Journal of Educational Evaluation for Health Professions

Research articles

Leveraging feedback mechanisms to improve the quality of objective structured clinical examinations in Singapore: an exploratory action research study: Han Ting Jillian Yeo, Dujeepa Dasharatha Samarasekera, Michael Dean; J Educ Eval Health Prof. 2025;22:28. Published online September 30, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.28

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Abstract PDF Supplementary Material: Purpose
Variability in examiner scoring threatens the fairness and reliability of objective structured clinical examinations (OSCEs). While examiner standardization exists, there is currently no structured, psychometric-informed, individualized feedback mechanism for examiners. This study explored the feasibility and perceived value of such a mechanism using an action research approach to co-design and iteratively refine examiner feedback reports.
Methods
Two exploratory cycles were conducted between November 2023 and June 2024 with phase 4 OSCE examiners at the Yong Loo Lin School of Medicine. In cycle 1, psychometric analyses of examiner scoring for a phase 4 OSCE informed the design of individualized reports, which were evaluated through interviews. Revisions were made to the format of the report and implemented in cycle 2, where examiner responses were again collected. Data were analyzed thematically, supported by reflective logs and field notes.
Results
Nine examiners participated in cycle 1 and 7 in cycle 2. In cycle 1, examiners highlighted challenges in interpreting complex terminology, leading to report refinements such as glossaries and visual graphs. In cycle 2, examiners demonstrated greater confidence in applying feedback, requested longitudinal reports, and shifted from initial resistance to reflective engagement. Across cycles, the reports improved credibility, neutrality, and examiner self-regulation.
Conclusion
This exploratory study suggests that psychometric-informed feedback reports can facilitate examiner reflection and transparency in OSCEs. While the findings highlight feasibility and examiner acceptance, longitudinal delivery of feedback, collection of quantitative outcome data, and larger samples are needed to establish whether such reports improve scoring consistency and assessment fairness.

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; J Educ Eval Health Prof. 2022;19:30. Published online November 7, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.30

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Purpose
Coronavirus disease 2019 (COVID-19) restrictions resulted in an increased emphasis on virtual communication in medical education. This study assessed the acceptability of virtual teaching in an online objective structured clinical examination (OSCE) series and its role in future education.
Methods
Six surgical OSCE stations were designed, covering common surgical topics, with specific tasks testing data interpretation, clinical knowledge, and communication skills. These were delivered via Zoom to students who participated in student/patient/examiner role-play. Feedback was collected by asking students to compare online teaching with previous experiences of in-person teaching. Descriptive statistics were used for Likert response data, and thematic analysis for free-text items.
Results
Sixty-two students provided feedback, with 81% of respondents finding online instructions preferable to paper equivalents. Furthermore, 65% and 68% found online teaching more efficient and accessible, respectively, than in-person teaching. Only 34% found communication with each other easier online; Forty percent preferred online OSCE teaching to in-person teaching. Students also expressed feedback in positive and negative free-text comments.
Conclusion
The data suggested that generally students were unwilling for online teaching to completely replace in-person teaching. The success of online teaching was dependent on the clinical skill being addressed; some were less amenable to a virtual setting. However, online OSCE teaching could play a role alongside in-person teaching.

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Perception of online learning, knowledge assessment, and clinical skills among third-year ophthalmology residents studying during the COVID-19 pandemic in Thailand
Wanicha Chuenkongkaew, Jimethat Chalermpong, Weerawat Kiddee, Prut Hanutsaha, Anita Manassakorn, Olan Suwan-apichon, Sakchai Vongkittirux, Raveewan Choontanom, Pittaya Phamonvaechavan, Tharnsook Kasemsup, Paradee Kunavisarut, Sudawadee Somboonthanakij, Su
Scientific Reports.2026;[Epub] CrossRef
Evaluation of a virtual objective structured clinical examination in the metaverse (Second Life) to assess the clinical skills in emergency radiology of medical students in Spain: a cross-sectional study
Alba Virtudes Perez-Baena, Teodoro Rudolphi-Solero, Rocio Lorenzo-Alvarez, Dolores Dominguez-Pinos, Miguel Jose Ruiz-Gomez, Francisco Sendra-Portero
Journal of Educational Evaluation for Health Professions.2025; 22: 12. CrossRef
A Comparative Study of Student Perspectives on Online Versus In-Person Objective Structured Clinical Examination (OSCE) Teaching at a Medical School in London
Nimalesh Yogarajah, Aniket Bharadwaj, Amelia Snook, Vashist Motkur
Cureus.2025;[Epub] 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
Should Virtual Objective Structured Clinical Examination (OSCE) Teaching Replace or Complement Face-to-Face Teaching in the Post-COVID-19 Educational Environment: An Evaluation of an Innovative National COVID-19 Teaching Programme
Charles Gamble, Alice Oatham, Raj Parikh
Cureus.2023;[Epub] CrossRef

