Journal of Educational Evaluation for Health Professions

Case Study

Feasibility of utilizing functional near-infrared spectroscopy to measure the cognitive load of paramedicine students undertaking high-acuity clinical simulations in Australia: a case study: Jason Betson, Erich Christian Fein, David Long, Peter Horrocks; J Educ Eval Health Prof. 2024;21:38. Published online December 10, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.38

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Purpose
Paramedicine education often uses high-fidelity simulations that mimic real-life emergencies. These experiences can trigger stress responses characterized by physiological changes, including alterations in cerebral blood flow and oxygenation. Functional near-infrared spectroscopy (fNIRS) is emerging as a promising tool for assessing cognitive stress in educational settings.
Methods
Eight final-year undergraduate paramedicine students completed 2 high-acuity scenarios 7 days apart. Real-time continuous recording of cerebral blood flow and oxygenation levels in the prefrontal cortex was undertaken via fNIRS as a means of assessing neural activity during stressful scenarios.
Results
fNIRS accurately determined periods of increased cerebral oxygenation when participants were undertaking highly technical skills or making significant clinical decisions.
Conclusion
fNIRS holds potential for objectively measuring the cognitive load in undergraduate paramedicine students. By providing real-time insights into neurophysiological responses, fNIRS may enhance training outcomes in paramedicine programs and improve student well-being (Australian New Zealand Clinical Trials Registry: ACTRN12623001214628).

Citations

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Effect of repeating simulated high-stress scenario assessments on paramedicine student performance and psychophysiological response
Jason Betson, Erich C. Fein, David Long, Peter Horrocks
Interactive Learning Environments.2025; : 1. CrossRef
Relationships between cognitive appraisals of threat and challenge, psychophysiological responses, and clinical performance during high-stress simulated osces
Jason Betson, Erich C. Fein, David Long, Peter Horrocks
BMC Medical Education.2025;[Epub] CrossRef

Research articles

Development and validation of the student ratings in clinical teaching scale in Australia: a methodological study: Pin-Hsiang Huang, Anthony John O’Sullivan, Boaz Shulruf; J Educ Eval Health Prof. 2023;20:26. Published online September 5, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.26

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Abstract PDF Supplementary Material: Purpose
This study aimed to devise a valid measurement for assessing clinical students’ perceptions of teaching practices.
Methods
A new tool was developed based on a meta-analysis encompassing effective clinical teaching-learning factors. Seventy-nine items were generated using a frequency (never to always) scale. The tool was applied to the University of New South Wales year 2, 3, and 6 medical students. Exploratory and confirmatory factor analysis (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA], respectively) were conducted to establish the tool’s construct validity and goodness of fit, and Cronbach’s α was used for reliability.
Results
In total, 352 students (44.2%) completed the questionnaire. The EFA identified student-centered learning, problem-solving learning, self-directed learning, and visual technology (reliability, 0.77 to 0.89). CFA showed acceptable goodness of fit (chi-square P<0.01, comparative fit index=0.930 and Tucker-Lewis index=0.917, root mean square error of approximation=0.069, standardized root mean square residual=0.06).
Conclusion
The established tool—Student Ratings in Clinical Teaching (STRICT)—is a valid and reliable tool that demonstrates how students perceive clinical teaching efficacy. STRICT measures the frequency of teaching practices to mitigate the biases of acquiescence and social desirability. Clinical teachers may use the tool to adapt their teaching practices with more active learning activities and to utilize visual technology to facilitate clinical learning efficacy. Clinical educators may apply STRICT to assess how these teaching practices are implemented in current clinical settings.

Empirical analysis comparing the tele-objective structured clinical examination and the in-person assessment in Australia: Jonathan Zachary Felthun, Silas Taylor, Boaz Shulruf, Digby Wigram Allen; J Educ Eval Health Prof. 2021;18:23. Published online September 23, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.23

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Abstract PDF Supplementary Material

Purpose
It aimed to compare the use of the tele-objective structured clinical examination (teleOSCE) with in-person assessment in high-stakes clinical examination so as to determine the impact of the teleOSCE on the assessment undertaken. Discussion follows regarding what skills and domains can effectively be assessed in a teleOSCE.
Methods
This study is a retrospective observational analysis. It compares the results achieved by final year medical students in their clinical examination, assessed using the teleOSCE in 2020 (n=285), with those who were examined using the traditional in-person format in 2019 (n=280). The study was undertaken at the University of New South Wales, Australia.
Results
In the domain of physical examination, students in 2020 scored 0.277 points higher than those in 2019 (mean difference=–0.277, P<0.001, effect size=0.332). Across all other domains, there was no significant difference in mean scores between 2019 and 2020.
Conclusion
The teleOSCE does not negatively impact assessment in clinical examination in all domains except physical examination. If the teleOSCE is the future of clinical skills examination, assessment of physical examination will require concomitant workplace-based assessment.

