Perceptions of the usefulness of an online simulated clinical examination.

Objectives: This study aims at evaluating the role of Monash Online Simulated Clinical Examination (MONSCE, where students demonstrate their clinical consultation, problem solving and counselling skills in a virtual encounter) in relation to the Observed Structured Clinical Examination (OSCE).  The study addresses feasibility and application, student, tutor and Simulated Patient (SP) acceptance and also assessing future role in student assessment. Methods: Drawing on social constructivism, the study employed a qualitative methodology to explore perspectives of medical students, examiners and SPs across metropolitan Melbourne, rural Victoria and Malaysia. Data included individual interviews with nine examiners, eleven SPs, and three focus groups with students. Data were transcribed and thematically analysed using framework analysis. Results: Analysis demonstrated overlapping perspectives with five themes - fit for purpose assessment, focus on dynamics of online discourse, perceiving realism, readiness for practice and implications for future, with ongoing role in Telehealth. Readiness or preparation for practice was acknowledged through impact on student performance for progression, examiners' focus on assessment rigour replicating chaos and complexity of real life and SPs drew analogy with real-life clinical consultations. Conclusions: MONSCE assessments appear to be useful for student assessment of skills like history taking and clinical counselling. Their role was considered complementary to in-person clinical skills assessment but not replace the complexity of real life or replicate skills assessment of empathy, physical examination, and difficult communication, where in-person assessment may be preferred.