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Introducción de un examen clínico estructurado de teleobjetivo para teléfonos inteligentes para respaldar decisiones
Xiaozhi Wang1, Junjie Du2, Binlin Luo3
1Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Background:
High-stakes Objective Structured Clinical Examinations (OSCEs) are resource-intensive and may constrain access and equity, especially for candidates from remote locations. Smartphone-based tele-OSCEs could reduce logistical burdens while maintaining assessment quality.
Objective:
To evaluate whether a smartphone tele-OSCE yields assessment outcomes comparable to an in-person OSCE while improving implementation efficiency, costs, and acceptability within an undergraduate medical curriculum.
Methods:
We conducted a quasi-experimental historical-control study (2021 tele-OSCE vs 2019 in-person OSCE) in 5th-year medical students at a single university in China. The tele-OSCE comprised 2 stations (history taking, clinical reasoning) aligned with the course blueprint. Primary outcomes included overall scores and pass/fail decisions; secondary outcomes included examiner/standardized patient (SP)/student acceptability, direct per-candidate costs, total examination time, and logistical metrics. Psychometric analyses included interexaminer correlations and descriptive consistency checks.
Results:
Of 176 candidates scheduled for the 2021 tele-OSCE, 164 without prior online-OSCE exposure were analyzed; 272 in-person candidates from 2019 served as historical controls. Students in the tele-OSCE cohort obtained lower mean scores than those in the 2019 in-person OSCE cohort (65.6 ± 11.2 vs 72.0 ± 10.6; P < .001; Cohen's d = 0.59), although pass rates remained similarly high in both years. Interexaminer correlations across 4 cases ranged from r = .47 to .93 (all P < .05), indicating moderate-to-high agreement. Direct costs per candidate were modestly higher for tele-OSCE than in-person (USD45.22 vs 40.13; +12.7%). The tele-OSCE eliminated the need for candidates to travel (commuting) and reduced on-site density; most students, SPs, and examiners reported positive acceptability.
Conclusions:
A smartphone tele-OSCE can support curriculum-integrated, high-stakes competency decisions with performance outcomes that remain within an acceptable range relative to the conventional format, while improving logistical feasibility. We provide implementation details and practical guidance to facilitate replication in similar curricular settings.