Comparing the cut score for the borderline group method and borderline regression method with norm-referenced standard setting in an objective structured clinical examination in medical school in Korea: Song Yi Park, Sang-Hwa Lee, Min-Jeong Kim, Ki-Hwan Ji, Ji Ho Ryu; J Educ Eval Health Prof. 2021;18:25. Published online September 27, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.25

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Abstract PDF Supplementary Material

Purpose
Setting standards is critical in health professions. However, appropriate standard setting methods do not always apply to the set cut score in performance assessment. The aim of this study was to compare the cut score when the standard setting is changed from the norm-referenced method to the borderline group method (BGM) and borderline regression method (BRM) in an objective structured clinical examination (OSCE) in medical school.
Methods
This was an explorative study to model the implementation of the BGM and BRM. A total of 107 fourth-year medical students attended the OSCE at 7 stations for encountering standardized patients (SPs) and at 1 station for performing skills on a manikin on July 15th, 2021. Thirty-two physician examiners evaluated the performance by completing a checklist and global rating scales.
Results
The cut score of the norm-referenced method was lower than that of the BGM (P<0.01) and BRM (P<0.02). There was no significant difference in the cut score between the BGM and BRM (P=0.40). The station with the highest standard deviation and the highest proportion of the borderline group showed the largest cut score difference in standard setting methods.
Conclusion
Prefixed cut scores by the norm-referenced method without considering station contents or examinee performance can vary due to station difficulty and content, affecting the appropriateness of standard setting decisions. If there is an adequate consensus on the criteria for the borderline group, standard setting with the BRM could be applied as a practical and defensible method to determine the cut score for OSCE.

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Standard setting methods in objective structured clinical examination (OSCE): A comparative study of five methods
Reshma Ansari, Norhafizah Ab Manan, Nur Ain Mahat, Norfaizatul Shalida Omar, Atikah Abdul Latiff, Sara Idris, Azli Shahril Othman
Journal of Medical Education Development.2024; 17(56): 87. CrossRef
Analyzing the Quality of Objective Structured Clinical Examination in Alborz University of Medical Sciences
Suleiman Ahmadi, Amin Habibi, Mitra Rahimzadeh, Shahla Bahrami
Alborz University Medical Journal.2023; 12(4): 485. CrossRef
Possibility of using the yes/no Angoff method as a substitute for the percent Angoff method for estimating the cutoff score of the Korean Medical Licensing Examination: a simulation study
Janghee Park
Journal of Educational Evaluation for Health Professions.2022; 19: 23. CrossRef
Newly appointed medical faculty members’ self-evaluation of their educational roles at the Catholic University of Korea College of Medicine in 2020 and 2021: a cross-sectional survey-based study
Sun Kim, A Ra Cho, Chul Woon Chung
Journal of Educational Evaluation for Health Professions.2021; 18: 28. 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; 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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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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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
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Newly appointed medical faculty members’ self-evaluation of their educational roles at the Catholic University of Korea College of Medicine in 2020 and 2021: a cross-sectional survey-based study
Sun Kim, A Ra Cho, Chul Woon Chung
Journal of Educational Evaluation for Health Professions.2021; 18: 28. CrossRef

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
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Feasibility and reliability of the pandemic-adapted online-onsite hybrid graduation OSCE in Japan
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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
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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
Journal of Educational Evaluation for Health Professions.2022; 19: 30. CrossRef
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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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 article

Sequential Objective Structured Clinical Examination based on item response theory in Iran: Sara Mortaz Hejri, Mohammad Jalili; J Educ Eval Health Prof. 2017;14:19. Published online September 8, 2017; DOI: https://doi.org/10.3352/jeehp.2017.14.19

