Experiences of Medical Students and Evaluators on Utilizing Simulators in Objective Structured Clinical Exam: A Qualitative Study

Introduction: Simulation is commonly used in health education, but its role in competency assessment remains underrecognized. This study examined the experiences and perceptions of medical students and evaluators regarding the use of simulators during an objective structured clinical exam (OSCE) to assess clinical competency. Methods: This qualitative study employed a conventional content analysis approach. Forty-three medical students and 2 evaluators from the Shahid Beheshti University of Medical Sciences in Tehran, Iran were recruited through purposive sampling in 2024 to 2025. Data collection involved 3 focus group interviews (first: 15 students; second: 14 students; third: 14 students), 2 semistructured individual interviews, and field notes, with data collection continued until saturation was achieved. Data analysis was conducted using a method developed by Graneheim and Lundman. Results: Six main categories were identified: (1) change management: resistance to change, stress from utilizing simulators, and positive adaptation to change; (2) facilitative role of the simulator: simulators overcome real-world limitations and act as facilitators rather than replacements for a clinical setting; (3) role of the human agent: the evaluator as a facilitator/interventionist, blended scoring, and feedback; (4) integration/coordination as the missing link: the simulator as a factor in vertical and horizontal integration; (5) challenges in utilizing a virtual patient simulator (VPS): lack of mastery learning before exams, insufficient time to use the simulator, absence of a holistic approach, low fidelity, and technical issues with VPS; and (6) progress toward enhancement: comparisons with past experiences, progress made, and the infrastructure and prerequisites of virtual OSCE. Conclusion: Although the use of simulators in OSCEs is a suitable method for clinical assessment, there are drawbacks in their implementation and training that require special attention. It is recommended that simulation-based assessment be more widely incorporated into the medical education curriculum.