The Reform of Clinical Teaching provided students with greater contact with patients and teachers/doctors, and there was a greater focus on the practical side where students will have the opportunity to get in touch with reality and thus develop their personal characteristics. “Each student makes his/her own individual development path, organising his/her time and study. When the time for assessment comes, this individual aspect is also present, because is part of an individual assessment with a multiple choice test and then the OSCE individualizes the student again, but with the guarantee that he/she is doing the same as all the others, just as happens in the multiple choice test”, said João Eurico Cabral da Fonseca, Professor at the Faculty of Medicine of the University of Lisbon (FMUL).

According to the Professor, behaviour does not only concern the practice of Medicine, but also all professional areas. People are prepared with certain sets of information and then it is the actions that differentiate them.

There are several reasons why OSCEs are important, such as testing gestures, that is, objective examination techniques, or therapeutic interventional techniques; testing how to take a story and value clinical data, and finally, it can also assess how the student communicates with a patient, such as how to prepare a request for authorisation for a procedure or information about a diagnosis, obtaining consent for a technique or treatment, and also to assess a therapeutic decision (what therapy to do; how to do it; how to inform). "This method of examination has as its main merit the ability to assess in a more objective and simplified way," he said.

The reform of education has reformulated the evaluation model, how do you see the implementation of the OSCE specifically and what benefits do you see?

JECF: This assessment technique is part of the remodelling of teaching, because one of the concepts of this remodelling is the integration of contents. Therefore, OSCEs are part of the Reform, as integrated assessment processes, where students will be tested, all at the same time, with all the skills that were being trained during the previous semester. Unlike previous models in which assessments were sectorial, carried out at different times, and in a significantly less objective manner. On the other hand, a standardisation of assessment helps the various subject areas to reflect on the structuring and standardisation of their own teaching. Therefore, the teaching has to have a different structure so that it makes sense with what is later requested in the OSCE. There is an interesting integration of the OSCE concept with the Teaching Reform.

How does this distinguish us from other faculties?
JECF: n the world, medical schools are all different and have different methods. In Europe, there are faculties that follow very classic methodologies, with very theoretical teaching and contact with patients is rather late and little valued. Then there are other faculties with the absolute opposite. They start in the 1st year with intense contact with standard patients, and early contact with real patients, and at the same time develop theoretical knowledge that goes from the most basic aspects of biomedical knowledge to clinical aspects. Aspects of assessment also vary greatly from school to school.
What we have implemented is innovative in relation to our faculty. We did not have this type of structuring and, on the other hand, the method of evaluation is revolutionary. What we want to apply in terms of Teaching Reform, and this is what we are trying to do in the 4th and 5th year, is to allow students autonomy and responsibility, that is, to give them time to study and to carry out their activities organising time and knowledge. Therefore, this allows students to be inserted in a small group, in contact with clinical lecturers, providing them with a more personalised teaching with a focus on the practical component and in contact with the lecturer. At the same time, theoretical-practical sessions are scheduled with relatively small groups, in close contact with the lecturer, in which clinical situations are reflected in a more structured way. Before the theoretical-practical sessions students have time to consult bibliographic sources, made available on moodle, and all this allows the student to be an autonomous student. Despite being inserted in a very large group of other students, each one does their own individual development path, organising their time and study. At the time of assessment, this individual aspect is again verified through a multiple choice test and the OSCE, but with the guarantee that you are doing the same path, with the same criteria, as all the others.

Do you agree that an adjustment is needed in who is preparing the practical lessons and who is assessing?
JECF: In the last two years, the Department of Medical Education (DEM) has organised several trainings that need a greater commitment in participation, by the faculty. There are several topics covered, such as OSCEs, or how to carry out a multiple choice test, and it is essential that everyone participates because a teacher is not trained to know how to do these exam models. This learning comes about in a spontaneous way as we participate in the teaching, so there is actually a great margin for progression for the teaching staff as a whole.
To bring OSCEs from theory to practice requires training of all parties involved in these procedures, both teachers and students. It is essential to be careful so that the teaching prior to the assessment can anticipate that certain situations will be effectively tested, so it is necessary to apply a practical teaching that minimally prepares the student for what the OSCEs will ask.

Will there be any evaluation to understand what still needs to be improved?

JECF: There is an evaluation commission for the implementation of the Reform that is collecting information based on surveys among teachers and students of the 4th year. Now, at the end of the first semester, they will proceed with this assessment, preparing a document that will serve as a basis to improve the next 4th year and to make an adequate preparation for the implementation of the next 5th year. Obviously, the 5th year has certain features, but much of what the 5th year will or will not do is learned on the basis of the pioneering work of the 4th year.

And how are students adapting to this new way of assessing?

JECF: There is no doubt that the reform was implemented to continue. It was an absolute revolution in the teaching and assessment processes in our faculty, requiring huge adaptations in quite classical concepts. Inevitably it had problems, as is normal, but I would say it went extremely much better than probably everyone was expecting. In particular, the level of organisation of the OSCEs was excellent and we owe this to the work of a large team involving teachers and administrative staff of the faculty led by Professor Diogo Ayres de Campos. Regarding the way small things went in practice, we will have to reflect on several aspects, namely, our own technique of preparing the various stations; the way we prepare students to answer; the way we can somehow give feedback to students, since the way it is designed it is not possible to give this feedback. Finally, the way the circuits are set up inevitably leads to waiting times that are sometimes at the limit of what is reasonable, and somehow we must optimise the circuits so that we do not have such long waiting times.
In short, I would say that overall there are more positive than negative points. So, the balance is good, but with the awareness that this process of Reform in evaluation is a process of continuous improvement, at each step we must identify the problems and improve, and so on.

Leonel Gomes
Editorial Team