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Abstract PDF

Purpose
In a sequential objective structured clinical examination (OSCE), all students initially take a short screening OSCE. Examinees who pass are excused from further testing, but an additional OSCE is administered to the remaining examinees. Previous investigations of sequential OSCE were based on classical test theory. We aimed to design and evaluate screening OSCEs based on item response theory (IRT).
Methods
We carried out a retrospective observational study. At each station of a 10-station OSCE, the students’ performance was graded on a Likert-type scale. Since the data were polytomous, the difficulty parameters, discrimination parameters, and students’ ability were calculated using a graded response model. To design several screening OSCEs, we identified the 5 most difficult stations and the 5 most discriminative ones. For each test, 5, 4, or 3 stations were selected. Normal and stringent cut-scores were defined for each test. We compared the results of each of the 12 screening OSCEs to the main OSCE and calculated the positive and negative predictive values (PPV and NPV), as well as the exam cost.
Results
A total of 253 students (95.1%) passed the main OSCE, while 72.6% to 94.4% of examinees passed the screening tests. The PPV values ranged from 0.98 to 1.00, and the NPV values ranged from 0.18 to 0.59. Two tests effectively predicted the results of the main exam, resulting in financial savings of 34% to 40%.
Conclusion
If stations with the highest IRT-based discrimination values and stringent cut-scores are utilized in the screening test, sequential OSCE can be an efficient and convenient way to conduct an OSCE.

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Beyond the Score: Riding the Possibilities of Item Response Theory in Medical Education
Gurjeet Singh, Nilakantan Ananthakrishnan, Raksha Singh
CHRISMED Journal of Health and Research.2025; 12(3): 221. CrossRef
Utility of eye-tracking technology for preparing medical students in Spain for the summative objective structured clinical examination
Francisco Sánchez-Ferrer, J.M. Ramos-Rincón, M.D. Grima-Murcia, María Luisa Sánchez-Ferrer, Francisco Sánchez-del Campo, Antonio F. Compañ-Rosique, Eduardo Fernández-Jover
Journal of Educational Evaluation for Health Professions.2017; 14: 27. CrossRef

Technical Report

Introduction and Administration of the Clinical Skill Test of the Medical Licensing Examination, Republic of Korea (2009): Kun Sang Kim; J Educ Eval Health Prof. 2010;7:4. Published online December 3, 2010; DOI: https://doi.org/10.3352/jeehp.2010.7.4

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Abstract PDF

The first trial of the clinical skill test as part of the Korean Medical Licensing Examination was done from September 23 to December 1, 2009, in the clinical skill test center located in the National Health Personnel Licensing Examination Board (NHPLEB) building, Seoul. Korea is the first country to introduce the clinical skill test as part of the medical licensing examination in Asia. It is a report on the introduction and administration of the test. The NHPLEB launched researches on the validity of introducing the clinical skill test and on the best implementation methods in 2000. Since 2006, lists of subjects of test items for the clinical skill test has been developed. The test consisted of two types of evaluation, i.e., a clinical performance examination (CPX) with a standardized patient (SP) and objective structured clinical examination (OSCE). The proctor (medical faculty member) and SP rate the examinees??proficiency for the OSCE and CPX respectively. Out of 3,456 applicants, 3,289 examinees (95.2%) passed the test. Out of 167 examinees who failed the clinical skill test, 142 passed the written test. This means that the clinical skill test showed characteristics independent from the written test. This successful implementation of the clinical skill test is going to improve the medical graduates??performance of clinical skills.

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Review Article

The New Horizon for Evaluations in Medical Education in Korea: Sang-Ho Baik; J Educ Eval Health Prof. 2005;2(1):7-22. Published online June 30, 2005; DOI: https://doi.org/10.3352/jeehp.2005.2.1.7

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Abstract PDF

Over the last two decades, there have been a number of significant changes in the evaluation system in medical education in Korea. One major improvement in this respect has been the listing of learning objectives at medical schools and the construction of a content outline for the Korean Medical Licensing Examination that can be used as a basis of evaluation. Item analysis has become a routine method for obtaining information that often provides valuable feedback concerning test items after the completion of a written test. The use of item response theory in analyzing test items has been spreading in medical schools as a way to evaluate performance tests and computerized adaptive testing. A series of recent studies have documented an upward trend in the adoption of the objective structured clinical examination (OSCE) and clinical practice examination (CPX) for measuring skill and attitude domains, in addition to tests of the knowledge domain. There has been an obvious increase in regional consortiums involving neighboring medical schools that share the planning and administration of the OSCE and CPX; this includes recruiting and training standardized patients. Such consortiums share common activities, such as case development and program evaluation. A short history and the pivotal roles of four organizations that have brought about significant changes in the examination system are discussed briefly.

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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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Michel Benyamin, Sandrella Hamdan, Timothy Fasham, Samuel Morice, Stephane Le Goff, Maria‐Antonietta D'Agostino, Marie Jannot, Yasmine Smail, Jean‐Pierre Attal, Hélène Gouze, Elisabeth Dursun, Philippe Francois
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