completedylmfos4.0

RESEARCHARTICLEOpenAccessHowtheintroductionofOSCEshasaffectedthetimestudentsspendstudying:resultsofanationwidestudyStefanMüller1,InesKoch2,UtzSettmacher1andUtaDahmen3*AbstractBackground:Medicalschoolsgloballynowuseobjectivestructuredclinicalexaminations(OSCEs)forassessingastudent'sclinicalperformance.
InGermany,almostallofthe36medicalschoolshaveincorporatedatleastonesummativeOSCEintotheirclinicalcurriculum.
ThisnationwidestudyaimedtoexaminewhethertheintroductionofOSCEsshiftedstudyingtime.
TheauthorsexploredwhatresourceswereimportantforstudyinginpreparationforOSCEs,howmuchtimestudentsspentstudying,andhowtheyperformed;eachcomparedtotraditionallyusedmultiplechoicequestion(MCQ)tests.
Methods:Theauthorsconstructedaquestionnairecomprisingtwoidenticalsections,oneforeachassessmentmethod.
Eithersectioncontainedalistof12studyresourcesrequestingpreferencesona5-pointscale,andtwoopen-endedquestionsaboutaveragestudyingtimeandaveragegradesachieved.
Duringspringtimeof2015,medicalschoolsinGermanywereaskedtoadministertheweb-basedquestionnairetotheirstudentsinyears3–6.
Statisticalanalysiscomparedtheresponsesontheopen-endedquestionsbetweentheOSCEandMCQsusingapairedt-test.
Results:Thesampleincluded1131studentsfrom32Germanmedicalschools.
PhysicalexaminationcoursesweremostimportantinpreparationforOSCEs,followedbyclassnotes/logsandtheskillslab.
Otheractivitiesinclinicalsettings(e.
g.
medicalclerkships)andcollaborativestrategiesrankednext.
Conversely,resourcesforgatheringknowledge(e.
g.
lecturesortextbooks)wereofminorimportancewhenstudyingforOSCEs.
ReportedstudyingtimewaslowerforOSCEscomparedtoMCQtests.
Thereportedaveragegrade,however,wasbetteronOSCEs.
Conclusions:ThestudyfindingssuggestthattheintroductionofOSCEsshiftedstudyingtime.
WhenpreparingforOSCEsstudentsfocusontheacquisitionofclinicalskillsandneedlessstudyingtimetoachievetheexpectedlevelofcompetence/performance,ascomparedtotheMCQtests.
Keywords:Assessment,OSCEs,Studybehaviour,Medicalstudents,SurveyBackgroundMedicalschoolsaroundtheworldhaveimplementedobjectivestructuredclinicalexaminations(OSCEs)[1].
InanOSCE,studentsmovethroughaseriesofstationswheretheyhavetoperformspecificclinicaltaskswithinatimelimit.
Thecontentdomainstobeassessedandthescoringschemefortheexaminationaredefinedinadvance[2].
Sinceitsfirstdescriptioninthemid-1970s[3],theOSCEhasbeenthesubjectofcountlesspapers[4].
AnumberofpapershaveshownthattheOSCEisavalidandreliableassessmentofastudent'sclinicalcom-petence[5–8].
PapershavealsoshownthatstudentsaccepttheOSCEasarelevantandfairexam[9–11].
However,onlyafewstudiesexistonhowthede-ploymentofOSCEsaffectsstudents'studybehaviour.
NewbleandJaeger[12],forinstance,reportedthatwork-basedlearning,textbooks,tutorials,andgroupactivitieswerethepredominantresourceswhenstudyingforaclinicalexamination.
Mavis[13]foundthatstudentsfocusedoncognitivelearningstrategies,suchasreviewingtextbooksorclassnotes,whenpreparingforanOSCE.
Thisstudy,however,waslimitedtotheextentthattheTheAuthor(s).
2019OpenAccessThisarticleisdistributedunderthetermsoftheCreativeCommonsAttribution4.
