"I still have not mastered that skill!" Medical student perspectives on a simulation-based evidence-based medicine competency assessment.

Objective: We expect medical students to be able to apply evidence-based medicine (EBM) skills in the context of the clinical care of patients. Previous assessments of this domain have primarily utilized decontextualized knowledge tests, which provide limited insights into students' understanding of EBM skills in the context of patient care. New performance-based EBM competence assessments using Objective Structured Clinical Examinations (OSCEs) are being developed and tested. Understanding how students experience and interact with a simulation-based assessment of EBM competence would enable us to improve the modality. Methods: We recruited 13 graduating medical students from one medical school who had recently completed an immersive multi station readiness-for-residency OSCE (Night onCall) which included a case-based EBM assessment. We conducted individual interviews to explore their perceptions of participating in this OSCE as a method of EBM assessment. The interviews were transcribed, coded, and analyzed using Dedoose by three health science librarians. Results: Students discussed their experience and perceptions in six main areas: connection to clinical practice, curricular timing and content coverage, feedback, station instructions, awareness of their own limitations, and an OSCE as a format for assessing EBM. Conclusion: Medical students appreciated the EBM OSCE because it enhanced their learning about how to integrate EBM into clinical practice. They proposed implementing multiple such opportunities throughout medical school because it would improve their competence and provide highly impactful opportunities to build toward EBM mastery. They endorsed that this would be well-accepted by medical students.