Formative assessment of practical skills with peer-assessors: quality features of an OSCE in general medicine at the Heidelberg Medical Faculty.

Background: Objective Structured Clinical Examinations (OSCEs) have become an established examination format at German medical faculties. Medical experts routinely use a summative assessment to evaluate practical and communicative skills, while the use of the OSCE format by student examiners, as a formative examination, remains rather limited. Objective: The formative OSCE program of the Department of General Practice and Implementation Research at the Heidelberg Medical Faculty, which is conducted and evaluated by peer tutors, is examined with regard to its quality criteria and compared with summative OSCEs from other departments. Methods: Difficulties and discriminatory power of individual testing stations were determined for the summative, as well as the formative OSCE, and compared with each other. To assess the reliability of the measurements, an analysis of the data was carried out using the Generalizability theory. In addition, a comparison is made between the assessments of student examiners and second assessments by medical experts. Results: The stations of the formative OSCE show similar difficulties as those of the summative comparison OSCEs (Pform=0.882; Psum=0.845 - 0.902). With respect to measurement reliability, there are no differences between the OSCE in General Medicine and the other subjects. The assessments of student examiners and medical experts correlate highly (r=0.888). Conclusion: The formative OSCE in General Medicine is comparable to the summative comparison formats in terms of its quality criteria. The use of student examiners can be a reliable alternative to medical experts in formative OSCEs.

The AaLplus near-peer teaching program in Family Medicine strengthens basic medical skills-A five-year retrospective study.

BACKGROUND: Basic medical skills such as history taking and physical examination are essential components of clinical work profiles, but nevertheless have been neglected by conventional preclinical curricula. The near-peer-teaching program AaLplus [living anatomy plus] teaches basic medical skills, especially history taking, physical examination, and venepuncture, to preclinical students. It is a highly popular compulsory course in the first four semesters (320 students/year, 9h/semester) at Heidelberg University and ends with a formative Objective Structured Clinical Examination (OSCE) during which students receive structured in-depth feedback on their performance. AaLplus is part of the Department of General Practice's longitudinal curriculum for Family Medicine. OBJECTIVES: This study aims to assess whether the AaLplus program has positive effects on students' clinical skill development and subjective confidence in history taking, physical examination and venepuncture. METHODS: From 2015 to 2019, we asked all AaLplus participants to rate the program and self-assess their medical skills on 5-point Likert scales (min 1, max 5). In 4-station OSCEs, trained tutors rated the students' performance in all taught skills using standardized checklists. RESULTS: From 2015 to 2019 n = 1534 questionnaires returned (response rate = 98.6%, 52.7% females). After course completion, students felt able to take a patient's history (mean 3.97, SD = 0.75) and perform physical examinations (means range 3.82-4.36, SDs range 0.74-0.89) as well as venepuncture (mean 4.12, SD = 0.88). A large majority of students claimed they acquired these skills in the AaLplus program. During OSCE, 81.9% passed anamnesis, 93.1% passed physical examination, and 95.4% passed venepuncture (of n = 1556). Students mostly rated the feedback they received during the OSCE as "helpful" or "very helpful" (means for different stations 4.69-4.76, SDs 0.50-0.70). CONCLUSIONS: AaLplus is a positive example of a peer teaching program in the preclinical stage of medical studies. It successfully trains junior students in essential medical abilities and increases their confidence in their skills. A high percentage of students pass the formative OSCE and evaluate it positively. Consistently high ratings indicate the program's routine viability. Further studies are needed to analyze if programs like AaLplus could have an impact on the number of graduates choosing career in Family Medicine.

Peers as OSCE assessors for junior medical students - a review of routine use: a mixed methods study.

BACKGROUND: Peer-assisted learning is well established in medical education; however, peer tutors rarely act as assessors for the OSCE. In the compulsory, near-peer teaching programme covering basic medical skills at the University of Heidelberg, peer tutors serve as assessors on a formative OSCE. This study aimed to investigate the feasibility and acceptance of peer assessors and to survey the perceived advantages and disadvantages of their use. METHODS: In 2016 and 2017 all OSCE peer assessors (third to sixth-year medical students) and all of the peer-assessed students in 2017 (second-year-medical students) were invited to participate in a survey. Both groups were asked to complete a tablet-based questionnaire immediately after the OSCE. Peer assessors were asked to rate eight statements and the peer-assessed students to rate seven statements on a five-point Likert scale. Both were asked to comment on the advantages and disadvantages of peer-assessors. RESULTS: Overall, 74 of 76 peer assessors and 307 of 308 peer-assessed students participated in the study. 94% (67/74) of peer assessors and 90% (276/307) of the peer-assessed group thought that it is important to have peer tutors as assessors. Of the peer assessors, 92% (68/74) felt confident in giving structured feedback during the OSCE and 66% (49/74) felt they had improved their teaching skills. Of the peer-assessed students, 99% (306/307) were satisfied with their peers as OSCE assessors and 96% (292/307) considered the peer feedback during the OSCE as helpful. The participants mentioned structural benefits, such as lower costs, and suggested the quality of the OSCE was higher due to the use of peer assessors. The use of peer assessors was found to be beneficial for the learners in the form of high-quality feedback and an overall reduction in stress. Furthermore, the use of peer assessors was found to be beneficial for the peer assessors (improved teaching and clinical skills). CONCLUSION: From a learner's perspective, the use of peer assessors for a formative OSCE that is part of a near-peer teaching program aimed at junior medical students is favourable for all. A broad implementation of peer assessment in the formative OSCE should be encouraged to investigate effects on quality and stress-reduction.