Summative Objective Structured Clinical Examination Research Articles

Evaluation of student readiness for clinical dental education at the end of preclinical education.

This study examined results of a summative objective structured clinical examination (OSCE) at the end of preclinical periodontal education to identify deficient areas for dental students in patient care and to explore factors affecting the probability of passing the OSCE. The summative OSCE was administered to two consecutive cohorts, Classes A (class of 2024; n1=134) and B (class of 2025; n2=129). The questions for each station in the OSCEs were available to both classes 1 week before the OSCEs. Descriptive statistics were used to identify deficient areas. The multiple logistic regression model was built to predict the probability of passing the OSCE based on the cohort, gender, and the practical and written examination scores. Fifty-one (38%) students in Class A and 66 (51%) students in Class B completed the OSCE by passing all stations. Students undergoing remediation showed deficiencies in demonstrating how to detect tooth mobility, performing periodontal probing, drawing the healthy positive bony architecture and the mucogingival junction, and using a universal and a Gracey 13/14 curette. The probability of passing the OSCE was significantly correlated with Class B (p=0.035) and the practical examination score (p=0.03) while not associated with gender (p=0.53) and the written examination score (p=0.11). Students showed deficiencies in assessment skills at the end of preclinical education. The study findings suggest that the implementation of the OSCE at the conclusion of preclinical education would be beneficial since the written examination score might not accurately reflect student readiness for clinical patient care.

Online medical student OSCE examinations during the first three years of the COVID-19 pandemic compared to three years pre-pandemic: An Australian experience in psychiatry and addiction medicine

Purpose We have evaluated the final-year Psychiatry and Addiction Medicine (PAM) summative Objective Structured Clinical Examination (OSCE) examinations in a four-year graduate medical degree program, for the previous three years as a baseline comparator, and during three years of the COVID-19 pandemic (2020–2022). Methods A de-identified analysis of medical student summative OSCE examination performance, and comparative review for the 3 years before, and for each year of the pandemic. Results Internal reliability in test scores as measured by R-squared remained the same or increased following the start of the pandemic. There was a significant increase in mean test scores after the start of the pandemic compared to pre-pandemic for combined OSCE scores for all final-year disciplines, as well as for the PAM role-play OSCEs, but not for the PAM mental state examination OSCEs. Conclusions Changing to online OSCEs during the pandemic was related to an increase in scores for some but not all domains of the tests. This is in line with a nascent body of literature on medical teaching and examination following the start of the pandemic. Further research is needed to optimise teaching and examination in a post-pandemic medical school environment.

Early formative objective structured clinical examinations for students in the pre-clinical years of medical education: A non-randomized controlled prospective pilot study

Background The value of formative objective structured clinical examinations (OSCEs) during the pre-clinical years of medical education remains unclear. We aimed to assess the effectiveness of a formative OSCE program for medical students in their pre-clinical years on subsequent performance in summative OSCE. Methods We conducted a non-randomized controlled prospective pilot study that included all medical students from the last year of the pre-clinical cycle of the Université Paris-Cité Medical School, France, in 2021. The intervention group received the formative OSCE program, which consisted of four OSCE sessions, followed by debriefing and feedback, whereas the control group received the standard teaching program. The main objective of this formative OSCE program was to develop skills in taking a structured medical history and communication. All participants took a final summative OSCE. The primary endpoint was the summative OSCE mark in each group. A questionnaire was also administered to the intervention-group students to collect their feedback. A qualitative analysis, using a convenience sample, was conducted by gathering data pertaining to the process through on-site participative observation of the formative OSCE program. Results Twenty students were included in the intervention group; 776 in the control group. We observed a significant improvement with each successive formative OSCE session in communication skills and in taking a structured medical history (p<0.0001 for both skills). Students from the intervention group performed better in a summative OSCE that assessed the structuring of a medical history (median mark 16/20, IQR [15; 17] versus 14/20, [13; 16], respectively, p = 0.012). Adjusted analyses gave similar results. The students from the intervention group reported a feeling of improved competence and a reduced level of stress at the time of the evaluation, supported by the qualitative data showing the benefits of the formative sessions. Conclusion Our findings suggest that an early formative OSCE program is suitable for the pre-clinical years of medical education and is associated with improved student performance in domains targeted by the program.

Impact of Formative Objective Structured Clinical Examination (OSCE) on Clinical Performance of Undergraduate Medical Students in Summative OSCE

Impact of Formative Objective Structured Clinical Examination (OSCE) on Clinical Performance of Undergraduate Medical Students in Summative OSCE

"We Need More Practice": Evaluating the Role of Virtual Mock OSCES in the Undergraduate Programme During the COVID Pandemic.