0InternationalLicense(http://creativecommons.
org/licenses/by/4.
0/),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicense,andindicateifchangesweremade.
TheCreativeCommonsPublicDomainDedicationwaiver(http://creativecommons.
org/publicdomain/zero/1.
0/)appliestothedatamadeavailableinthisarticle,unlessotherwisestated.
*Correspondence:uta.
dahmen@med.
uni-jena.
de3DepartmentofGeneral,VisceralandVascularSurgery,ExperimentalTransplantationSurgery,UniversittsklinikumJena,DrackendorferStr.
1,07747Jena,GermanyFulllistofauthorinformationisavailableattheendofthearticleMülleretal.
BMCMedicalEducation(2019)19:146https://doi.
org/10.
1186/s12909-019-1570-6examinedOSCEwasaformative,andnotasummativeassessment,whichmayexplainthedifferentfindings.
Rudlandandcolleagues[14]identifiedthattheOSCEfosteredcollaborativelearning,butdidnotencouragestudentstospendmoretimelearninginclinicalset-tings.
ThedisparitiesfoundintheliteraturesuggestthattheOSCEdoesnotalwaysdrivestudentlearninginthedesirableway.
ThestudentstudybehaviourmayratherdependuponofwhatisspecificallyassessedintheOSCEs,thepurposeoftheassessment(summativevs.
formative),aswellasotherfactorssuchaspatientavailability[15],advicegivenbytheteachersorinfor-mationfrompeers.
TheaimofourstudywastoexaminewhethertheintroductionofOSCEassessmentsshiftedthetimestudentsspendstudying.
WeexploredwhatresourceswereimportantforstudyingandhowmuchtimestudentsspentwhenstudyingforOSCEscomparedtotraditionallyusedmultiplechoicequestion(MCQ)tests,andhowtheyperformedontherespectiveassess-mentformat.
MethodsContextWeconductedthepresentstudyinthecontextoftheamendmentofthenationalmedicallicensureactcarriedoutin2002,whichcalledforamorepractice-andpatient-orientedalignmentofmedicaleducationinGermany[16].
Eachofthe36medicalschoolsestab-lishedbefore2012hasasix-yearcurriculum.
Thecur-riculausuallyconsistoftwopreclinicalyearsfollowedbythreeclinicalyearsand,finally,theclinicalintern-shipyear.
Accordingtotheguidelinesofthemedicallicensureact,theclinicalyearscomprise41predeter-minedcoursesentailingthefullrangeofclinicalareasordisciplines.
Duringthesecourses,studentshavetopasssummative(graded)in-houseassessmentsdesignedbymedicalschoolmemberstobeadmittedtothenationallicensingexamination.
Themedicallicensureactsetsthegeneralframeworkoftheundergraduateprogramme,butschoolshaveconsiderablefreedomtoorganisetheirowncurricula.
Thus,boththesuccessionoftheindividualcoursesandtheirspecificcontent,aswellastheaccompanyingassessmentstrategydifferfromoneschooltoanother.
Writtenassessments,intheformofMCQtests,arestillmostcommonlyusedduringtheclinicalyearsinallGermanmedicalschools.
Thefocusisontestingastudent'sknowledgeaboutdiseases,involvingpatho-genesis,signsandsymptoms,diagnosticapproaches,andtreatmentstrategies.
Inordertocomplywiththenewlegalrequirements,medicalschoolshavebroadenedtheirassessmentrepertoiretoincludeperformancere-latedskills.
Bynow,33ofthe36medicalschools(92%)haveintroducedatleastonesummativeOSCEintotheirin-houseassessmentsystemusedfortheclinicalcurricu-lum[17].
IntheheldOSCEs,themainfocusisontheperformancedomainsphysicalexamination,historytaking,practicalprocedures,andcommunicationskills.
PassingtheOSCE(s)isalsoaprerequisiteforstudentstobeadmittedtothenationallicensingexamination.
StudentpopulationIntheacademicyear2014/15,therewerearound88,000medicalstudentsinGermany.
