Using the OSCE to assess medicine students' communication and clinical reasoning during five years of restricted clinical practice

Abstract Background: Objective and Structured Clinical Examination (OSCE) is a widely used evaluation method for health profession students. In Chile, physicians OSCEs have incorporated clinical reasoning and patient-centered communication assessment since 2015. The global impact of the pandemic hindering clinical practice. Is still unknown if this context affects disproportionately affected lower-income regions, and that was the case of the University analyzed in this study. Aim: This research compares the OSCE patient-centered communication and clinical reasoning results among five cohorts of intermediate-level medicine students with restricted clinical practice in Chile. Methods: We designed an observational study analyzing five cohorts of fourth-year medicine students with different clinical practice opportunities, with 3rd to 4th-year progression analysis in two cohorts. Adaptations to compensate lack of clinical practice hours include high-fidelity simulation and theoretical discussion of clinical cases, as well as formative OSCE at third-year level in two cohorts. Communication in OSCE was assessed using CAT, and clinical reasoning with a register form. We applied descriptive statistics, central tendency measurements, Kruskal Wallis tests and Wilcoxon's test for paired sample analysis. Ethical approval was obtained. Findings: The 2018 cohort shows the lowest results in both variables although it was the cohort with more clinical practice opportunities. The higher CAT result was in the 2021 cohort, while the 2022 cohort exhibited a significantly higher clinical reasoning score (p<0.05). There is a linear tendency to grow over the years for both measures. The 2023 cohort shows significant improvement between third-year and fourth-year OSCEs in all items of CAT and a detriment in clinical reasoning, while the 2022 cohort shows a significant increment in clinical reasoning and four items of CAT (p<0.05). Conclusion: The students with fewer hours of clinical practice showed similar clinical reasoning and communication results to the prepandemic group, probably because of the adaptations implemented. Simulation was an effective alternative practice in a restricted clinical practice context. Component-by-component analysis and trends of change are a better approach to assessing progression than global scores.