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Review

Assessment methods and the validity and reliability of measurement tools in online objective structured clinical examinations: a systematic scoping review: Jonathan Zachary Felthun, Silas Taylor, Boaz Shulruf, Digby Wigram Allen; J Educ Eval Health Prof. 2021;18:11. Published online June 1, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.11

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Abstract PDF Supplementary Material

The coronavirus disease 2019 (COVID-19) pandemic has required educators to adapt the in-person objective structured clinical examination (OSCE) to online settings in order for it to remain a critical component of the multifaceted assessment of a student’s competency. This systematic scoping review aimed to summarize the assessment methods and validity and reliability of the measurement tools used in current online OSCE (hereafter, referred to as teleOSCE) approaches. A comprehensive literature review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Articles were eligible if they reported any form of performance assessment, in any field of healthcare, delivered in an online format. Two reviewers independently screened the results and analyzed relevant studies. Eleven articles were included in the analysis. Pre-recorded videos were used in 3 studies, while observations by remote examiners through an online platform were used in 7 studies. Acceptability as perceived by students was reported in 2 studies. This systematic scoping review identified several insights garnered from implementing teleOSCEs, the components transferable from telemedicine, and the need for systemic research to establish the ideal teleOSCE framework. TeleOSCEs may be able to improve the accessibility and reproducibility of clinical assessments and equip students with the requisite skills to effectively practice telemedicine in the future.

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Intra-rater reliability of in-person versus simulated remote synchronous faculty evaluation of pharmacy student objective structured clinical examinations
Alex N. Isaacs, Jenny L. Newlon, Kimberly S. Illingworth, Alan J. Zillich, Zachary A. Weber, Jamie L. Woodyard
Currents in Pharmacy Teaching and Learning.2026; 18(2): 102520. CrossRef
Introducing a Smartphone Tele-Objective Structured Clinical Examination to Support High-Stakes Competency Decisions: A Quasi-Experimental Study and Curricular Implications
Xiaozhi Wang, Junjie Du, Binlin Luo, Liling Chen, Huanhuan Chen, Surong Jiang, Wei Sun, Lei Zhou, Lars Konge, Hua Huang, Qiang Ding
Journal of Medical Education and Curricular Development.2026;[Epub] CrossRef
Validity of pediatric index of mortality 2 scoring in a pediatric ICU setting in Ethiopia: A prospective observational study
Mikiyas G. Teferi, Bethel A. Awoke, Iyassu S. Melkie, Oghenekenu Oshare, Soliana Solomon Birhanu, Gelila Gemeda Gage, Biruk T. Mengistie, Chernet T. Mengistie, Alehilign M. Abebe
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Brooke Flew, Lucy Chipchase, Darren Lee, Jodie A. McClelland
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Structured oral clinical assessment for pharmacotherapy competencies in medical education: a study of validity and reliability analyses of seven domains
Abdul Khairul Rizki Purba, David Sontani Perdanakusuma, Arifa Mustika, Tanja Fens, Maarten Jacobus Postma
Korean Journal of Medical Education.2025; 37(3): 331. CrossRef
Feasibility and reliability of the pandemic-adapted online-onsite hybrid graduation OSCE in Japan
Satoshi Hara, Kunio Ohta, Daisuke Aono, Toshikatsu Tamai, Makoto Kurachi, Kimikazu Sugimori, Hiroshi Mihara, Hiroshi Ichimura, Yasuhiko Yamamoto, Hideki Nomura
Advances in Health Sciences Education.2024; 29(3): 949. CrossRef
A level playing field? Evaluation of the virtual Objective Structured Clinical Examination in Psychiatry and Addiction Medicine: A mixed methods study
Rebecca E Reay, Paul A Maguire, Jeffrey CL Looi
Australasian Psychiatry.2024; 32(4): 359. CrossRef
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Andrea Gotzmann, John Boulet, Yichi Zhang, Judy McCormick, Mathieu Wojcik, Ilona Bartman, Debra Pugh
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Is online objective structured clinical examination teaching an acceptable replacement in post-COVID-19 medical education in the United Kingdom?: a descriptive study
Vashist Motkur, Aniket Bharadwaj, Nimalesh Yogarajah
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Equal Z standard-setting method to estimate the minimum number of panelists for a medical school’s objective structured clinical examination in Taiwan: a simulation study
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Indian Journal of Dermatology.2022; 67(4): 477. CrossRef
Empirical analysis comparing the tele-objective structured clinical examination and the in-person assessment in Australia
Jonathan Zachary Felthun, Silas Taylor, Boaz Shulruf, Digby Wigram Allen
Journal of Educational Evaluation for Health Professions.2021; 18: 23. CrossRef

