In the driver's seat: Students' perspectives on a formative OSCE in a multisite OB/GYN clerkship

Dear Sir

As of 2003, only 38% (48/126) of OB/GYN clerkships used OSCEs as a part of their curriculum (Casey et al. 2009). In 2010, we sought to incorporate a formative OSCE into the OB/GYN clerkship that would provide third-year medical students with the opportunity to practice their ability to counsel patients in areas that are relevant no matter which specialty they choose. Like many other schools, our students rotate in multiple hospitals throughout the state. If our aim was to have the OSCE experience be a teaching tool, we were concerned that returning to the home institution could require significant travel costs for students that may detract from their perception of the activity as valuable.

We conducted a prospective observational study conducted during the 2011 academic year during which we collected surveys from 118 third-year medical students during their Obstetrics and Gynecology clerkship at the University of North Carolina at Chapel Hill. The clerkship takes place at Chapel Hill as well as three teaching hospitals around the state in Raleigh, Charlotte, and Asheville (AHEC sites). The OSCE consisted of three stations: a young woman with a seizure disorder considering becoming pregnant, an older woman desiring contraception, and a disgruntled patient that is angry after her 45-minute wait.

The majority of students performed their OB/GYN rotation either in Chapel Hill (47%) or Raleigh (24%), while only 11 and 16 students Asheville and Charlotte, 12% and 17%, respectively. Out of all responders, 39% were considering OB/GYN as one of their top 3 choices for residency and the Raleigh site had the largest proportion of them (50%) followed closely by Chapel Hill (42%) and Asheville (36%) while Charlotte (19%) had the least.

Most students felt that, prior to this OSCE, other OSCE experiences at UNC had been beneficial and contributed to their learning (59%). However, when asked about this OSCE in particular as being more beneficial than a day in clinic or on the wards 41% of students agreed while 34% disagree and 25% said neither. Overall, only 51% felt that it would be important to include OSCE-type examinations of clinical skills in the OB/GYN clerkship.

Because many students must travel from their AHEC site to Chapel Hill in order to participate in the OSCE, it was necessary to address the burden of this commute as a detractor from the overall experience. When asked whether the experience gained through the OSCE was worth the expense of travelling back to Chapel Hill, the responses of students rotating at AHEC sites were fairly evenly divided, 51% in agreement and 39% in disagreement.

In summary, a third-year OSCE, taking place during the students’ OB/GYN clerkship appears to be a useful learning tool to which the majority of students responded positively, including those at off campus sites. However, it is not clear whether students find it to be an indispensable portion of their clinical medical education or if it performs functions that could not be replicated without student s being removed from a day of clinic.