• Rozhan Nabaz Mohammed Sediq Department of Medical Education, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Jamal Mahmood Salih Department of Physiology, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Fattah Hama Rahim Fattah Department Community Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Adnan Mohammed Hassan Department of Medical Education, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.



OSCE, Clinical skill assessment, Student perception, Examiner perception, Feedback



Objective Structured Clinical Examination (OSCE) is globally used in the assessment of the clinical competency of medical students. Nevertheless, OSCE has to be carefully designed and organised to be fair and reliable.


The study aimed to observe the perception of medical students and their examiners towards OSCE.

Materials and Methods

The survey is a cross-sectional study in which a self-administrative questionnaire was designed and filled by 286 third-year students and 64 examiners of the College of Medicine /University of Sulaimani after the end of phase-1 assessment OSCE of 2020-2021. Ethical approval has been obtained from the university. The study data were collected and analysed by SPSS (23.0).


The response rate was high among the students and examiners; 95.6% (286/299) and 80% (64/80), respectively. The OSCE reliability test was acceptable (Cronbach’s alpha = 0.78-0.81). The proportions of agreed students to the OSCE fairness, tested skills, and minimising the chance of failing were 42.7%, 51.4%, and 33%, respectively; however, 65.8% found the OSCE very stressful. Although 45% of the students felt dissatisfied with the OSCE instructions, 42-58% and 33-39% agreed with the OSCE organisation and performance, respectively. Among the examiners, the majority perceived that the OSCE was fair, well-organised, and timed. Compared to the conventional method, 79.7% of the examiners thought that OSCE was better in various domain assessments, whereas 60.9% found it exhausting. 


Overall, students’ perception of the OSCE was similarly spread to agree, neutral, and disagree, which was lower than the examiner’s great satisfaction. These results highlighted the necessity of further improvement in future OSCEs.


Khan KZ, Ramachandran S, Gaunt K, Pushkar P. The objective structured clinical examination (OSCE): AMEE guide no. 81. Part I: a historical and theoretical perspective. Medical teacher. 2013 Sep 1;35(9):e1437-46. DOI:

Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using the objective structured examination. Br Med J. 1975 Feb 22;1(5955):447-51. DOI:

Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Medical education. 1979 Jan;13(1):39-54. DOI:

Carraccio C, Englander R. The objective structured clinical examination: a step in the direction of competency-based evaluation. Archives of pediatrics & adolescent medicine. 2000 Jul 1;154(7):736-41. DOI:

Sales I, Bawazeer G, Mahmoud MA, Aljohani MA, Almalag HM, Alhossan A, et al. Use an objective structured clinical examination (OSCE) to assess intern performance in an advanced pharmacy practice experiences (APPE) Ambulatory Care rotation. Saudi Pharmaceutical Journal. 2021 Oct 25. DOI:

Woodburn J, Sutcliffe N. The reliability, validity, and evaluation of the objective structured clinical examination in podiatry (chiropody). Assessment & Evaluation in Higher Education. 1996 Jun 1;21(2):131-46. DOI:

Sloan DA, Donnelly MB, Schwartz RW, Strodel WE. The Objective Structured Clinical Examination. The new gold standard for evaluating postgraduate clinical performance. Annals of surgery. 1995 Dec;222(6):735. DOI:

Duerson MC, Romrell LJ, Stevens CB. Impacting faculty teaching and student performance: nine years' experience with the Objective Structured Clinical Examination. Teaching and Learning in Medicine. 2000 Oct 1;12(4):176-82. DOI:

Newble DI, HOARE J, Elmslie RG. The validity and reliability of a new examination of the clinical competence of medical students. Medical Education. 1981 Jan;15(1):46-52. DOI:

Gormley G. Summative OSCEs in undergraduate medical education. The Ulster medical journal. 2011 Sep;80(3):127.

