Around 60 fifth- and sixth-year general medicine students will take an objective structured clinical examination (OSCE) in the spring of 2024 at the UP Medical School, where this internationally widespread, complex examination method was first modelled in Hungary in 2023.
The objective structured clinical examination (OSCE) is an internationally widespread, complex examination methodology in which students’ performance is observed through a series of realistic, simulated clinical situations. Research has shown that it is a reliable tool for assessing a wide range of clinical skills and an important milestone in developing the competencies needed to perform everyday medical tasks.
On the initiative of Dr. László Czopf, Vice-Dean for Education, the Medical School has set the goal of modelling the methodology in Hungary starting in 2023. The project has been funded within the framework of the RRF-2.1.2-21 “Infrastructure and skills development for practice-oriented higher education training programs” tender, and the leadership of the faculty is committed to its implementation.
After the preparatory work, the first formative OSCE exam was held on 22 April 2023 with the participation of 16 Hungarian fifth- and sixth-year medical students. The students demonstrated their practical skills by completing eight 10-minute stations in two rounds. They had to solve a specific clinical situation at each station - the location could be a GP’s office, an emergency room, or a hospital department. During the no-stakes exam, students took history in internal medicine and neurology, performed physical examination components, attended to a patient with acute complaints, performed an invasive procedure, and consulted with patient who had just been discharged from the department.
The cases were modelled by simulated patients trained by the Simulated Patient Program, a unique program in Hungary that is part of the Department of Languages for Biomedical Purposes and Communication. Examiners (doctors, nurses, or communication experts) assigned to the station, who observed the situations in the background, gave each student immediate and detailed feedback using an evaluation form. This covered not only the observed clinical competencies but also clinical thinking and communication skills.
Participants rated OSCE positive, the first of its kind in the country to include trained simulated patients. Feedback from teachers and students indicated that they felt that the situations and cases presented by the simulated patients were realistic and that the exam assessed practical skills adequately and consistently. All students found the feedback from the examiners and simulated patients helpful. Below are some comments from the participants:
“I had to go over a patient pathway from start to finish, which I didn’t really do during my training so far.” (student)
“There were some things that did not go very well during the situations, which the teachers reflected on, and I feel that these comments were in my best interest. I think my result reflects the reality; it highlighted my strengths and weaknesses.” (student)
“The uniform assessment system was a good experience; it would be worthwhile to use it more broadly in everyday life.” (teacher)
“I would like to use the simulated patients to teach basic clinical skills. It would make the classes more plannable and reduce the workload on patients.” (teacher)
The work of the participating departments is coordinated by Dr. Judit Sebők, teacher at the 2nd Department of Internal Medicine and Nephrology, Diabetology Center, who acts as medical director, and by Dr. Gergely Csaba, a staff member of the Department of Behavioural Sciences Division of Medical Education Development and Communication (OOKT), who is the OSCE-lead, the organiser of the program. The coordination and preparation of the simulated patients are carried out by the teachers of the Department of Languages for Biomedical Purposes and Communication; last year by Dr. Anikó Hambuchné Kőhalmi, Dr. Judit Fekete and Dr. Katalin Eklicsné Lepenye, who also helped assess the students during the exam as communication experts. The significantly expanded Medical Skills Education and Innovation Centre (OKIK) and its specialists and technicians provide the infrastructure and the modern simulation tools needed for the exam.
The clinics, examiners, and simulated patients of the 2023 OSCE stations were the following:
- 1st Department of Medicine (director: Dr. Kálmán Tóth, full professor) - Dr. László Czopf, Dr. Patrícia Sarlós, Dr. Szilvia Soós
- 2nd Department of Internal Medicine and Nephrology, Diabetology Center (director: Dr. István Wittmann, full professor) - Dr. Judit Sebők
- Department of Languages for Biomedical Purposes and Communication (director: Dr. Vilmos Warta) and Simulated Patient Program - Dr. Anikó Hambuchné Kőhalmi, Dr. Judit Fekete, Dr. Katalin Eklicsné Lepenye, Péter Csatlós, Márk Dömötör, Genovéva Horváth, Dávid Lokodi, Ákos Markovics, Ildikó Russay, György Szabó, Tamás Tóth
- Department of Neurology (director: Dr. József Janszky, full professor) - Dr. Márk Harmat, Dr. Zsófia Karádi
- Medical Skills Education and Innovation Centre (director: Dr. Szilárd Rendeki) - Péter Szűcs, Mihály Csont
- Heart Institute (director: Dr. Attila Cziráki, full professor) - Dr. Balázs Gaszner, Dr. Máté Hajdu
In April 2024, it is planned to conduct the formative examinations of 60 fifth- and sixth-year general medicine students, with 20-20 students per language program. The project’s long-term objective is to integrate the exam format into the compulsory curriculum, in addition to the current clinical exams, which will contribute to the high-quality assessment of essential practical skills. The current practices and practical exams with actual patients are seen as a strength of the training in international and accreditation viewpoint. An OSCE carried out at critical points in the curriculum could complement these, further enhancing the effectiveness and prestige of the training.
Photos:
Lajos Kalmár
Dr. Kristóf Filipánits