Institute of Education in Healthcare and Medical Sciences, University of Aberdeen, Aberdeen, UK.
Department of Continuing Professional Development and Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Med Educ. 2024 Feb;58(2):235-246. doi: 10.1111/medu.15173. Epub 2023 Jul 30.
The Objective Structured Clinical Examination (OSCE) is a key feature of healthcare education assessment. Many aspects of the OSCE are well-investigated, but not so its sociomaterial assemblage. The Covid-19 pandemic provided a unique opportunity to (re)consider taken-for-granted OSCE practices. Drawing on Law's modes of ordering, our aim was to demonstrate the 'mangle of practice' between space and people; the spatialised and spatialising processes of an OSCE.
We used a case study approach to critically examine a redesigned final year MBChB OSCE held during the pandemic. We used multiple sources of data to attune to human and non-human actors: OSCE documentation, photographs, field notes and semi-structured interviews with OSCE staff/organisers. Law's modes of ordering was used as an analytical lens to critically consider how people and things flowed through the adapted OSCE.
The overarching ordering was the delivery of a 'pandemic safe' OSCE. This necessitated reordering of 'usual' process to deliver a socially distanced, safe flow of human and non-human actors through the assessment space. Each change had material and social 'knock on' effects. We identified three main interrelated orderings: Substituting technologies for bodies: Disembodied and dehumanised but feasible; Flow through space: Architectural affordances and one-way traffic; Barriers to flow: Time and technology.
Looking at the OSCE through a sociomaterial lens allows us to critically examine the OSCE's essential and complex processes and the restrictions and affordances of the spaces and props within the OSCE. In doing so, we open the possibility of considering alternative ways of doing OSCEs in the future. Moreover, conceptualising the OSCE as a living set of socially (human) and materially (nonhuman) enacted processes changes the social perception of the OSCE and highlights that an OSCE has agency on people, places and things.
客观结构化临床考试（OSCE）是医疗保健教育评估的一个关键特征。OSCE 的许多方面都得到了很好的研究，但并非如此，其社会物质组合。Covid-19 大流行提供了一个独特的机会来（重新）考虑被视为理所当然的 OSCE 实践。借鉴法律的排序模式，我们的目的是展示 OSCE 中的“实践的纠缠”；OSCE 的空间化和空间化过程。
我们使用案例研究方法批判性地审查了大流行期间进行的最后一年 MBChB OSCE 的重新设计。我们使用多种数据来源来适应人类和非人类行为者：OSCE 文档、照片、实地笔记和对 OSCE 工作人员/组织者的半结构化访谈。法律的排序模式被用作分析镜头，批判性地考虑了人和物如何通过适应的 OSCE 流动。
总体排序是提供“安全大流行”的 OSCE。这需要重新安排“通常”的流程，以实现人类和非人类行为者通过评估空间的社交距离、安全流动。每个更改都具有物质和社会的“连锁”影响。我们确定了三个主要的相互关联的排序：替代技术替代身体：非实体化和非人性化但可行；空间中的流动：建筑优势和单向交通；流动障碍：时间和技术。
通过社会物质视角审视 OSCE，使我们能够批判性地检查 OSCE 的基本和复杂流程，以及 OSCE 内空间和道具的限制和优势。通过这样做，我们为未来考虑替代的 OSCE 方式提供了可能性。此外，将 OSCE 概念化为一组具有社会（人类）和物质（非人类）实施过程的活的集合，改变了对 OSCE 的社会认知，并强调 OSCE 对人和物具有能动性。