Pierre RB, Wierenga A, Barton M, Branday JM, Christie CD. Student evaluation of an OSCE in paediatrics at the University of the West Indies, Jamaica. BMC medical education. 2004 Dec;4(1):1-7. DOI:


Zayyan M. Objective structured clinical examination: the assessment of choice. Oman medical journal. 2011 Jul;26(4):219. DOI:

Barman A. Critiques on the objective structured clinical examination. Annals-Academy of Medicine Singapore. 2005 Sep 1;34(8):478.

Elfaki OA, Al-Humayed S. Medical students' perception of OSCE at the department of internal medicine, college of medicine, King Khalid University, Abha, KSA. J Coll Physicians Surg Pak. 2016 Feb 1;26(2):158-9.

Al Nazzawi AA. Dental students' perception of the objective structured clinical examination (OSCE): The Taibah University experience, Almadinah Almunawwarah, KSA. Journal of Taibah University Medical Sciences. 2018 Feb 1;13(1):64-9. DOI:

Siddiqui FG. Final year MBBS students’ perception for observed structured clinical examination. J Coll Physicians Surg Pak. 2013 Jan 1;23(1):20-4. Low perception

Ameh N, Abdul MA, Adesiyun GA, Avidime S. Objective structured clinical examination vs traditional clinical examination: An evaluation of student's perception and preference in a Nigerian medical school. Nigerian medical journal: journal of the Nigeria Medical Association. 2014 Jul;55(4):310. DOI:

Duffield KE, Spencer JA. A survey of medical students' views about the purposes and fairness of the assessment. Medical education. 2002 Sep;36(9):879-86. DOI:

Okugbo SU, Agbonrofo P, Irowa O. Five years after commencing the objective structured clinical examination: are we getting it right? Medical students’ assessment as the measuring index. African Health Sciences. 2020 Jul 22;20(2):960-5. DOI:

Munkhondya TE, Msiska G, Chilemba E, Majamanda MD. Experience in Conducting Objective Structured Clinical Evaluation (OSCE) in Malawi. Open Journal of Nursing. 2014 Sep 12;4(10):705. DOI:

Pugh D, Smee S. Guidelines for developing objective structured clinical examination (OSCE) cases. Ottawa: Medical Council of Canada. 2013.

Brand HS, Schoonheim-Klein M. Is the OSCE more stressful? Examination anxiety and its consequences in different assessment methods in dental education. European Journal of Dental Education. 2009 Aug;13(3):147-53. DOI:

Zhang N, Rabatsky A. Effects of test stress during an objective structured clinical examination. Journal of Chiropractic Education. 2015 Sep;29(2):139-44. DOI:

Bellido-Esteban A, Beltrán-Velasco AI, Ruisoto-Palomera P, Nikolaidis PT, Knechtle B, Clemente-Suárez VJ. The Effect of Psychology Objective Structured Clinical Examination Scenarios Presentation Order on Students' Autonomic Stress Response. Frontiers in Psychology. 2021 Mar 24;12:931. DOI:

Starcke K, Wiesen C, Trotzke P, Brand M. Effects of acute laboratory stress on executive functions. Frontiers in Psychology. 2016 Mar 31;7:461. DOI:

Yusefzadeh H, Iranagh JA, Nabilou B. The effect of study preparation on test anxiety and performance: a quasi-experimental study. Advances in medical education and practice. 2019;10:245. DOI:

Mavis B. Self-efficacy and OSCE performance among second-year medical students. Advances in health sciences education. 2001 May;6(2):93-102. DOI:

Majumder MA, Kumar A, Krishnamurthy K, Ojeh N, Adams OP, Sa B. An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives. Advances in medical education and practice. 2019;10:387. DOI:

Gormley G, Sterling M, Menary A, McKeown G. Keeping it real! Enhancing realism in standardised patient OSCE stations. The clinical teacher. 2012 Dec;9(6):382-6. DOI:

Brown C, Morse J, Nesvadba D, Meldrum A. Twelve tips for introducing simulation-based assessment in the objective structured clinical examination. Medical Teacher. 2021 Apr 3;43(4):380-3. DOI:

Shitu B, Girma T. Objective structured clinical examination (OSCE): examinee's perception at the department of paediatrics and child health, Jimma University. Ethiopian Journal of Health Sciences. 2008;18(2).

