title: Can teaching hospitals use serial formative OSCEs to improve student performance?
abstract: BACKGROUND
  We report on interns' clinical competence and experiences of an objective structured clinical examination (OSCE) training program over 3 years. We aimed to determine whether repeated formative OSCEs allow teaching hospitals to improve the effectiveness of clinical training and help interns to achieve high scores in the national summative OSCE.
  
  
  METHODS
  This study included 207 participants, among whom 82 were interns who had completed four mock OSCEs and a national OSCE at the clinical center of Cathay General Hospital (CGH). The other 125 participants were final-year medical students from Fu-Jen University who had completed the national OSCE between 2013 and 2015 at one of four teaching hospitals (including CGH). CGH interns were categorized into three groups according to the medical school attended and Fu-Jen University students were grouped according to their training hospitals. CGH held four mock OSCEs (30 stations), whereas each of the four training hospitals for Fu-Jen students each held one or two OSCEs (6-12 stations) annually. Differences in the mean OSCE scores among groups were analyzed. The medical school attended, pre-internship OSCE experience and the frequency of mock OSCEs held by training hospitals were independent factors in this study.
  
  
  RESULTS
  The cumulative mean scores for five OSCEs among three groups of students trained at CGH tended to increase from the first OSCE (OSCE1) to the fifth (OSCE5). The mean score of the students who attended Fu-Jen Medical School was higher than that of students who graduated from foreign medical schools in all five OSCEs; however, the differences were significant only for OSCE2 (P = 0.022) and OSCE3 (P = 0.027). The mean national OSCE scores of FJU students showed no statistically significant differences among the four training hospitals for 2013; however, students training at CGH had significantly higher mean scores in the 2014 (P = 0.001) and 2015 (P = 0.005) OSCEs compared with students training at the other three hospitals.
  
  
  CONCLUSIONS
  Serial administration of formative OSCEs by teaching hospitals enhances the performance of students on the sequential summative OSCE. Such programs provide multiple opportunities for students to practice their clinical skills, and for faculty to develop their teaching, assessment and consensus building skills.
authors.affiliation: School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. hhlhhl@cgh.org.tw.|Clinical Skills Center, Cathay General Hospital, 280 Sec.4, Jen-Ai Road, Taipei, Taiwan. hhlhhl@cgh.org.tw.
authors.forename: Heng-Hui
authors.identifier: http://orcid.org/0000-0003-0156-2681
authors.initials: HH
authors.lastname: Lien
authors.affiliation: Clinical Skills Center, Cathay General Hospital, 280 Sec.4, Jen-Ai Road, Taipei, Taiwan.
authors.forename: Sang-Feng
authors.initials: SF
authors.lastname: Hsu
authors.affiliation: Clinical Skills Center, Cathay General Hospital, 280 Sec.4, Jen-Ai Road, Taipei, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Chen
authors.affiliation: School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Jiann-Horng
authors.initials: JH
authors.lastname: Yeh
mesh_terms: D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D010808:Physical Examination / Q000379:methods*
keywords: Clinical skill; OSCE