Dr. Natalie McCall

Background: Despite the objective structured clinical examinations (OSCE) being widely used in the assessment of clinical competency, the optimal scoring systems remains debatable with limited data from sub-Saharan Africa. This study compared the performance, reliability, and agreement between global rating scales (GRS) and checklist scores at a comprehensive exit examination for undergraduate medical students in Rwanda. Methods: This cross-sectional descriptive study was conducted during the final ‘Exit Exams’ of undergraduate medical students at the University of Global Health Equity, Rwanda. The OSCE included 15 stations spread across major clinical specialties and subspecialties. Each station had a checklist with a total score of 20 marks and a three-level GRS (failed, borderline, or passed) Results: A total of 36 students took part in the OSCE examinations. The mean (standard deviation) checklist score was 84.3 (5.3) %, which was lower than the mean GRS score, 94.3 (6.9) %, p < 0.001. All students achieved overall scores above the standard-setting pass mark of 64.4% [set from modified Angoff method], on both scoring systems. While no student failed any station using checklist scores, the GRS identified failures in stations 5 and 6 (one student each), and stations 7 and 13 (two students each). Overall internal consistency (Cronbach's Alpha) across all the stations was 0.760 [ranged from -0.216 (station 15) to 0.746 (station 9)]. Pearson correlation demonstrated a very strong positive correlation between the checklist and GRS (r= 0.924, p<0.001). Bland-Altman plot showed a mean (standard deviation) of difference of 10.01 (2.8) in favor of GRS, with a lower and upper limit of agreement of 4.44 to 15.58 respectively. Conclusion: Checklist and GRS scores in the OSCEs demonstrated strong positive correlation, but GRS showed a higher discriminatory ability, identifying performance differences that checklists did not capture. Incorporating GRS alongside checklists may enhance the robustness of high-stakes clinical assessment. Key words: Checklist, Global rating scale, High-stake examinations, Undergraduates, Sub-Saharan, Rwanda

Background Otoscope examinations are a fundamental skill in pediatric care, crucial for diagnosing and managing ear conditions such as otitis media. Traditional training methods for pediatric otoscopic examination often rely on adult standardized patients (SPs) or simulated models, which may not be adequate for pediatric examinations. Objectives This study evaluates the feasibility and effectiveness of use of children as SPs in Objective Structured Clinical Examinations (OSCEs) to assess medical students’ competency in pediatric otoscopy. Methods This descriptive cross-sectional study was conducted at the University of Global Health Equity (UGHE), Rwanda during the final exit examinations. This study included 30 final-year medical students, and six child SPs aged 5–8 years, along with their guardians. Quantitative data were collected using structured questionnaires on students perceived self-efficacy and performance. Qualitative data were obtained through focus group discussions with guardians and child SPs. Results The mean (standard deviation) performance of students at the otoscope examination station was 81.67 (5.7) %, with a significant positive correlation between perceived self-efficacy and actual performance (r = 0.493, p = 0.006). The mean performance at the OSCE station was slightly higher than perceived students’ self-efficacy, (72.5 (6.8) vs. 81.67%. p < 0.001). Students reported high levels of satisfaction with the use of child SPs, with 83.3% recommending their use in pediatric OSCEs. Guardians and child SPs also expressed overall satisfaction, though concerns were noted regarding students’ levels of confidence. and communication skills. Conclusion Incorporating children as SPs in pediatric OSCEs enhances the realism and educational value of otoscope training with positive correlation between perceived self-efficacy and actual performance.