Omu AE, Al-Azemi MK, Omu FE, Al-Harmi J, Diejomaoh MF. Attitudes of academic staff and students towards the Objective structured clinical examination (OSCE) in obstetrics and gynecology. Creative Education. 2016;7(06):886. DOI:

Saeed A, Al Suwayh WM, Alomri AS. Students' perceptions and attitudes towards Objective Structured Clinical Examination (OSCE) in the College of Medicine, KSAU-HS, King Fahad Medical City, Riyadh, Saudi Arabia. Journal of Medical Science And clinical Research. 2016 Mar 4 (3); 9741. DOI:

Nasir AA, Yusuf AS, Abdur-Rahman LO, Babalola OM, Adeyeye AA, Popoola AA, Adeniran JO. Medical students' perception of objective structured clinical examination: feedback for process improvement. Journal of Surgical Education. 2014 Sep 1;71(5):701-6. DOI:

Gruppen LD, Davis WK, Fitzgerald JT, McQuillan MA. Reliability, number of stations, and examination length in an Objective Structured Clinical Examination. Advances in medical education 1997 (pp. 441-442). Springer, Dordrecht. DOI:

Varkey P, Natt N, Lesnick T, Downing S, Yudkowsky R. Validity evidence for an OSCE to assess competency in systems-based practice and practice-based learning and improvement: a preliminary investigation. Academic Medicine. 2008 Aug 1;83(8):775-80. DOI:

Kumar S, Ranjan A, Kumar G, Mishra A, Barat D. Assessment of undergraduate medical students using Objective Structured Clinical Examination in General Medicine: student’s and teacher’s perception. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES-JEMDS. 2015 Dec 10;4(99):16481-4. DOI:

McLaughlin K, Ainslie M, Coderre S, Wright B, Violato C. The effect of differential rater function over time (DRIFT) on objective structured clinical examination ratings. Medical education. 2009 Oct;43(10):989-92. Rating DOI:

Hope D, Cameron H. Examiners are most lenient at the start of a two-day OSCE. Medical Teacher. 2015 Jan 2;37(1):81-5. DOI:

Troncon LE. Clinical skills assessment: limitations to introducing an" OSCE"(Objective Structured Clinical Examination) in a traditional Brazilian medical school. Sao Paulo Medical Journal. 2004;122:12-7. DOI:

Elfagi S, Elamni SF, Nouh F, Eltohami A, Omar M. Undergraduate Student Feedback on OSCE: The First Experience of a Nutrition Department, University of Benghazi 2019. Journal of Advances in Education and Philosophy. 2020;4(5):187-91. DOI:

Chong L, Taylor S, Haywood M, Adelstein BA, Shulruf B. The sights and insights of examiners in objective structured clinical examinations. Journal of educational evaluation for health professions 2017;14:34 DOI:

Alsaid AH, Al-Sheikh M. Student and faculty perception of objective structured clinical examination: A teaching hospital experience. Saudi journal of medicine & medical sciences. 2017 Jan;5(1):49. DOI:

AlQhtani A, AlSwedan N, Almulhim A, Aladwan R, Alessa Y, AlQhtani K, et al. Online versus classroom teaching for medical students during COVID-19: measuring effectiveness and satisfaction. BMC medical education. 2021 Dec;21(1):1-7. DOI:

Gado AS, Khater RA. Conducting a medical examination in the COVID-19 era: an Egyptian experience. The Egyptian Journal of Internal Medicine. 2021 Dec;33(1):1-3. DOI:

Collaborative TM. The perceived impact of the Covid-19 pandemic on medical student education and training–an international survey. BMC Medical Education. 2021;21.



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