Almost2=3ofthem(53,352[61%])werefemalestudents[18].
WesurveyedmedicalschoolsonboththenumberofstudentsperyearandthetimingwhenOSCEsoccurredinthecur-riculum.
Withthesedata,wecalculatedtheproportionofstudentsduringtheclinicalyearsortheclinicalin-ternshipyearwhohadexposuretoasummativeOSCEatslightlymorethan32,700.
DatacollectionBetweenFebruaryandAprilof2015,weconductedthisstudyusingthefreesoftwarepackageSoSciSurvey(www.
soscisurvey.
de).
Duetoprivacyterms,wedidnotgetaccesstothestudents'emailaddresses.
Wethereforecouldnotadministerourweb-basedquestionnairetoaselectedsampleofthepopulationinstudy;butinstead,askedthemedicalschoolsinGermanytoadvertisethesurveyontheirwebsitesorthroughmessagingsystems.
Allmedicalstudentsofyears3,4,5,and6,whohadundertakenatleastonesummativeOSCE,wereeligibletoparticipateinthestudy.
Participationwasvoluntaryandanonymous,andtherespondentsdidnotreceiveanyincentiveforcompletingthequestionnaire.
Thestudywasinaccordancewiththeethicalstandardsofourinstitutionalreviewboard(EthicsCommitteeofJenaUniversityHospitalatFriedrichSchillerUniversity).
DesignofthequestionnaireWefirstreviewedliteratureandconductedinterviewswithstudentstoidentifyitemsthatwecoulduseforourstudy.
Basedonthisknowledge,wedevelopedadraftquestionnaire.
Asanextstep,werepeatedlypilot-testedandrevisedthedraftforensuringthatrespondentscompletedthesurveyintheintendedmanner.
Thefinalversionofthequestionnairecomprisedtwoidenticalsections,thefirstfortheOSCEandthesecondfortheMCQs.
Eachsectioncontainedalistof12studyresources(Table1).
Participantsratedtheirpreferencesinpre-parationfortherespectiveassessmentmethodona5-pointscale,anchoring1(notimportant),2(slightlyimportant),3(moderatelyimportant),4(important),and5(veryimportant).
Participantsthenansweredtwoopen-endedquestions.
Firstly,wepromptedthemtoMülleretal.
BMCMedicalEducation(2019)19:146Page2of7estimatetheaveragetotaltimetheyspentpreparingforasinglesummativein-houseOSCEorMCQtest.
Toimproveeaseofcompletion,werequestedthemtoindicatetheirtimespentinworkingdaysofabout8h.
Secondly,weaskedthemtoreporttheiroverallaveragegradeachievedoneachofthetwoassessmentmethods.
Inthispaper,wepresentthereportedgradesona4.
0gradingscalerangingfrom0.
0(failinggrade)and1.
0(lowestpassinggrade)to4.
0(bestpossiblegrade).
Finally,thequestionnairecollecteddemographicdetails,involvinggender,age,academicyear(semester),andmedicalschoolaffiliation.
Thequestionnairealsoincludedan11-itemsetonthebenefitoftheOSCEorMCQs(atthebeginningofeachsection).
Theresultsarepresentedinasepa-ratepaperrecentlypublishedinGMSJournalforMedicalEducation[19].
AllthequestionnaireitemscanbefoundinAdditionalfile1.
DataanalysisAftersampling,weverifiedthateachrespondenthadex-posuretoasummativeOSCEbysquaringtheindicatedsemesterorthedaywhencompletingourquestionnairewiththespecificcurriculumoftherelevantmedicalschool.
Forcarryingoutthestatisticalanalysis,weusedIBMSPSSStatisticsforWindows,Version24(IBMCorp.
,Armonk,NY,USA).
Weperformeddescriptivestatisticsandusedapairedt-testtocompareparti-cipants'responsesontheopen-endedquestionsbetweentheOSCEandMCQs.