Research articles

Journal clubs in Australian medical schools: prevalence, application, and educators’ opinions: Damian James Ianno, Kelly Mirowska-Allen, Stephen Anthony Kunz, Richard O’Brien; J Educ Eval Health Prof. 2020;17:9. Published online February 26, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.9

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Abstract PDF Supplementary Material

Purpose
Medically-focused journal clubs have been used as an educational tool for over 100 years, with research indicating that they improve knowledge, reading behaviour, and critical appraisal skills. However, it is unknown how widespread they are in Australian medical schools, nor the opinions of medical education leaders as to their value.
Methods
A nationwide cross-sectional study was performed among academic leaders from every Australian medical school. Individuals were asked to complete a survey detailing their attitudes towards journal clubs using single- or multiple-answer questions, Likert scales, and ranked data. They were asked whether students at their institutions were able to partake in journal clubs, and if so, provided details on their implementation.
Results
At least 1 response was collected from 18 of 19 Australian medical schools. The response rate was 40.8% (60 of 147), and 36 responses (60.0%) were from heads of clinical schools. Respondents from 15 of 18 institutions (83.3%) stated that their institution had a journal club. Of these, 23 (65.7%) were metropolitan institutions and 12 (34.3%) were rural institutions. Eighteen (51.4%) journal clubs were clinician-led, 13 (37.1%) were run through specific hospital departments, and 23 (65.7%) occurred during clinical years. Most respondents (20 [57.1%]) stated that the primary aim of the journal club was to develop critical appraisal skills.
Conclusion
Journal clubs are a highly regarded educational tool in the armoury of medical school educators, with significant heterogeneity in their structure, geographic prevalence, and intended purpose. Further studies of their efficacy in teaching evidence-based medicine is warranted.

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Journal club as a teaching–learning strategy: a case for plant genetics lectures during the COVID-19 pandemic
Flavio Lozano-Isla, Elizabeth Heros-Aguilar, Andres Casas-Diaz
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Using a journal club to navigate a maze of COVID-19 papers in a front-line hospital service
Rachel Wenke, Paulina Stehlik, John Gerrard, Sharon Mickan, David Henry
BMJ Evidence-Based Medicine.2023; 28(3): 210. CrossRef
Club bibliográfico de la Sociedad Española de Radiología Médica: Historia, análisis y perspectivas tras 10 años de trayectoria
D. Herrán de la Gala, C. Biosca Calabuig, J. Miranda Bautista
Radiología.2023; 65(4): 376. CrossRef
Spanish Society of Medical Radiology Journal Club: History, analysis and perspectives after ten years of experience
D. Herrán de la Gala, C. Biosca Calabuig, J. Miranda Bautista
Radiología (English Edition).2023; 65(4): 376. CrossRef
Assessing Medical Students’ Perception of Implementing Journal Club Activities: A Qualitative Study
Roaa Aljumaa, Reem Elmokattaf, Mohammad Aljumaa, Haifa Almuhanna , Marukh Rashid , Ismail A Abdullah, Abdul Rahman Sukar
Cureus.2023;[Epub] CrossRef
Medical students’ attitudes towards the teaching of cervical and ovarian cancer screening protocols in Ireland: a qualitative study
Paul McHugh, Donal Brennan, Mary F. Higgins
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Comparison of the effects of simulated patient clinical skill training and student roleplay on objective structured clinical examination performance among medical students in Australia: Silas Taylor, Matthew Haywood, Boaz Shulruf; J Educ Eval Health Prof. 2019;16:3. Published online January 11, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.3

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Abstract PDF Supplementary Material