Feedback collated at University College London Medical School (UCLMS) during the COVID pandemic identified how many students felt unprepared for their summative Objective Structured Clinical Examinations (OSCEs) despite attending mock face-to-face OSCEs. The aim of this study was to explore the role of virtual mock OSCES for improving student's sense of preparedness and confidence levels for their summative OSCEs. All Year 5 students (n=354) were eligible to participate in the virtual mock OSCEs and were sent a pre- and post-survey for completion. Hosted on Zoom in June 2021, each circuit comprised six stations, assessing history taking and communication skills only, in Care of the Older Person, Dermatology, Gynaecology, Paediatrics, Psychiatry and Urology. Two hundred and sixty-six Year 5 students (n=354) participated in the virtual mock OSCEs, with 84 (32%) students completing both surveys. While a statistically significant increase in preparedness was demonstrated, there was no difference in overall confidence levels. In contrast, between specialties, a statistically significant increase in confidence levels was seen in all specialties barring Psychiatry. Despite half of the participants highlighting how the format did not sufficiently represent the summative OSCEs, all expressed interest in having virtual mock OSCEs incorporated into the undergraduate programme. The findings of this study suggest that virtual mock OSCEs have a role in preparing medical students for their summative exams. While this was not reflected in their overall confidence levels, this may be due to a lack of clinical exposure and higher anxiety levels among this cohort of students. Although virtual OSCEs cannot replicate the "in-person" experience, considering the logistical advantages, further research is required on how these sessions can be developed, to support the traditional format of face-to-face mock OSCEs within the undergraduate programme.

Teaching Clinical Skills Using Online Modality through Modified Peyton's Framework: An Experience from a Medical University in Pakistan.

Medical institutions worldwide faced an unprecedented situation during COVID-19 of identifying alternative strategies to sustain the continuum of learning process. This led to several innovations in the traditional medical curriculum. This study explored the effectiveness and feasibility of using the Peyton's framework modified for a virtual platform (Microsoft Teams) for teaching clinical skills to first and second-year medical students at The Aga Khan University, Karachi, Pakistan. In 2020-2021, the modified Peyton's framework was integrated in the clinical skills (CS) curriculum for all first- and second-year students (N=200). For evaluation, a mixed-method design was used, with pre-and post-session questionnaires. Students' satisfaction was obtained through the standard session evaluation tool of the university. For the qualitative arm, to explore the instructors' experiences, purposive sampling was used (n=8) and a focused group discussion (FGD) was conducted. Finally, performance of the students at the end of year summative Objective Structured Clinical Examination (OSCE) was compared with the students of previous year. Quantitative data were analysed using STATA® version 15.1, using paired t-test to compare the differences in OSCE scores in selected CS stations. A p-value of <0.05 was considered significant for all tests. The FGD was transcribed and analysed through manual content analysis. Nine clinical skills (that included history and examination skills) were taught using the virtual platform. There was a significant improvement in post-session questionnaires in seven of these skills (p value <0.01). Session evaluations showed that most students were satisfied with the learning experience. The instructors showed that the online teaching offered a promising platform for teaching history taking skills. The OSCE scores showed mixed results, with significant improvement in two out of four repeated stations by using paired t-test [abdominal exam (87.33 ± 8.99, <0.001); and precordial examination (88.45 ± 8.36, 0.001)]. Modifying Peyton's framework to a virtual platform allowed us to sustain the continuum of clinical education during the COVID-19 pandemic. The results support the use of a blended learning environment for teaching clinical skills.

Revised paper ASIM-D-21-00055R1: “Consulting properly rather than acting”: advocating for real patient involvement in summative OSCEs

BackgroundIn this “Advancing simulation practice” article, we offer an expose of the involvement of real patients in Objective Structured Clinical Examinations (OSCEs), inviting educators who traditionally involve solely SPs in their summative OSCEs to consider the practice. The need for standardisation in summative assessments can make educators understandably wary to try this, even if the rhetoric to involve real patients is accepted. We offer this as an instance of the tussle between standardisation and validity experienced throughout health professions education.Main textWe offer our experience and empirical evidence of this simulation practice, based on an institutional ethnographic examination of the involvement of real patients in summative OSCEs from an undergraduate medical school in the UK. Our critique demonstrates the merits of this approach as an assessment environment closer to the real clinical environments where these soon-to-be doctors interact in a more authentic way with real patients and their illness experiences. We balance this against the extra work required for all involved and suggest the biggest challenge is in the reorientation work required for both Faculty and students who are institutionalised to expect standardisation above all in assessment.ConclusionWe advocate for involving real patients in summative OSCEs and hope that readers may feel compelled and empowered to foster this shift in mindset required to introduce this practice into their assessments.

