics of Participants

Variables		N (%)	P-value*
Age	25 to 34 years	98 (70.0)	0.171
	35 to 44 years	37 (26.4)
	45 to 54 years	5 (3.6)
Gender	Males	94 (67.1)	0.339
	Females	46 (32.9)
Classification	Instructors	66 (46.8)	0.150
	Residents	70 (49.6)
Group of practice	Adult	91 (64.54)	0.740
	Paediatric	6 (4.26)
	Both	41 (31.21)
Training	Residency	44 (36.1)	0.884
	Workshops	10(8.2)
	Life support	22 (18.0)
	Interprofessional	2 (1.6)
	Simulation competition	9 (7.4)
	Mock-up exam	8 (6.6)
	Hospital drills	27 (22.1)

Note: *Difference on agreement on implementing multimodality simulation in emergency medicine final board exam.

Table 2 Percentages of Belief Scores Among Instructors and Residents Regarding Simulation-Related Questions

Question	Respondents	Strongly Disagree	Disagree	Agree	Strongly Agree	Not Sure	Mean±SD	P-value
I would like to see simulation implemented in the final EM board OSCE examinations.	Resident	8.6	17.1	51.4	18.6	4.3	2.7±1.0	0.036
	Instructors	9.1	3.0	50.0	33.3	4.5	2.98±1.1
Simulation can be implemented in all OSCE stations.	Resident	1.4	21.4	54.3	20.0	2.9	2.9±.85	0.032
	Instructors	10.8	30.4	40.0	15.4	3.1	2.5±.99
Implementing simulation-based OSCE exams will improve the assessment of EM residents’ competencies.	Resident	10.0	11.4	50.0	24.3	4.3	2.8±1.1	0.474
	Instructors	6.2	4.6	43.1	33.8	12.3	2.8±1.3
Simulation-based examinations would be better than structured oral examinations in reflecting residents’ real performance.	Resident	2.9	10.0	44.3	35.7	7.1	2.99±1.1	0.008*
	Instructors	6.1	10.6	37.9	22.7	22.7	2.3±1.46
It is possible to conduct a high-quality simulation-based examination.	Resident	0	4.3	72.9	14.3	8.6	2.8±.97	0.028*
	Instructors	6.1	4.5	56.1	33.3	6.1	2.8±1.1
I feel comfortable being assessed for my competencies using simulation in high-stakes assessments.	Resident	1.4	15.7	58.6	18.6	5.7	2.8±.95	0.319
	Instructors	6.1	7.6	48.5	30.3	7.6	2.8±1.1
I would like to see at least one oral OSCE station in the final board exams.	Resident	4.3	12.9	57.1	14.3	11.4	2.6±1.1	0.001*
	Instructors	7.6	4.5	39.4	45.5	3.0	3.1±1.1
Simulation-based examinations can be used to assess a variety of EM competencies.	Resident	2.9	15.7	60.0	2.9	5.7	2.77±.95	0.001*
	Instructors	4.6	0	55.4	36.9	3.1	3.2±.81
Simulation-based OSCE examinations can be structured as a standardized method to assess residents’ competencies.	Resident	2.9	17.1	52.9	20.0	7.1	2.8±1.0	0.324
	Instructors	4.5	7.6	54.5	25.8	7.6	2.8±1.1
Simulation-based OSCE examinations can be a fair method to assess EM residents’ competencies.	Resident	2.9	11.4	60.0	17.1	8.6	2.7±1.1	0.741
	Instructors	3.0	10.6	42.4	28.8	15.2	2.7±1.3

Note: *Statistically significant (P-value < 0.05).

Table 3 Percentages of Belief Scores Among Instructors and Residents Regarding the Probability of Applying Simulation to Assess the Following Domains of EM Competencies in the Final EM Board Exams

Question	Respondents	Strongly Disagree	Disagree	Agree	Strongly Agree	Not Sure	P-value
History taking	Resident	8.6	10.0	55.7	17.1	8.6	0.109
	Instructors	4.5	12.1	42.4	33.3	7.6
Physical examination	Resident	4.3	11.6	50.7	29.0	4.3	0.875
	Instructors	7.6	7.6	37.9	36.4	10.6
Procedural skills	Resident	4.3	14.3	49.3	26.1	5.7	0.064
	Instructors	7.6	1.5	47.0	42.4	1.5
Clinical decision making	Resident	4.3	10.0	50.0	30.0	5.7	0.554
	Instructors	7.6	3.0	51.5	33.3	4.5
Communication with patient	Resident	4.3	14.5	49.3	26.1	5.8	0.834
	Instructors	6.1	15.2	36.4	31.8	10.6
Communication with patient’s family	Resident	2.9	14.3	50.0	21.4	11.4	0.675
	Instructors	6.1	19.7	36.4	30.3	7.6
Annotating medical records	Resident	4.3	27.1	37.1	18.6	12.9	0.517
	Instructors	4.5	22.7	40.9	13.6	18.2
Conflict management	Resident	4.3	14.5	53.6	15.9	11.6	0.236
	Instructors	9.1	10.6	40.9	30.3	9.1
Interaction with healthcare workers	Resident	8.6	17.1	41.4	22.9	10.0	0.014*
	Instructors	7.6	3.0	42.4	42.4	4.5
Leadership	Resident	8.6	5.7	51.4	30.0	4.3	0.185
	Instructors	7.6	3.0	42.4	42.4	4.5
Teaching skills	Resident	5.7	10.0	54.3	20.0	10.0	0.027*
	Instructors	3.0	3.0	51.5	34.8	7.6

Note: *Statistically significant (P-value < 0.05).

Table 4 Percentages of Belief Scores Among Instructors and Residents Regarding Possible Implementation of the Following Modalities of Simulation in the Final EM Board Examinations

Question	Respondents	Strongly Disagree	Disagree	Agree	Strongly Agree	Not Sure	P-value
Standardized patients	Resident	1.5	22.7	47.0	21.2	7.6	0.002*
	Instructors	3.2	4.8	51.6	38.7	1.6
Part-task trainers	Resident	4.8	14.3	47.6	19.0	14.3	0.007*
	Instructors	3.3	1.6	55.7	32.8	6.6
High-fidelity simulators	Resident	3.0	7.5	50.7	26.9	11.9	0.007*
	Instructors	4.8	4.8	40.3	48.4	1.6
Virtual simulation	Resident	6.2	15.4	40.0	24.6	13.8	0.556
	Instructors	8.5	10.2	57.6	18.6	5.1
Hybrid simulation	Resident	1.7	5.0	53.3	18.3	21.7	0.007*
	Instructors	5.2	1.7	56.9	32.8	3.4

Note: *Statistically significant (P-value < 0.05).