Purpose
Optimal methods for communication skills training (CST) are an active research area, but the effects of CST on communication performance in objective structured clinical examinations (OSCEs) has not been closely studied. Student roleplay (RP) for CST is common, although volunteer simulated patient (SP) CST is cost-effective and provides authentic interactions. We assessed whether our volunteer SP CST program improved OSCE performance compared to our previous RP strategy.
Methods
We performed a retrospective, quasi-experimental study of 2 second-year medical student cohorts’ OSCE data in Australia. The 2014 cohort received RP-only CST (N=182) while the 2016 cohort received SP-only CST (N=148). The t-test and analysis of variance were used to compare the total scores in 3 assessment domains: generic communication, clinical communication, and physical examination/procedural skills.
Results
The baseline characteristics of groups (scores on the Australian Tertiary Admission Rank, Undergraduate Medicine and Health Sciences Admission Test, and medicine program interviews) showed no significant differences between groups. For each domain, the SP-only CST group demonstrated superior OSCE outcomes, and the difference between cohorts was significant (P<0.01). The superiority of volunteer SP CST over student RP CST in terms of OSCE performance outcomes was found for generic communication, clinical communication, and physical examination/procedural skills.
Conclusion
The better performance of the SP cohort in physical examination/procedural skills might be explained by the requirement for patient compliance and cooperation, facilitated by good generic communication skills. We recommend a volunteer SP program as an effective and efficient way to improve CST among junior medical students.

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Empirical analysis comparing the tele-objective structured clinical examination and the in-person assessment in Australia
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Review Article

Medical school accreditation in Australia: Issues involved in assessing major changes and new programs: Michael J. Field; J Educ Eval Health Prof. 2011;8:6. Published online June 8, 2011; DOI: https://doi.org/10.3352/jeehp.2011.8.6

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Abstract PDF

The Australian Medical Council (AMC) is an independent company for quality assurance and quality improvement in medical education in Australia and New Zealand. Accreditation procedures for the 20 medical schools in these two countries are somewhat different for three different circumstances or stages of school development: existing medical schools, established courses undergoing major changes, and new schools. This paper will outline some issues involved in major changes to existing courses, and new medical school programs. Major changes have included change from a 6 year undergraduate course to a 5 year undergraduate course or 4 year graduate-entry course, introduction of a lateral graduate-entry stream, new domestic site of course delivery, offshore course delivery, joint program between two universities, and major change to curriculum. In the case of a major change assessment, accreditation of the new or revised course may be granted for a period up to two years after the full course has been implemented. In the assessment of proposals for introduction of new medical courses, six issues needing careful consideration have arisen: forward planning, academic staffing, adequate clinical experience, acceptable research program, adequacy of resources, postgraduate training program and employment.

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Research article

Examiner seniority and experience are associated with bias when scoring communication, but not examination, skills in objective structured clinical examinations in Australia: Lauren Chong, Silas Taylor, Matthew Haywood, Barbara-Ann Adelstein, Boaz Shulruf; J Educ Eval Health Prof. 2018;15:17.; DOI: https://doi.org/10.3352/jeehp.2018.15.17

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Abstract PDF Supplementary Material

Purpose
The biases that may influence objective structured clinical examination (OSCE) scoring are well understood, and recent research has attempted to establish the magnitude of their impact. However, the influence of examiner experience, clinical seniority, and occupation on communication and physical examination scores in OSCEs has not yet been clearly established.
Methods
We compared the mean scores awarded for generic and clinical communication and physical examination skills in 2 undergraduate medicine OSCEs in relation to examiner characteristics (gender, examining experience, occupation, seniority, and speciality). The statistical significance of the differences was calculated using the 2-tailed independent t-test and analysis of variance.
Results
Five hundred and seventeen students were examined by 237 examiners at the University of New South Wales in 2014 and 2016. Examiner gender, occupation (academic, clinician, or clinical tutor), and job type (specialist or generalist) did not significantly impact scores. Junior doctors gave consistently higher scores than senior doctors in all domains, and this difference was statistically significant for generic and clinical communication scores. Examiner experience was significantly inversely correlated with generic communication scores.
Conclusion
We suggest that the assessment of examination skills may be less susceptible to bias because this process is fairly prescriptive, affording greater scoring objectivity. We recommend training to define the marking criteria, teaching curriculum, and expected level of performance in communication skills to reduce bias in OSCE assessment.

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