The use of a formative OSCE to prepare emergency medicine residents for summative OSCEs: a mixed-methods cohort study

BackgroundThe objective structured clinical examination (OSCE) is a part of emergency medicine (EM) examinations such as the Masters of Medicine in Emergency Medicine (MMed) examination and the equivalent Member of the Royal College of Emergency Medicine (MRCEM) examination. The use of formative OSCEs to prepare EM residents for summative OSCEs has not been investigated. This study aimed to evaluate the role of formative OSCEs in preparing EM residents for the MMed and MRCEM OSCE.MethodsThis was an observational, retrospective, mixed-methods cohort study. We analysed data from formative OSCEs conducted by the National Healthcare Group EM residency programme from 2013 to 2019, and from a questionnaire distributed to all residents during the study period. Residents’ formative OSCE participation and scores were compared with first-attempt summative OSCE success. Qualitative analysis of residents’ opinions on the usefulness of the formative OSCE was performed.ResultsForty-three of the 50 (86.0%) residents attended at least one formative OSCE. Of the 46 who responded to the questionnaire, 40 (87.0%) had attempted and succeeded in the MMed or MRCEM OSCE, of whom 35 (87.5%) had succeeded on the first attempt. Residents who succeeded in the summative OSCE on the first attempt tended to have higher proximate (mean = 70.6, SD = 8.9 vs mean = 64.3, SD = 10.8) and mean (mean = 67.4, SD = 7.1 vs mean = 62.8, SD = 7.3) formative OSCE scores. All 8/40 (20.0%) residents who attended more than three formative OSCEs succeeded in the summative OSCE on their first attempt. Residents’ formative OSCE scores tended to improve with successive formative OSCEs, demonstrating a positive training effect. All residents felt that the formative OSCE was useful in preparing them for the summative OSCE.ConclusionsParticipation in multiple formative OSCEs was beneficial in preparing residents for the summative OSCE. The formative OSCE was useful in familiarising residents with the examination, giving them an opportunity to perform in near-examination conditions, and providing feedback to residents and faculty about their progress. Our findings may support the implementation of formative OSCEs in other training programmes to prepare learners for high-stake summative OSCEs.

Medical Emergency Management in the Dental Office (MEMDO): A Pilot Study Assessing a Simulation-Based Training Curriculum for Dentists.

In the event of a medical emergency in the dental office, the dentist must be able to identify a patient in distress, assess the situation, and institute proper management. This study assessed the impact of a simulation-based medical emergency preparedness curriculum on a resident's ability to manage medical emergencies. This interventional and pre-post educational pilot study included 8 participants who completed a standard curriculum and 8 who completed a modified curriculum (N = 16). The intervention consisted of a comprehensive medical emergency preparedness curriculum that replaced lecture sessions in a standard curriculum. Participants completed performance assessments using scenario-based objective structured clinical examinations (OSCEs) that were recorded and evaluated by calibrated faculty reviewers using a customized scoring grid. The intervention group performed significantly better than the control group on their summative OSCEs, averaging 90.9 versus 61.2 points out of 128 (p = .0009). All participants from the intervention group passed their summative OSCE with scores >60%, while none from the control group received passing scores. Completion of a simulation-based medical emergency preparedness curriculum significantly improved resident performance during simulated medical emergencies.

Development and evaluation of a spiral model of assessing EBM competency using OSCEs in undergraduate medical education

