Revising an objective structured clinical examination in a resource-limited Pakistani Medical School

The objective structured clinical examination (OSCE) has not been used extensively in undergraduate medical education in resource-constrained locations, including Pakistan. The Shifa College of Medicine (SCM) in Islamabad modified an end-of-clerkship OSCE assessment in internal medicine for final year medical students from a previous static, pattern-recognition format to an interactive, clinical reasoning and skill-based format.

We modified the OSCE to be more dynamic and effective by creating a customized clinical skills laboratory, using standardized patients, developing competency checklists for OSCE stations, and stimulating more active participation from faculty members. Students were surveyed at the end of their medicine clerkship about the OSCE's organization, content, perceived utility and validity and its stressfulness. Faculty involved in the modified format also reported their perceptions in an open-ended survey.

The modified format was generally received positively by students and faculty. Twenty-eight percent of students found the OSCE to be stressful, which is a lower proportion than reported in the literature in other settings. Students suggested that OSCEs should be given more frequently and come with clearer instructions, and they indicated a need for better training in counseling skills. Responses from faculty were generally positive even though the modified format was regarded as more labor-intensive and time-consuming.

The OSCE, in its true sense, can be created and successfully implemented to assess the clinical skills of medical students in a resource-limited setting in the developing world.