Giulia Manzini*, Maximilian Denzinger, Marko Kornmann, Ian N. Hines,Michael Kremer
Background: The Objective Structured Clinical Examination (OSCE) was introduced by Harden et al. (1975) as an instrument to assess clinical, theoretical, and practical competencies. The COVID-19 pandemic had a significant impact on medical education, especially in the area of practical clerkships of medical students where in person, hands-on, instruction was replaced by online seminars.
Aim: To assess if the pandemic has influenced medical student performance on the surgical OSCE.
Methods: Student performance at a German University Hospital during three surgical OSCE examination windows, winter semester 2018/2019, 2020/2021 and 2021/2022, corresponding to before, during, and after pandemic changes to instruction were compared. For this comparison, 3 out of the 12 total OSCE stations were considered: suturing (0 to 20 points scale), determination of visceral surgical cases with clinical abdominal examination (0 to 10 points), and visceral description of surgical operation technics (0 to 8 points). The marks achieved by the students were compared among the three groups above using the Student t-test for independent samples. Evaluators at both visceral surgical stations were the same during the three OSCE and are senior consultants in visceral surgery. Evaluators of suturing were older students which changed at each OSCE.
Key findings: A total of 423 students took part in one of the three OSCE examination; 125 students were examined in winter semester 2018/2019, 155 in winter semester 2020/2021 and 143 students in winter semester 2021/2022. The pandemic impacted group had a higher average score than the group before pandemic (170.52 vs. 157.43) as well as the group after pandemic (170.52 vs. 168.60). Student performance in suturing was better during the pandemic than before pandemic (19.59 (± 0.95) vs 17.00 (± 2.04), p<0.001) as well as during pandemic than after pandemic (19.59 (± 0.95) vs 18.25 (± 1.87), p<0.001). Student performance in theoretical solving of a clinical case and performance of a complete abdominal examination was better before the COVID-19 pandemic than during the pandemic (8.32 (± 1.37) vs 7.94 (± 1.61), p=0.04) as well as after pandemic than during pandemic (8.36 (± 1.37) vs 7.94 (± 1.61), p=0.02). No difference was found in the comparison of the performance before and after pandemic (8.32 (± 1.37) vs 8.36 (± 1.37), p=0.83). Student’s performance in surgical technique was not different both before pandemic versus pandemic (p=0.37) and during pandemic versus after pandemic (p=0.14).
Conclusion: Cessation of the practical, in person, hands-on internship reduced student performance on the OSCE clinical case and abdominal examination section but not on suturing or surgical technique sections. These data suggest that alternative approaches to instruction including online education may be sufficient for some but not all aspects of the surgical internship. Further research is needed to understand how other competencies may have been affected during the pandemic and how instruction methodologies may be amended in the future to better serve student success.
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