WecalculatedCohen'sdasameasureofeffectsizefromthet-statistic(t-value,groupsize,andPearson'scorrelationcoefficient).
Todeterminewhetherthemedicalschoolhadaninfluenceontheresults,weconductedaunivariateANOVAusingthemeanoftheresponsesforthetwoassessmentmethods(excludingmissingdata)asthedependentvariableandthemedicalschoolasthefixedfactor.
Weconsideredpvaluesbelow0.
05statisticallysignificant.
Whennotstatedotherwise,wepresentdataasmeanswithstand-arddeviationsinparentheses.
ResultsSampleThenumberofparticipantswhocompletedtheques-tionnairewas1189.
Weremoved58respondents,aseitherthedemographicdetailswereincompleteorweobservedthatthoserespondentshadnotyetbeenexposedtoasummativein-houseOSCE.
Ouranalysisincluded1131respondents(777femalestudents[69%]vs.
354malestudents[31%])from32ofthe33medicalschools(97%)thatwereholdingsummativeOSCE(s).
Thesamplerepresentedallagegroupsofstudents,witharangefrom19to45years(median25).
Groupsizesofyears4,5,and6weresimilar(318[28%],338[30%],and303[27%],respectively),whiletheproportionofyear3duetolessexposuretoOSCEswaslower(172[15%]).
Thenumberofrespondentsineachofthe33medicalschoolsvariedbetween0and123,withameanof34responsesperschool,dependingonhowtheindividualschoolsadvertisedourstudy(websitesvs.
messagingsystems).
StudyresourcesAll1131respondentsincludedintotheanalysiscom-pletedthelistonstudyresources.
TheratingsindicatedthatinpreparationforOSCEs,studentsmostlypreferredresourcestoacquireclinicalskills.
Physicalexaminationcourses(4.
38[0.
82])rankedfirst,followedbyclassnotes/logs(3.
88[1.
11])andtheskillslab(3.
87[1.
21]).
Medicalclerkships(3.
58[1.
16])andclinicalworkplace-ments(3.
56[1.
12]),aswellasgrouplearning(3.
61[1.
26])andpeertutorials(3.
53[1.
19])rankednext.
Theratingsalsoshowedthatstudentsattachedmoderateimportancetoresourcesforgatheringknowledge,suchaslectures(2.
67[1.
08])ortextbooks(3.
17[1.
07]),whenstudyingforOSCEs.
Students'preferencesofresourcesforstudyingweredifferentwhentheywerepreparingforMCQtests.
Resourcestogatherknowledgeweremostimportant,whereasthosetoacquireclinicalskillswereofminorimportance.
Classnotes/logs(4.
25[0.
95]),lectures(4.
07[1.
03]),andtextbooks(3.
97[0.
98])rankedfirst,second,andthird,followedbymultimediamaterials(3.
32[1.
19]).
Table1showsthecompleteratingsonthelistofstudyresourcesforbothassessmentmethods.
Table1Students'preferencesofstudyresourceswhenpreparingforOSCEsandMCQtestsStudyresourceOSCEsMCQtestsMean(SD)Mean(SD)Physicalexaminationcourses4.
38(0.
82)2.
09(1.
07)Classnotes/logs3.
88(1.
11)4.
25(0.
95)Skillslab3.
87(1.
21)1.
83(0.
97)Grouplearning3.
61(1.
26)2.
57(1.
29)Medicalclerkships3.
58(1.
16)2.
48(1.
14)Clinicalworkplacements3.
56(1.
12)2.
37(1.
13)Peertutorials3.
53(1.
19)2.
15(1.
11)Textbooks3.
17(1.
07)3.
97(0.
98)Multimediamaterials3.
05(1.
11)3.
32(1.
19)Casebooks2.
90(1.
14)2.
42(1.
14)Lectures2.
67(1.
08)4.
07(1.
03)PBLcourses2.
48(1.
14)2.
12(1.
