Association Between Pre-Internship Examination Scores and OSCE Performance: Implications for Resource-Efficient...

Competency-based medical education (CBME) requires robust alignment between theoretical knowledge assessments and clinical performance evaluations. In resource-constrained settings like Iran, conducting separate high-stakes examinations strains limited faculty, infrastructure, and budgets. This study examined the predictive relationship between pre-internship written examination scores and Objective Structured Clinical Examination (OSCE) performance, with implications for sustainable assessment redesign.

Retrospective analytical study of 312 sixth-year medical students (208 female, 104 male) from OSCE sessions 17-20 (2021-2024) at Ahvaz Jundishapur University. Pre-internship scores (200-item MCQ, 0-100 scale) and OSCE scores (12 stations: 6 theoretical, 6 practical) were analyzed using t-tests, Pearson correlations, multiple regression, and quartile analysis (SPSS 26.0).

No gender differences emerged (pre-internship: female 66.2±7.9 vs male 64.8±8.7, P=0.18; OSCE: female 69.4±9.8 vs male 67.1±10.9, P=0.07). Strong positive correlation existed between assessments (r=0.55, 95% CI: 0.45-0.63, P<0.001, R²=0.30). Correlations persisted for theoretical stations (r=0.52) and practical stations (r=0.48), consistent across genders. Regression confirmed pre-internship as significant predictor (β=0.55, adjusted R²=0.29). Top pre-internship quartile: 38% achieved top OSCE quartile vs 9% from lowest quartile (χ²=32.1, P<0.001).

Theoretical knowledge explains ∼30% of OSCE variance, supporting integrated curricula while highlighting needs for enhanced practical training. In Iran's resource-limited context, consolidated hybrid or programmatic assessment models could optimize efficiency, reduce costs, maintain validity, and advance sustainable CBME implementation.