Assessing Progress, Shaping Futures: A Qualitative Exploration of Final-Year Medical Students' Perspectives on the Clinical Assessment for Progression Examination (Clinical APEx): A Novel Competency-Based Exam.

Introduction: Traditional OSCEs, while reliable, are criticized for limited authenticity, delayed feedback, and high stress. The Clinical Assessment for Progression Examination (Clinical APEx), a new competency-based assessment at Monash, was developed to address these issues. Methods: We conducted an interpretivist qualitative interview study with 33 final-year medical students who completed both the Clinical APEx and OSCE, recruited via post-assessment survey and site-wide invitations. Semi-structured Zoom interviews were analysed using inductive reflexive thematic analysis. Results: Analysis revealed four key themes: Authenticity and Empathy, Feedback and Learning, Supportive Environment, and Challenges, which included concerns about standardisation, subjectivity, and under-assessment of clinical reasoning. Conclusion: Beyond describing a local innovation, this study highlights broader mechanisms of educational impact, particularly authenticity, feedback, and psychological safety, that can inform assessment design across contexts. The Clinical APEx serves as a case example for reimagining high-stakes assessment as assessment for learning rather than solely of learning. These findings provides conceptual insights as to how clinical assessments might be made both rigorous and developmentally meaningful.