09)PBLproblem-basedlearning,SDstandarddeviationTheresponsesweremadeona5-pointscalewithanchors1(notimportant),2(slightlyimportant),3(moderatelyimportant),4(important),and5(veryimportant)Numberofrespondents,n=1131Mülleretal.
BMCMedicalEducation(2019)19:146Page3of7StudyingtimeWeobtainedvalidresponsesfrom1043respondents.
There-portednumberofhoursspentforanOSCEwas66.
5(52.
5)and94.
8(71.
5)foranMCQtest,respectively,whichwassignificantlydifferent(t[1042]=14.
78,p<0.
01).
Cohen'sdof0.
44showedaneffectsizeinthemediumrange.
TheANOVArevealedthatthemedicalschoolhadasignificantinfluenceonthedurationofstudying(F[31,1011]=5.
40,p<0.
01,partialetasquared=0.
14).
Table2includestheresultsonstudyingtimebymedicalschoolaffiliation.
Wefoundthatrespondentsfromabouthalfofthemedicalschools(15/32[47%])reportedasignifi-cantlylowertimespentinpreparationforanOSCEcomparedtoanMCQtest,whilethetimespentdidnotdiffersignificantlybetweentheassessmentmethodsforrespondentsoftheotherschools.
PerformanceoutcomesFromourrespondents,1111repliedtothequestionaboutperformanceoutcomes.
Thereportedaveragegradewas3.
13(0.
62)onOSCEsand2.
84(0.
62)onMCQtests,respectively.
Thedifferencewassignificant(t[1110]=12.
55,p<0.
01).
Cohen'sdeffectsizewas0.
47indicatingamediumeffect.
TherewasasignificantinfluenceofthemedicalschoolontheOSCEandMCQgrades(F[31,1079]=6.
48,p<0.
01,partialetasquared=0.
16).
Table3showstheresultsonperformanceoutcomesbymedicalschoolaffiliation.
OuranalysisrevealedthatthereportedgradesweresignificantlybetteronOSCEsforrespon-dentsofalmosthalfofthemedicalschools(14/32[44%]),whereasthegradesonMCQtestsweresignifi-cantlybetteronlyinoneschool(XV).
DiscussionInresponsetotheamendmentofthenationallicensureact,GermanmedicalschoolshaveincorporatedOSCEsintotheirsystemofassessment.
ThisnationwidestudysoughttoaddresshowtheintroductionofOSCEshasaffectedthetimestudentsspendstudying.
WeidentifiedthatstudentsusedifferentstrategiestoprepareinadvanceofOSCEassessmentsthancommonMCQtests.
However,thisfindingwasnotsurprising:Whenpre-paringforanassessment,studentsadapttheirstudybehaviour(whatandhowtheylearn)totheassessmentratherthantothelearningobjectiveslaiddowninthecurriculum.
Boththecontentdomainstobeexpectedandthetasksrequiredintheupcomingassessmentinfluencestudentlearning[20,21],whichhasbeendescribedaspre-assessmentlearningeffectsofassess-ment[22].
GiventhetasksbeingtestedintheOSCEs(takingahistory,examiningapatientorcarryingoutaprocedure),wethereforeexpectedthatstudentsseekopportunitiestorehearsethedesiredclinicalskills.
Althoughotherauthorshavereportedsimilarfindings,theyonlyexaminedoneOSCEatasingleinstitutionanddidnotuseamulti-centreapproach[23,24].
Inconclusion,ourfindingsdepictedthatthedeploy-mentofOSCEshasanimpactonthestudents'learningbehaviour.
Inagreementwithpreviousstudies[23–25],theassessmenttoolencouragesstudentstoacquireclinicalskillsin,forexample,physicalexamination,Table2ReportedstudyingtimeforOSCEsandMCQtestsbymedicalschoolaffiliationMedicalschoolnbTimespent(h)foranOSCEaTimespent(h)foranMCQtestapcMeanMeanVI5151.
887.
7<0.
01VII3841.
676.
5<0.
01VIII3850.
6109.
5<0.
01X10889.
1146.
2<0.
01XI3451.
792.
