Program design and development
The MasterOSCE medical and surgical finals OSCE revision program was created to address two important issues identified by the authors, all of whom are recent graduates and junior doctors. Firstly, many medical schools are continuously updating their examination format, in particular the final OSCE. This may prove a source of anxiety for many medical students [16–19]. Secondly, senior consultants often deliver the majority of revision teaching provided by medical schools. Although many junior doctors teach medical students, most of this is informal and undertaken impromptu on the wards .
We developed a revision specifically for final year medical students to assist preparation for their final OSCE at a medical school in the North West of England. Common topics encountered by foundation trainees were identified following a consultation process with junior doctors. A program was developed by the authors to include the common clinical scenarios identified in addition to topics thought to be difficult or 'tricky' by local students including safe prescribing skills, ethics and other speciality areas less frequently encountered such as ophthalmology and dermatology. Several modalities of teaching were incorporated in the program including lectures, small group seminars, videos, interactive modules and revision notes (made available online and in a course booklet). All teaching was prepared and delivered exclusively by junior doctors, who had recently completed a similar examination.
Broad content areas, that were considered core topics, were taught in a lecture format. These included cardiology, respiratory medicine, gastroenterology and neurology. Small group seminars were reserved for smaller topics as well as those areas thought to cause concern for medical students. This was to allow more opportunity to ask the tutor questions regarding these less familiar topics: ethics, communication skills, dermatology, radiograph interpretation, peripheral vascular and hernia examinations. A session named "Ask the panel" was reserved so that students could ask the near-peer tutors about OSCE technique, specific OSCE stations encountered or any concerns regarding their own examination preparation. Additional supplementary material was made available online in the form of revision notes. Furthermore, a course booklet was developed to provide students with written notes that complemented the topics taught in the lectures and small group seminars. The booklet also included material for the interactive modules placed within the program.
All three authors undertook the planning and co-ordination of the revision program as well as the production of all revision materials equally. This included creation of online revision notes, communication with near-peer tutors and recruitment of students. The development of content included in the lectures and small-group seminars was delegated to each near-peer tutor delivering that particular session and peer reviewed.
The revision course took place 4 months following the commencement of the final medical year and 6 weeks prior to the final OSCE. Online revision notes were accessible four months in advance of the course. Students received a course booklet on the first day of the course after registration. At this time a self-administered feedback questionnaire was provided to each participant. The two-day course followed a similar structure on both days. Lectures were delivered in the mornings, separated by coffee breaks. In the afternoon, a rotation system of five small group seminars was employed.
Final year medical students attending a University in the North West of England were invited via email to participate in the program. Of the 457 students sitting the final OSCE examination, 125 were enrolled into the revision program on a first come, first served basis. Numbers were limited to 125 allowing for five small group seminars of 25 students each. Students were invited to attend through an online enrolment page. Three separate emails between 1 and 4 months prior to the commencement of the revision program were sent to all 457 final year medical students sitting the final OSCE examination. Enrolment was closed after 125 students were recruited.
Near-peer tutors were invited to attend an informal interview via email. There were no specific pre-requisites other than a passion to teach medical students and motivation to develop teaching skills. Six recent medical graduates expressed interest in being involved with developing and delivering the program. Each met with all three authors to discuss the aims of the study and to outline what was expected from their teaching. There was no formal interview process for recruiting near-peer tutors however an informal discussion with the authors occurred on an individual basis to outline the nature of the revision program and its principles. Topics were allocated based upon their personal preference, which was usually driven by career aspirations/areas of personal interest.
Prior to enrolment into the program all students were asked to read a document outlining how the data will be used to conduct research and electronically confirm they agree to these terms. This was in line with local ethical guidance and outlined how the data gathered from feedback questionnaires would be used and handled. Anonymised self-administered feedback questionnaires were provided to all participants at the time of registration.
The questionnaires contained four main sections including: pre-course questions, lectures and small group seminar feedback, free text comments and post-course feedback. Five point Likert scales were used for all questions. Students were asked about their confidence, expectations, preparation and previous teaching in the pre-course section. Feedback on lectures focused on clarity of aims/objectives, delivery, content, relevance and tutor knowledge. Students were asked to provide similar feedback on the small group seminars but also including organisation, efficiency, and usefulness of the session. Free text comments were encouraged following each day of the course. Finally a post course evaluation addressed what effect the program had on the students' confidence, preparation and expectations for their final OSCE. Specifically students were asked to compare teaching provided by junior doctors to traditional consultant-led teaching and whether they would recommend the program to future students.
All feedback questionnaires were collected at the end of the revision course therefore all feedback was provided at the time of or immediately after teaching delivery. Data was anonymous and securely stored.