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The Objective Structured Clinical Examination (OSCE) has become a staple in medical education, since its inception over 40 years ago. A recent article; ‘The art of reinvention: the remarkable longevity of the OSCE’[1] examines how OSCEs have continually adapted to meet the changing needs of medical education to endure as a popular assessment method.

Taking inspiration from the article, here we explore how emerging technologies in medicine could innovate OSCEs, not only by bringing improvements but also by offering dynamic learning opportunities to enrich students’ objective structured clinical exam experiences.

The Traditional Objective Structured Clinical Exam

Historically, using OSCEs to assess clinical competence has been crucial. They employ standardised patients and real-world scenarios to evaluate a student’s ability to apply theoretical knowledge in practical situations.

This often involves a huge amount of planning and organisation. Arranging venues, simulated patients, and examiners. Designing the stations and rotations and then assigning the students. With the success of the OSCE hinging on all elements coming together smoothly.

When organised diligently, this works very effectively. However, the onset of the Covid-19 pandemic saw OSCEs disrupted across the world. Suddenly it wasn’t possible to gather in person and exams were thrown into disarray and institutions were faced with finding alternative solutions.

Remote OSCE Innovation

This led to a major innovation in OSCE Exams; virtual or remote OSCEs;  Incorporating technology to simulate realistic patient encounters, utilising video conferencing, virtual patient cases, and interactive tools to replicate the challenges of real-world clinical practice, they provided a solution that was workable in challenging circumstances. In the early days, many hastily assembled rudimentary solutions using video platforms such as Teams and Zoom, however, these were far from ideal.

While developing the eSystem remote OSCE module, the focus was on creating a seamless and user-friendly remote process that mirrored the traditional OSCE format as much as possible. The eSystem remote OSCE module therefore,  has integrated video functionality, which allows practical exams to be run from any location, without the need for third-party software. It provides all the benefits of streamlined processes and reduced complexity, without the need for physical stations and locations. Virtual stations can include multiple examiners, simulated patients and images if required. Candidates are automatically rotated around the circuit until all stations are complete.

Studies [2] [3] have shown that the remote format of OSCE is successful, with student outcomes being comparable to traditional OSCEs. Remote OSCEs provide a flexible and convenient alternative for assessment while maintaining the integrity of evaluating practical skills essential for healthcare professionals.

Using Virtual Reality (VR) and Augmented Reality (AR) to Innovate OSCEs

Both Virtual Reality (a computer-generated, immersive experience that simulates a real-world environment) and Augmented Reality (technology that overlays computer-generated information, such as images, sounds, or data, onto the real-world environment) applications are starting to be used in OSCEs.

These technologies allow students to engage with and be assessed on realistic scenarios, such as surgical procedures and clinical consultations. Not only can they practice and refine skills without the constraints of the physical world, but they can do so in a safe and controlled environment, reducing the risk of harm to real patients in the learning process. VR and AR also have the ability to expand the scope of assessable competencies. For example, they allow the simulation of intricate surgical procedures that may be challenging to replicate in a physical OSCE. Rare and complex scenarios that may be infrequently encountered in real-life clinical settings can also be easily tested.

Furthermore, by providing standardised scenarios, objective assessment is possible. When using simulated patients or actors, the potential for discrimination may increase, as there can be varying interpretations of instructions or scenarios, leading to different exam experiences among candidates and compromising exam integrity.

The technology can be used for both in-person and remote exams meaning it has the flexibility to adapt according to the circumstances. Comparative studies[4] have found virtual stations to be akin to physical stations.

Simulation Centres and High-Fidelity Mannequins

Simulation centres equipped with high-fidelity mannequins are being increasingly used in the modern OSCE. Like AR and VR these mannequins have been designed to mimic various medical conditions and respond dynamically to interventions in a controlled and consistent manner. However, they have the added benefit of providing a physical, tangible, presence that closely resembles the human body. This provides a level of touch and feel realism that VR and AR lack. Students can be assessed on clinical procedures that would be difficult to perform on a simulated patient, from intubations to cardiac resuscitations, in a risk-free environment. Practicing paediatric procedures is another example where they may be particularly useful.

Transforming Exam Feedback

Technology has transformed how post-exam feedback is given to candidates. With the eSystem, examiners record marks directly onto a mark sheet on their device. Marks and individual feedback are instantly captured and detailed, personalised candidate feedback reports can be shared quickly and easily after the exam.

With emerging technologies, it’s possible to conceive that technology can further enhance the way that feedback is given. For example, the use of smart sensors and cameras could capture and analyse students’ interactions and provide a useful record for students to revisit post-exam for constructive feedback on procedural techniques, clinical judgement or communication skills.


It’s clear that technology is helping to bring enhancements and innovations to OSCEs. In the future, we could see further advancements, such as Artificial Intelligence (AI), potentially playing a role in scenario customization and adaptive learning.

However, it’s important to note that while these developments could bring immense value to medical education, they also pose challenges. Barriers such as cost, accessibility, and acceptability persist. Although, it’s likely that over time they will become more accessible and acceptable.

The OSCE has demonstrated its adaptability to changing times, and as technology evolves, so does the OSCE, ensuring that medical education stays at the forefront of innovation. There’s no doubt it will continue to prepare the next generation of healthcare professionals for the challenges of a rapidly advancing field.

For further reading on technological advancements in medicine the article telemedicine and remote learning: Bridging the gap in medical education is worth a look.

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[1] Carol Chan, S. C., & Rashid, M. A. The art of reinvention: The remarkable longevity of the OSCE. Medical Education.


[2] Shaban, S., Tariq, I., Elzubeir, M. et al. Conducting online OSCEs aided by a novel time management web-based system. BMC Med Educ 21, 508 (2021).


[3] Shorbagi S, Sulaiman N, Hasswan A, Kaouas M, Al-Dijani MM, El-Hussein RA, Daghistani MT, Nugud S, Guraya SY. Assessing the utility and efficacy of e-OSCE among undergraduate medical students during the COVID-19 pandemic. BMC Med Educ. 2022 Mar 8;22(1):156. doi: 10.1186/s12909-022-03218-9. Erratum in: BMC Med Educ. 2022 Apr 1;22(1):230. PMID: 35260144; PMCID: PMC8902284.


[4] Clinical Competency Assessments: A Comparative Study of Virtual-Reality-Based and Traditional

Physical OSCE Stations. Tobias Mühling, Verena Schreiner, Marc Appel, Tobias Leutritz, Sarah König