2<0.
01XII3254.
3120.
6<0.
01XIV7259.
982.
0<0.
01XVI4052.
5105.
8<0.
01XXXI5546.
480.
0<0.
01II1154.
5103.
30.
01III1757.
284.
70.
01XXII885.
0156.
00.
02XXIII1844.
195.
60.
02XXIV38111.
8139.
80.
02XXXII5047.
963.
70.
04IX3367.
989.
70.
06XXX2554.
270.
40.
06V1645.
559.
50.
07I1853.
879.
80.
08XXV660.
089.
30.
08XXI5156.
969.
60.
09XXVIII5461.
370.
80.
20IV5778.
389.
20.
22XIII1570.
992.
80.
32XX462.
046.
00.
47XXVI3177.
285.
50.
47XIX6121.
3149.
30.
48XV1149.
556.
00.
57XXIX567.
277.
60.
60XXVII460.
052.
00.
64XVII9599.
398.
70.
90XVIII264.
060.
00.
91aAveragenumberofhours(h)studentsreportedtostudyinpreparationforasinglesummativein-houseOSCEorMCQtestbNumberofresponsescApairedt-testwasusedMülleretal.
BMCMedicalEducation(2019)19:146Page4of7practicalproceduresorcommunication.
Theassessmentalsoappearstomotivatestudents–ascomparedtotheMCQtests–tofocusmoreonstudyinginauthenticlearningenvironmentsandthecommunity,bothofwhichhasbeenseenasimportanttosupportlearning[26,27].
IfstudentsprepareforanOSCE"designedtoassesscertaincompetenciesorskills"[28];vs.
MCQs,whichdrawitemsfromamuchlargercontentdomain,thentheywouldprobablyneedlessstudytimetoachievetherequiredlearningoutcomes.
Ourfindingsconfirmedthisassumptionforthefirsttime.
Wefoundthateventhoughthereweredifferencesbetweenschools,studentsspentlesstimepreparingforanOSCEcomparedwithanMCQtest,andyetperformedwell.
TherehasbeenevidencethatscoresachievedontheOSCEarestrongpredictorsofalaterclinicalperfor-mance[29,30].
However,goodperformanceontheOSCEdoesnotnecessarilymeanastudentwillhavethesamelevelofcompetenceorperformanceintheclinicalworkplace.
ThesimulatedenvironmentinwhichtheOSCEstakeplacecaninfluencetheperformance.
Thus,astudentmightperformpoorerwhenhe/sheisfacedwithunexpected,unusualcircumstancesintherealworkplace[31].
Itisimportanttokeepthisinmindwhenconsideringthe(good)performanceoutcomesinOSCEs[28].
LimitationsOurstudyhasseverallimitationsrelatedtoitssample.
First,aswechosethesamplingdesignofcollectingdatafromeveryindividualofthestudiedpopulationbyusingadvertisements,wecouldnotretracehowmanyoftheeligiblestudentsweapproached.
Therefore,wecanre-portneitheraresponsenoranon-responserate.
Second,wefoundanoverrepresentationofrespondentsfromparticularmedicalschoolsinoursample,whichmighthaveskewedtheresults.
Thevaryingdegreetowhichtheindividualmedicalschoolssupportedourstudymayhavecausedthisfact.
Nevertheless,thedemographicprofileofoursamplereflectedthegeneralmake-upofthemedicalstudentpopulationinGermanyand,inaddition,wehadasufficientlylargesamplesizeforouranalysis.
Anotherlimitationofthestudyisthatitreliedonaself-reportinginstrumenttodeterminestudyresources,studyingtime,andperformanceoutcomesleadingtopotentialbias.
Thisneedstobeconsideredwheninter-pretingtheresults.
ConclusionsWeconcludethattheintroductionoftheOSCEassess-mentshiftedthetimestudentsspendstudying.
Inpre-parationforOSCEs,studentsfocustheirattentiononacquiringthenecessaryclinicalskills,andtheyneedlessstudytimetoachievetheexpectedlevelofcompetenceorperformancecomparedwithMCQtests.