BackgroundMedical students often struggle to understand the relevance of Evidence Based Medicine (EBM) to their clinical practice, yet it is a competence that all students must develop prior to graduation. Objective structured clinical examinations (OSCEs) are a valued assessment tool to assess critical components of EBM competency, particularly different levels of mastery as they progress through the course. This study developed and evaluated EBM based OSCE stations with an aim to establish a spiral approach for EBM OSCE stations for undergraduate medical students.MethodsOSCE stations were developed with increasingly complex EBM tasks. OSCE stations were classified according to the classification rubric for EBP assessment tools (CREATE) framework and mapped against the recently published core competencies for evidence-based practice (EBP). Performance data evaluation was undertaken using Classical Test Theory analysing mean scores, pass rates, and station item total correlation (ITC) using SPSS.ResultsSix EBM based OSCE stations assessing various stages of EBM were created for use in high stakes summative OSCEs for different year groups across the undergraduate medical degree. All OSCE stations, except for one, had excellent correlation coefficients and hence a high reliability, ranging from 0.21–0.49. The domain mean score ranged from 13.33 to 16.83 out of 20. High reliability was demonstrated for the each of the summative OSCE circuits (Cronbach’s alpha = 0.67–0.85).In the CREATE framework these stations assessed knowledge, skills, and behaviour of medical students in asking, searching, appraising, and integrating evidence in practice. The OSCE stations were useful in assessing six core evidence-based practice competencies, which are meant to be practiced with exercises. A spiral model of OSCEs of increasing complexity was proposed to assess EBM competency as students progressed through the MBChB course.ConclusionsThe use of the OSCEs is a feasible method of authentically assessing leaner EBM performance and behaviour in a high stakes assessment setting. Use of valid and reliable EBM-based OSCE stations provide evidence for continued development of a hierarchy of assessing scaffolded learning and mastery of EBM competency. Further work is needed to assess their predictive validity.

Measuring the Effect of Examiner Variability in a Multiple-Circuit Objective Structured Clinical Examination (OSCE).

Ensuring that examiners in different parallel circuits of objective structured clinical examinations (OSCEs) judge to the same standard is critical to the chain of validity. Recent work suggests examiner-cohort (i.e., the particular group of examiners) could significantly alter outcomes for some candidates. Despite this, examiner-cohort effects are rarely examined since fully nested data (i.e., no crossover between the students judged by different examiner groups) limit comparisons. In this study, the authors aim to replicate and further develop a novel method called Video-based Examiner Score Comparison and Adjustment (VESCA), so it can be used to enhance quality assurance of distributed or national OSCEs. In 2019, 6 volunteer students were filmed on 12 stations in a summative OSCE. In addition to examining live student performances, examiners from 8 separate examiner-cohorts scored the pool of video performances. Examiners scored videos specific to their station. Video scores linked otherwise fully nested data, enabling comparisons by Many Facet Rasch Modeling. Authors compared and adjusted for examiner-cohort effects. They also compared examiners' scores when videos were embedded (interspersed between live students during the OSCE) or judged later via the Internet. Having accounted for differences in students' ability, different examiner-cohort scores for the same ability of student ranged from 18.57 of 27 (68.8%) to 20.49 (75.9%), Cohen's d = 1.3. Score adjustment changed the pass/fail classification for up to 16% of students depending on the modeled cut score. Internet and embedded video scoring showed no difference in mean scores or variability. Examiners' accuracy did not deteriorate over the 3-week Internet scoring period. Examiner-cohorts produced a replicable, significant influence on OSCE scores that was unaccounted for by typical assessment psychometrics. VESCA offers a promising means to enhance validity and fairness in distributed OSCEs or national exams. Internet-based scoring may enhance VESCA's feasibility.

OSCEGame: A serious game for OSCE training.

Objective Structured Clinical Examinations (OSCEs) are amongst the most anxiety-provoking competency assessment methods. An online serious game (OSCEGame) was developed and implemented within the OSCE curriculum. This study aimed to evaluate the usefulness of this serious game on preparedness and reducing OSCE-related stress. A serious game was designed to help dental students train for OSCEs. Two game courses (4 stations each) were designed according to year of undergraduate training (4th and 5th year), based on 6 pre-existing multi-competency OSCE stations. The OSCEGame was available online on a learning platform 4 to 6weeks before the summative OSCEs. Game use was evaluated by analysing connection data. Preparedness, stress and time management skills were assessed using a questionnaire following the summative OCSEs. The results of 4th -year students (OSCE naive population) were compared to those of 5th -year students to assess usefulness and benefits of such preparation method. In total, 97% and 60% of the students in 4th year and 5th year, respectively, used the game. The game was seen as an essential preparation tool to reduce anxiety (for 60% of all students) and increase time management skills (65% of all students). However, significant differences were observed between 4th- and 5th -year students (anxiety reduction: 65% vs. 22%, p<0.001; time management skills: 59% vs. 41%, p<0.05) suggesting that it is most useful for OSCE naive students. This serious game is a useful time efficient online tool, for OSCE preparation, especially in OSCE naive students.

Formative assessment of practical skills with peer-assessors: quality features of an OSCE in general medicine at the Heidelberg Medical Faculty.

