"I Wish It Was Like This All the Time": Promoting Self-Efficacy and Self-Regulated Learning Through a Student-Run Formative Objective Structured Clinical Examination in Norway

Abstract

Background: Formative assessments give students feedback on performance to enhance learning. Peer-assisted learning has also been shown to enhance learning. Although peer-assisted formative objective structured clinical examinations (fOSCE) are used in medical education; how, when and what students learn during participation have not been fully explored. Methods: We piloted a student-run fOSCE where 11 fourth-year medical students and seven mentors from academic staff were purposefully recruited as participants. Students were trained in OSCE-case writing and feedback principles. They authored OSCE-cases with guidance from faculty mentors; set up and run a fOSCE where they took turns as examiners and students; and gave structured feedback. Approximately five weeks later, students had a summative end-of-term OSCE. The students’ experiences during the study were explored via individual interviews. Data was analyzed inductively through a qualitative content analytic approach, resulting in descriptive categories and interpretations relating to the phenomenon of students’ learning. Results: The student-run fOSCE provided an uncommon learning environment that was safe, student-controlled and where learning was fun, enjoyable and gave a sense of mastery. Learning was active and authentic, with clinical cases, challenging problem-solving, and retrieval practice; giving students the right level of attentiveness. Participants described feeling assessed as their distant future selves - physicians; and as their near future selves - summative OSCE exam takers. Part of the spectrum of learning was also students becoming more aware of their knowledge and competencies; and getting boosts of self-confidence and motivation. The usual roles, relationships and power differential between students and academic staff were altered during the learning process. Discussion and conclusion: Participation in the student-run fOSCE promoted self-efficacy by mirroring to students their hidden capabilities; and stimulating empowerment, motivation and a sense of mastery. Self-regulated learning was fostered through giving students the responsibility for their own and their peers’ learning, providing instances of self-reflection and -assessment; and showing them the outcome from being active learners with the right level of attentiveness. As learners and examinees, medical students bring unique insight to OSCE case creation. Data from this study support the incorporation of new student-driven active and authentic learning activities into the curriculum.