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60 fifth- and sixth-year general medicine students could test their clinical skills and clinical thinking in the frame of an objective structured clinical examination (OSCE) at the UP Medical School in April 2024. The use of the internationally widespread complex examination method will continue in the spring of 2025.

The Objective Structured Clinical Examination (OSCE) is a complex examination methodology widely used internationally, in which students’ performance is observed in 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 the development of competences for everyday medical practice.

On the initiative of Dr. László Czopf, Vice-Dean for Education, the School has set a goal for 2023 to model the methodology in Hungary and gradually introduce it. The project has been funded in the frame of the RRF-2.1.2-21 “Infrastructure and skills development for practice-oriented training in higher education” tender and the leadership of the School has committed to its implementation.

In 2023, the first formative OSCE examination was held with 16 Hungarian fifth- and sixth-year general medicine students, and in April 2024, 20-20 Hungarian, English and German students had the opportunity to take part in an OSCE examination. The students demonstrated their practical skills by completing ten different 7-minute stations in six rounds. At each station, the students had to solve a specific clinical situation – it could be a GP’s office, an emergency room or a hospital ward. During the no-stakes exam, students took the anamnesis, performed physical examination components, attended to patients with acute complaints, performed invasive interventions and wound treatment, and practiced a special situation of doctor-patient communication, namely the delivery of bad news, mainly in the fields of internal medicine, neurology and oncology.

The cases were modelled by trained simulated patients, who were prepared by the Simulated Patient Programme, a unique Hungarian programme in Hungarian, English and German operating within the Department of Languages for Biomedical Purposes and Communication. The examiners (doctors and communication specialists) assigned to the stations who observed the situations in the background gave each student immediate and detailed feedback using an evaluation form. This covered not only the clinical competences but also clinical thinking and communication skills.

Participants were clearly positive about OSCE. Feedback from both teachers and students indicated that they felt that the situations were realistic and that the exam assessed practical skills in an appropriate and consistent manner. All students found the feedback from the examiners and the simulated patients useful, and the international students unanimously welcomed the opportunity to examine simulated patients who spoke excellent English and German. Below are some comments from the participants:

• “The best things about OSCE were to be in realistic situations and to perceive their gravity, to feel the responsibility and the importance of professional knowledge, to practice communication and to get quick feedback on my performance. The teachers were supportive of me, they did not focus on my mistakes only, but also highlighted the positive things and gave me a noticeably encouraging critique.” (student)
• “I found the exam to be very useful because I could explore my own skills in very realistic clinical situations. It was not only my theoretical knowledge that mattered, but I was assessed based on the overall situation. The best thing was that I learned a lot in a short time.” (student)
• “I really enjoyed working with a team of like-minded, enthusiastic examiners, and the facilities of the Medical Skills Education and Innovation Centre are exemplary! I would provide more opportunities in the curriculum for conducting examinations in a simulated environment.” (teacher)
• “I find bedside examination more preferable, but the OSCE is better suited to hold up a mirror to both the student and the teacher to see where the teaching and learning process is at. It would therefore be advantageous if all students could take the OSCE examination once." (teacher)

The work of the participating departments is coordinated by Dr. Judit Sebők, teacher at the 2^nd 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 (DMEDC), who is the organiser of the programme. The coordination and preparation of the simulated patients are carried out by the teachers of the Department of Languages for Biomedical Purposes and Communication; by Hambuchné Dr. Anikó Kőhalmi, Dr. Judit Fekete, Eklicsné Dr. Katalin Lepenye, Dr. Renáta Halász, Dr. Rita Kránicz, and Szántóné Dr. Alexandra Csongor, who also helped assess the students during the exam as communication experts. The Medical Skills Education and Innovation Centre (MSEIC) 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 2024 OSCE stations were the following:

• Department of Primary Health Care: Dr. Ágnes Csikós, Dr. Balázs Fülöp, Dr. Éva Pozsgai, Dr. Balázs Ujvári, Dr. Péter Varga, Dr. Réka Várnai
• 1^st Department of Medicine: Dr. Alizadeh Hussain, Dr. László Czopf, Dr. Éva Németh, Dr. Anita Kacsó, Dr. Szabolcs Kosztolányi, Dr. Judit Pammer, Dr. István Ruzsics, Dr. Mariann Szabó, Dr. Zsolt Szakács, Dr. Orsolya Tóth, Dr. Péter Varjú, Dr. Péter Vén
• 2^nd Department of Internal Medicine and Nephrology, Diabetology Centre: Dr. György Fábián, Dr. Márton Mohás, Dr. Gergő Molnár, Dr. Judit Sebők, Dr. Nóra Szigeti
• Department of Languages for Biomedical Purposes and Communication: Hambuchné Dr. Anikó Kőhalmi, dr. Judit Fekete, Eklicsné Dr. Katalin Lepenye, Renáta Halász, Szántóné Dr. Alexandra Csongor and Corina Kappen, Péter Csatlós, Szilvia Dargó, Márk Dömötör, Mária Flódung, Csilla Földes, Péter Gátos, Guillermo Gastiaburu, Genovéva Horváth, Ákos Kránicz, Leah Stanzel, Orsolya Ligetfalvi, Lívia Breuer, Ákos Markovics, Zsófia Pásztor, Peter Holly, Piros Pőgl, Vince Ronczyk, Ildikó Russay, György Szabó, Gergely Szép, Thea Miller, Vincent Keppler
• Department of Otorhinolaryngology: Dr. István Háromi, Dr. Márton Kovács, Dr. Krisztina Somogyvári
• Department of Paediatrics: Dr. Dániel Kardos
• Department of Behavioural Sciences: Dr. Gergely Csaba, Dr. Boróka Gács
• Department of Neurology: Dr. László Szapáry, Dr. Csilla Gyimesi, Dr. Márk Harmat, Dr. Zsófia Karádi, Dr. Renáta Rozgonyi
• Department of Oncotherapy: Dr. Szabolcs Bellyei
• Department of Orthopaedics: Dr. Dániel Kovács
• Medical Skills Education and Innovation Centre: Dr. Alan Abada, Dr. Viktor Bacher, Adrienn Jakabovics, Dr. Orsolya Török
• Department of Surgery: Dr. Sándor Ferencz
• Department of Emergency Medicine: Dr. Péter Kanizsai, Dr. Balázs Cséke, Dr. Lajos Szakó
• Urology Clinic: Dr. Máté Mészáros

In April 2025, it is planned to resume the formative examination of 60 fifth- and sixth-year general medicine students, with 20-20 students per language programme. 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, which an OSCE carried out at critical points in the curriculum could complement, further enhancing the effectiveness and prestige of the training. Furthermore, it is important to note that international accreditation processes are increasingly expecting the inclusion of such standard clinical examinations in the curriculum, for example, it has become a mandatory examination format for German medical schools.

Colleagues interested in the OSCE can learn more about the topic in various teacher training courses - for example, the course on “Learning about modern teaching methods and developing teaching skills” on the topic of examination methodology, or in the materials of the “Módszertani Morzsák” available on POTEPedia.

Inline photos:

Dr. Kristóf Filipánits