A simulation-based OSCE with case presentation and remote rating - development of a prototype.

Simulation-based examination formats improve the possibility to assess medical students' competences during their performance. Additionally, videotaping of simulations allows for remote rating, providing advantages for raters, students, and exam organizers. We describe a simulation-based OSCE prototype with remote rating of students' competences, developed to replace a conventional OSCE at Hamburg Medical Faculty. The assessment consists of two phases: a consultation phase with four simulated patient encounters and a case presentation phase where four students present two cases each. All encounters from the consultation and the presentation phase are to be videotaped and remotely rated by clinical raters. Advanced medical students (year 4) are to be assessed regarding their clinical knowledge as well as physician-patient-communication, clinical reasoning competence, and patient management competence. We provide detailed schedules for the simulation-based OSCE procedure and a roster for organization. When piloting the assessment, we encountered two major obstacles with respect to legal obligations regarding examination time and videotaping which allowed us to provide tips on how to successfully implement this assessment prototype. Remote rating will, when successfully implemented, help students to concentrate on their consultation or presentation tasks, reduce raters' time constraints and also allow for randomized rating. Using established instruments for competence-rating rather than OSCE checklists provides an additional feature for this simulation-based OSCE prototype. Legal issues can be avoided by using the prototype for formative assessment but should be addressed in advance when it is planned to be used as summative assessment.