The search for the optimal model of the state exam for graduates of medical universities is one of the most urgent and at the same time the most difficult tasks for the medical education system of any developed country in the world [1, 2]. The graduation certification is a kind of reflection of the quality of the several-year educational process, which should determine the theoretical training of the students in the field of basic, general professional and special disciplines, as well as the level of mastery of clinical competencies for the successful performance of medical duties and solving professional tasks in the future [3, 4]. It is important to emphasize that the results of the unified state exam are also a summary of the organizational and managerial competence of the higher education institution itself, the expertise of the university teachers, their psychological-pedagogical, research, reflective, worldview and communicative competences [5].
It is quite obvious that the methods of clinical examination, which have been used in the Ukrainian medical educational institutions for a long time, had two very important shortcomings. First, according to the European standards they did not provide a sufficient level of validity of the final exam - a key criterion for assessing the quality of the methodology. That is, it was not possible to carry out a reliable assessment of the student's training as a part of the certification due to the lack of demonstration of a wide range of specialized knowledge by him, namely abilities and practical skills, clinical examination methods, interpretation of clinical laboratory and instrumental examination methods used by experts. These competencies have a common name - "hard skills" (or skills of a specific specialization). In addition, the format of the exam that existed significantly narrowed the opportunities for the student to demonstrate the so-called "soft skills" (flexible, interprofessional skills) - the ability to listen to the patient, observe and identify the essence of the problem, avoid or resolve conflict during communication, convince, understand non-verbal signals, non-standard thinking, etc. It is known that the combination of these abilities allows a doctor to gain competitiveness and demand in the modern world.
The second disadvantage of the traditional clinical examination was the presence of a high risk of unfair assessment. When choosing a question card, there was a certain lottery of the complexity of questions or tasks, in addition, the student answered in most cases to one examiner, so there was a risk of discriminatory influences and non-compliance with the established rules and standards of the exam by the university teacher himself.
Taking into account the above-mentioned shortcomings, the options for conducting the state exam were constantly improved, but its concept did not change over the years.
At present, the most acceptable format for graduation certification is the objective structured clinical exam (OSCE) [6]. The unique and flexible method of conducting OSCE is aimed at assessing the clinical competence of the student in one exam with the wide involvement of modern simulators, dummies, phantoms as well as standardized or real patients, with any possibility of bias on the part of the patient or the examiner reduced to the extent that the result is a true assessment of the clinical competence of the learner [7, 8]. The introduction of the OSCE certification system became a significant factor in increasing the motivation and responsibility of students to master practical skills in accordance with international standards, as well as a significant impetus for significant and qualitative changes in the conceptual approaches of imparting knowledge by the university teachers.
The first OSCE took place at the University of Dundee in Scotland in 1972. It should be emphasized that the University of Dundee is one of the most prestigious British educational institutions, which is among the 400 best universities in the world according to the main global rankings of 2023 (Academic Ranking of World Universities, QS World University Rankings, Times and CWTS Leiden Ranking), it is leader in the field of "Life Sciences and Medicine", occupying the 116th position in the world in this direction.
The structure of OSCE, its format, conditions of conduction, assessment system were developed by a team of the university teachers under the chairmanship of the director of the Center for Medical Education at the University of Dundee, Professor Ronald M. Harden. The first paper with a detailed description of the new approach to the assessment of graduates of higher medical education appeared in the British Medical Journal in 1975 under the title "Assessment of Clinical Competence using Objective Structured Examination" [9]. Since then, numerous analytical publications have appeared on various modifications of the exam, the experience of conducting them and possible ways of improvement. Elsevier - one of the largest publishing companies in the world, released the book "The Definitive Guide to the OSCE: The Objective Structured Clinical Examination as a performance assessment" in 2015. This unique publication contains a detailed description of the international experience of OSCE, the ranges of its use, the possibilities of application at various stages of training, and discussion of controversial issues. Based on many years of experience, the authors have provided comprehensive practical instructions and useful tips. Today, Professor Ronald M. Harden is recognized as a leading international expert in the field of medical education, holds the position of general secretary of The Association for Medical Education in Europe, which has held annual conferences for many years (the next conference will be held in Glasgow, Scotland on 26 - August 30, 2023). At the previous conference, which took place on August 27-31, 2022 in Lyon, France, Professor Ronald M. Harden stated: “From the very beginning, my approach has been that we must challenge the system. I think we have an exciting future ahead of us in medical education. There are still so many things that need to be done." The writing of the book "The Changing Role of Medical Students", which has just been published by Elsevier, became a significant aspect of the activity of the professor and his followers. The monograph raises a very relevant issue - the need to change the student's role from a consumer and client to a partner in the learning process. According to experts, this book will be one of the most important events in medical education in the last two decades.
