How can we reduce the cost of OSCEs? A cost-minimization and test accuracy study

Objective Structured Clinical Examinations (OSCEs) are resource‑intensive, yet little empirical evidence exists on how specific design choices influence cost. This study evaluated the cost implications of multiple OSCE variations while examining whether these modifications affect test accuracy.

A test accuracy and cost-minimization study was conducted using four years of OSCE data from an undergraduate pharmacy program. Variations to delivery mode (face-to-face (F2F) or online) and use of human simulated patients (yes or no) were evaluated. Test accuracy (Cronbach's alpha; standard error of measurement) was compared across delivery modes and use of simulated patients. A cost‑minimization analysis using the ingredients method modelled four OSCE variations, calculating average cost per student.

Neither delivery mode nor use of simulated patients significantly affected test accuracy. Online delivery with examiner dual role as examiner and patient was the lowest cost ($241), followed by F2F delivery with examiner dual role as examiner and patient ($339), online delivery with human simulated patients ($345), and F2F delivery with human simulated patients ($448).

This study highlights the potential for careful OSCE design to achieve cost savings without sacrificing test accuracy. Given the twofold difference between the lowest and highest cost variations, the cost implications are substantial. Within the context of a pharmacy program in a 'global north' country, cost-optimisation may be achieved through online delivery and having examiners perform the dual role of examining and acting as patients.