ThisclearlyconfirmsthevalueofaddingtheOSCEassessmenttoatestingprogramme,asitplacestheemphasisontheacquisitionofpracticalskillsinadditiontoknowledge.
Table3PerformanceoutcomesinOSCEsandMCQtestsbymedicalschoolaffiliationMedicalschoolnbAveragegradeonOSCEsaAveragegradeonMCQtestsapcMeanMeanI223.
522.
90<0.
01V163.
382.
47<0.
01VI523.
532.
73<0.
01VII423.
613.
00<0.
01IX353.
483.
01<0.
01XI343.
262.
86<0.
01XIV723.
122.
76<0.
01XXI542.
892.
60<0.
01XXIV483.
383.
03<0.
01XXVIII583.
372.
54<0.
01XXXI573.
382.
81<0.
01XXVII43.
752.
130.
01III173.
543.
120.
02XIII153.
402.
930.
02XXV63.
422.
620.
06XXIX53.
603.
000.
07XXXII493.
062.
890.
08VIII392.
962.
790.
09XX42.
503.
000.
09XXII83.
253.
000.
10XVI433.
243.
080.
13XXX232.
982.
720.
16XVII1053.
052.
950.
19XIX83.
192.
840.
21X1222.
602.
660.
38XII332.
812.
710.
38XVIII23.
252.
750.
50XXIII203.
103.
140.
88IV622.
962.
970.
92XXVI312.
812.
810.
96II123.
333.
331.
00XV132.
853.
480.
01aOverallaveragegradeacrossallassessmentsofthatkindasreportedbythestudents.
Weuseda4.
0gradingscale(minimum–maximum,0.
0–4.
0)bNumberofresponsescApairedt-testwasusedMülleretal.
BMCMedicalEducation(2019)19:146Page5of7AdditionalfileAdditionalfile1:Questionnaireitems(translatedintoEnglish).
(PDF238kb)AbbreviationsANOVA:Analysisofvariance;MCQs:Multiplechoicequestions;OSCEs:ObjectivestructuredclinicalexaminationsAcknowledgementsTheauthorswouldliketothanktherepresentativesofmedicalschoolsfortheirsupport,aswellasThomasKesslerfromtheDepartmentofSocialPsychology,UniversityofJenaforhishelpfuladviceondatacollectionandanalysis.
Aspecialthanksgoestothestudentswhocompletedthequestionnaire.
FundingNone.
AvailabilityofdataandmaterialsThedatathatsupportthefindingsofthisstudyareavailablefromthecorrespondingauthoruponreasonablerequest.
Authors'contributionsThestudywasdesignedandconceptualisedbySM,UD,andUS.
SM,IK,andUDcontributedtotheacquisition,analysis,andinterpretationofthedatausedforthework.
SMwasamajorcontributorinwritingthemanuscriptandallauthorsreadandapprovedthefinalmanuscripttobepublished.
EthicsapprovalandconsenttoparticipateAccordingtotheguidelinesoftheEthicsCommitteeofJenaUniversityHospitalatFriedrichSchillerUniversity,noformalethicsapprovalwasrequiredforthisstudy(https://www.
uniklinikum-jena.
de/ethikkommission/Antragstellung.
html).
Studentsindicatedtheirconsenttoparticipatebycompletingthequestionnaire.
ConsentforpublicationNotapplicable.
CompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.
Publisher'sNoteSpringerNatureremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations.
Authordetails1DepartmentofGeneral,VisceralandVascularSurgery,UniversittsklinikumJena,AmKlinikum1,07747Jena,Germany.
2DepartmentofGynaecologyandReproductiveMedicine,UniversittsklinikumJena,AmKlinikum1,07747Jena,Germany.
3DepartmentofGeneral,VisceralandVascularSurgery,ExperimentalTransplantationSurgery,UniversittsklinikumJena,DrackendorferStr.
1,07747Jena,Germany.
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