Thus, OSCE is a completely new concept of determining the quality of the received medical education, which allows to determine the level of mastery of basic clinical competencies by the student in detail and systematically during one exam - communication skills and clinical examination of the patient, the ability to prescribe the necessary laboratory and instrumental studies and evaluate their results, perform specialized manipulations, establish the most likely diagnosis, diagnose life-threatening conditions for the patient, provide emergency medical care, recommend treatment and preventive measures [10, 11].
At Odesa National Medical University (ONmedU) OSCE-2, as a practical part of the unified state qualifying exam, has been held since 2018 in accordance with the Resolution of CMU No. 302 of 03.27.2018 "On approval of the Procedure for the implementation of the unified state qualifying exam for holders of a master's degree in specialties of field of knowledge "Health care".
29 departments of the university participate in the preparation for OSCE, which create a valid list of practical medical skills and situational tasks, in accordance with national recommendations approved by educational and professional, standard and work programs. Almost all departments of ONmedU have simulation training classes, where students have ample opportunities to improve significantly the level of mastery of practical skills on modern phantoms, dummies and mannequins under the supervision of the university teacher. Moreover, the Department of "Simulation Medical Technologies" was created at ONmedU. In practical classes, students practice practical skills and algorithms of emergency measures on simulators in clinical situations of different complexity and format, work in virtual operating rooms, which definitely contributes to the formation of clinical thinking in students, faster assimilation of the necessary professional competences and, as a result, successful completion of OSCE.
It is important to emphasize that a separate structural unit operates in ONmedU - "Educational and production complex of innovative technologies of learning, informatization, continuous education" (EPC ITICE). One of the tasks of EPC ITICE is to conduct internal monitoring of the quality of education and preparation for OSCE, which begins in September of the current academic year. Thanks to the use of the electronic "Information System of ONMedU", each department teacher participating in OSCE has his "private office", where the date and time of the master class and the list of practical skills are indicated in the "my classes" section according to the schedule. Students have the opportunity to sign up for a 2-hour training on a day convenient for them, during which the teacher demonstrates, explains and monitors the correctness of the students' performance of practical skills, discusses issues, and answers questions. It should be noted that the number of students in a study group is usually regulated - no more than 5-6 people. At the end of the class, the teacher must fill in the electronic journal created for each student who signed up for the training. This journal displays information about the student's visits to master classes and the degree of assimilation of each practical skill (failed, passed, passed with help). Such a modern electronic control system allows for an objective, detailed and comparative analysis of the student preparation for the unified state qualifying exam, which is a fundamental component for achieving strategic goals and objectives in the field of ensuring the quality of the educational process at ONmedU.
It should also be emphasized that OSCE is held in a separate two-story building, the design of which allows for very convenient placement of 11 stations for conducting the exam, a rest area, and a room for holding briefings and debriefings. Twice before the decisive exam, a "trial OSCE" is held, which is as close as possible to the real one. It helps students to familiarize themselves with and understand the OSCE algorithm, practice response strategies and communication with standardized patients, time management skills (learn how to rationally manage the allotted time in certain parts of the exam), analyze mistakes, identify weak points in their knowledge, which certainly significantly reduces stress on the day of the exam and helps to strengthen confidence in the successful completion of the final certification.
Thus, ONmedU has created the most convenient conditions for conducting and passing the unified state qualification exam successfully. The experience gained is invaluable and was the result of the adopted strategic direction of improving the quality of higher medical education, unwavering adherence to defined priorities and achievable goals, team interaction of department teachers and university management, thoughtful positioning and responsible attitude to the work of each of the participants.
References:
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2. Catherine R. Lucey, John A. Davis, Marianne M. Green. We have no choice but to transform: the future of medical education after the COVID-19 pandemic. Acad Med. 2022 Mar; 97(3): S71–S81. Published online 2022 Feb 23. doi: 10.1097/ACM.0000000000004526 PMCID: PMC8855762
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5. Eui-Ryoung Han, Sanghee Yeo, Min-Jeong Kim, Young-Hee Lee, Kwi-Hwa Park, Hyerin Roh. Medical education trends for future physicians in the era of advanced technology and artificial intelligence: an integrative review. BMC Med Educ. 2019; 19: 460. Published online 2019 Dec 11. doi: 10.1186/s12909-019-1891-5 PMCID: PMC6907217
6. Sloan AD, Donnelly MB, Schwartz RW, Strodel WE. The objective structured clinical examination. The new gold standard for evaluating postgraduate clinical performance. Annals of Surgery. 1995;222:735–742.
7. U, Onwudiegwu. OSCE: design, development and deployment. J West Afr Coll Surg. 2018 Jan-Mar; 8(1): 1–22. PMCID: PMC6398515
8. Md Anwarul Azim Majumder, Alok Kumar, Kandamaran Krishnamurthy, Nkemcho Ojeh, Oswald Peter Adams, Bidyadhar Sa. An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives. Adv Med Educ Pract. 2019; 10: 387–397. Published online 2019 Jun 5. doi: 10.2147/AMEP.S197275
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