Background: Objective Structured Clinical Examinations (OSCEs) have become an established examination format at German medical faculties. Medical experts routinely use a summative assessment to evaluate practical and communicative skills, while the use of the OSCE format by student examiners, as a formative examination, remains rather limited.Objective: The formative OSCE program of the Department of General Practice and Implementation Research at the Heidelberg Medical Faculty, which is conducted and evaluated by peer tutors, is examined with regard to its quality criteria and compared with summative OSCEs from other departments. Methods: Difficulties and discriminatory power of individual testing stations were determined for the summative, as well as the formative OSCE, and compared with each other. To assess the reliability of the measurements, an analysis of the data was carried out using the Generalizability theory. In addition, a comparison is made between the assessments of student examiners and second assessments by medical experts.Results: The stations of the formative OSCE show similar difficulties as those of the summative comparison OSCEs (Pform=0.882; Psum=0.845 – 0.902). With respect to measurement reliability, there are no differences between the OSCE in General Medicine and the other subjects. The assessments of student examiners and medical experts correlate highly (r=0.888).Conclusion: The formative OSCE in General Medicine is comparable to the summative comparison formats in terms of its quality criteria. The use of student examiners can be a reliable alternative to medical experts in formative OSCEs.

Students' perceptions of a near-peer Objective Structured Clinical Examination (OSCE) in medical imaging

IntroductionNear-peer learning, where peers from more senior year levels teach more junior peers is a popular teaching strategy in healthcare education. There is an emerging trend to utilise this teaching strategy in preparing students for Objective Structured Clinical Examinations (OSCEs) in the form of near-peer led formative OSCEs (NP-OSCE). However, there is little exploration of this teaching strategy in medical imaging education, nor how students perceive NP-OSCEs as beneficial to their learning. This study addresses this gap. MethodsUsing a students as partners inquiry approach, 47 near-peer learners' (NPLs) and 6 near-peer teachers' (NPTs) perceptions of participating in a NP-OSCE were examined using an anonymous self-report questionnaire. ResultsNPLs reported that participating in the immersive NP-OSCE helped their performance in the summative OSCE by helping with their preparedness; including understanding expectations, experiencing emotions and being able to identify gaps in their knowledge and skills, which they then used to direct their revision in a manner that demonstrated the development of skills in evaluative judgement. There were mixed findings regarding the impact the NP-OSCE had on NPLs' levels of anxiety. NPTs also found the NP-OSCE beneficial for identifying gaps in their own knowledge and skills, yet found taking on the role of an examiner challenging. ConclusionStudents perceive NP-OSCEs as a valuable learning activity that helps them prepare for their OSCEs by providing a student perspective of an authentic immersive learning experience. NP-OSCEs enable students to focus their revision and develop skills in evaluative judgement. Implications for practiceEducators should consider including NP-OSCEs in their medical imaging curriculum as students perceive it as a valuable learning experience that assists them to prepare for their OSCE.

How the introduction of OSCEs has affected the time students spend studying: results of a nationwide study

BackgroundMedical schools globally now use objective structured clinical examinations (OSCEs) for assessing a student’s clinical performance. In Germany, almost all of the 36 medical schools have incorporated at least one summative OSCE into their clinical curriculum. This nationwide study aimed to examine whether the introduction of OSCEs shifted studying time. The authors explored what resources were important for studying in preparation for OSCEs, how much time students spent studying, and how they performed; each compared to traditionally used multiple choice question (MCQ) tests.MethodsThe authors constructed a questionnaire comprising two identical sections, one for each assessment method. Either section contained a list of 12 study resources requesting preferences on a 5-point scale, and two open-ended questions about average studying time and average grades achieved. During springtime of 2015, medical schools in Germany were asked to administer the web-based questionnaire to their students in years 3–6. Statistical analysis compared the responses on the open-ended questions between the OSCE and MCQs using a paired t-test.ResultsThe sample included 1131 students from 32 German medical schools. Physical examination courses were most important in preparation for OSCEs, followed by class notes/logs and the skills lab. Other activities in clinical settings (e.g. medical clerkships) and collaborative strategies ranked next. Conversely, resources for gathering knowledge (e.g. lectures or textbooks) were of minor importance when studying for OSCEs. Reported studying time was lower for OSCEs compared to MCQ tests. The reported average grade, however, was better on OSCEs.ConclusionsThe study findings suggest that the introduction of OSCEs shifted studying time. When preparing for OSCEs students focus on the acquisition of clinical skills and need less studying time to achieve the expected level of competence/performance, as compared to the MCQ tests.

