Conducting a high-stakes OSCE in a COVID-19 environment

The COVID-19 pandemic has presented significant challenges for medical schools. It is critical to ensure final year
medical school students are not delayed in their entry to the clinical workforce in times of healthcare crisis.
However, proceeding with assessment to determine competency for graduation from medical school, and
maintaining performance standards for graduating doctors is an unprecedented challenge under pandemic
conditions. This challenge is hitherto uncharted territory for medical schools and there is scant guidance for medical
educators. In early March 2020, Duke-National University Singapore Medical School embraced the challenge for
ensuring competent final year medical students could complete their final year of studies and graduate on time, to
enter the medical workforce in Singapore without delay. This paper provides details of how the final year clinical
performance examinations were planned and conducted during the COVID-19 pandemic. The aim of the paper is to
provide guidance to other medical schools in similar circumstances who need to plan and make suitable adjustments
to clinical skills examinations under current pandemic conditions. The paper illustrates how it is possible to design
and implement clinical skills examinations (OSCEs) to ensure the validity and reliability of high-stakes performance
assessments whilst protecting the safety of all participants, minimising risk and maintaining defensibility to key
stakeholders.