Does voluntary practice improve the outcome of an OSCE in undergraduate medical studies? A Propensity Score Matching approach

In Objective Structured Clinical Examinations (OSCE), students have to demonstrate proficiency in a wide array of medical knowledge and different skills, ranging from physical examinations to medical-practical skills and doctor-patient interactions. In this study, we empirically test the concept 'assessment drives learning' and investigate whether an OSCE motivates extracurricular, voluntary free practice (FP) of specific skills in a Skills Lab, and whether this has positive treatment effects on exam success in the respective parts of the OSCE. To explore causal inference with observational data, we used Propensity Score Matching (PSM) to generate a control and a treatment group that only differed in their practice behavior. For internal examinations and practical skills such as venous catheter placement and IM injections, we find strong, positive effects of FP that can result in a grade-jump. We further show that the presence and strength of effects depends on the complexity and type of the task. For instance, we find no effect for practicing venipuncture, and performance in communicative skills is associated with the willingness to repeatedly engage with instructional contents inside and outside the Skills Lab, and not with targeted practice of specific skills. We conclude that the anticipation of the complex OSCE is effective in motivating students to engage with a wide range of competencies crucial to the medical profession, and that this engagement has positive effects on exam success. However, consistent practice throughout the study program is necessary to sustain and nurture the acquired skills.