S-Vest: a novel hybrid method to allow standardised patients to put on the objective physical examination findings of a disease

BackgroundSimulation hybrids combine single modality simulation such as simulated patients (SP) with low-fidelity simulation to create a potentially more powerful set of educational tools. To make a hybrid that is...

Pass-Fail Decisions for Borderline Performers After a Summative Objective Structured Clinical Examination

Objective. To determine what expert assessors value when making pass-fail decisions regarding pharmacy students based on summative data from objective structured clinical examinations (OSCE), and to determine the reliability of these judgments between multiple assessors. Methods. All assessment data from 10 exit-from-degree OSCE stations for seven borderline pharmacy students (determined by standard setting methods) and one control was given to three of eight assessors for review. Assessors determined an overall pass-fail decision based on their perception of graduate competency. Assessors were interviewed to determine their decision-making rationale. Intraclass correlation coefficients were used to calculate reliability between assessor judgments. Results. Expert consensus was achieved for three of the eight students, however, the assessors' decisions did not align with standard-setting results. The reliability of assessors' decisions was poor. Assessors focused on ability to make correct recommendations rather than on gathering information or providing follow-up advice. Global evaluations (including a student's communication skills) rarely influenced the assessors' decision-making. Conclusion. When faced with making pass-fail decisions for borderline students, the assessors focus on evaluating the same competencies in the students but differed in their expected performance levels of these competencies. Pass-fail decisions are primarily based on task-focused components instead of global components (eg, communication skills), despite that global components are weighted the same for scoring purposes.

Summative Objective Structured Clinical Examination Assessment: A Mini Review

The end of any form of rigorous, specific, and high-stakes process of systematic and structured instruction is characterized by a summative assessment to evaluate the learner’s ability to apply the body of knowledge or clinical skills encountered and interacted with over a specific duration and to progress to the next phase of training. The aim of this project is to analyze the design, validity, delivery, supervision, and feedback of a summative objective structured clinical examination (OSCE) assessment. The results of this analysis showed a satisfactory and widely accepted method of assessment in medical education despite a few shortcomings. All forms of assessment have their inherent strengths and weaknesses, but it is essential that these assessments encourage future learning. Summative assessment has been proven to be a valid, comprehensive, and reliable method, and most importantly, it allows direct observation and evaluation of procedural and clinical skills.

Summative Objective Structured Clinical Examination Assessment at the End of Anesthesia Residency for Perioperative Ultrasound

While standardized examinations and data from simulators and phantom models can assess knowledge and manual skills for ultrasound, an Objective Structured Clinical Examination (OSCE) could assess workflow understanding. We recruited 8 experts to develop an OSCE to assess workflow understanding in perioperative ultrasound. The experts used a binary grading system to score 19 graduating anesthesia residents at 6 stations. Overall average performance was 86.2%, and 3 stations had an acceptable internal reliability (Kuder-Richardson formula 20 coefficient >0.5). After refinement, this OSCE can be combined with standardized examinations and data from simulators and phantom models to assess proficiency in ultrasound.

Use of a fundus photograph matching program in imparting proficiency in ophthalmoscopy

ObjectiveTo determine whether practice using an online fundus photograph program results in a long-term increase in proficiency with direct ophthalmoscopy skills in medical students. DesignThis study was a prospective medical education trial. Students were enrolled to participate in a voluntary Objective Structured Clinical Examination (OSCE) using 5 patients with ocular findings. Students who matched a minimum of 6 discs 16 months before the study were assigned to the intervention group and were compared with students who did not participate in the exercise. ParticipantsForty-six second-year medical students at Queen’s University: 15 in the intervention group and 31 in the control group. MethodsStudents were evaluated using the Queen’s University Ophthalmoscopy OSCE Checklist (QUOOC). Students were asked to calculate the cup-to-disc ratio, comment on disc margins, and whether there was any macular pathology. Students participated in a summative OSCE as part of the curriculum in which all students attempted to match fundus photographs. ResultsStudents in the intervention group performed significantly better on the QUOOC, with a mean score of 78.3% (± 4.2), compared with the control, who had a mean score of 69.4% (± 4.2) (p = 0.005). The intervention group was significantly more accurate at matching optic nerve photographs, with 100% (15/15) of the students correctly identifying the correct optic nerve on first attempt compared with 53.3% (16/30) in the control group (p = 0.0014). ConclusionsThe use of an online peer fundus photograph program leads to a long-term increase in examination technique, proficiency in ophthalmoscopy, and accuracy at matching optic nerve photographs.