Deborah Collier¹
1 University of Liverpool

In Liverpool we have taken a journey with our clinical assessment since 2017 of moving from a traditional sit and resit large number of stations OSCE sat by all students to a sequential model using a smaller first sequence for the full cohort and a small sequence 2 for students not exempt. 

To accommodate a large cohort in the traditional model this was originally over a number of days with a perceived unfairness of sitting the exam on day 1 compared to day 5. 

With the implementation of a sequential model all students sat 12 stations over 2 days exempting those students who perform very well. Followed by a second sequence for a smaller cohort over 2 days with different clinical scenarios. The combination of sequence 1 and 2 providing a pass/fail boundary (1). The resulting outcome was to reduce the number of fails in the cohort but also to see that the students who did fail either just managed a pass at resit or failed again. Those who did pass at resit where seen in the failing group during the next assessment cycle. These students were unable to effect a long term deeper learning following a short term remediation (3). 

Our next step was to have the resit opportunity the next academic year (the next full assessment cycle) during which time the students where enrolled of the “Support in Clinical Learning Programme”. This gives students a shared bespoke learning opportunity with a tutor helping to guide and support their learning during the repeated year. We are now seeing the students who engage with the program are not only passing but passing at sequence 1. Those students who choose not to engage continue to struggle and either choose to leave the course of subsequently fail and will have studies terminated. 

References (maximum three) 

1.Homer, M., Fuller, R., and Pell, G. “The benefits of sequential testing: Improved diagnostic accuracy and better outcomes for failing students.” Medical Teacher,40.3 (2017): 275-284 

2.Cleland, Jennifer, et al. "The remediation challenge: theoretical and methodological insights from a systematic review." Medical education 47.3 (2013): 242-251