Co-construction of a student-teacher tutoring program improves the performance of medical students in the first French national OSCE exam

Co-construction of a student-teacher tutoring program improves the performance of medical students in the first French national OSCE exam | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Co-construction of a student-teacher tutoring program improves the performance of medical students in the first French national OSCE exam Lola Borg, Karolina Griffiths, Claire Duflos, Geoffrey Blaizot, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6092093/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: In France, Objective Structured Clinical Examination (OSCE) was recently established as a mandatory evaluation for final-year medical students, with the first national OSCE conducted in 2024. Due to high costs, formative OSCEs are limited, prompting demand for more training. Few studies explore tutoring programs combining formative OSCE stations and station design, especially those jointly led by peers and teachers. We developed and evaluated the impact of a non-mandatory, student-teacher co-constructed tutoring program “Perform’OSCE” to prepare students for the national OSCE. Methods: A prospective cohort study was conducted from October 2023 to May 2024 at the Medical Faculty of Montpellier-Nîmes to evaluate the impact of participation in Perform’OSCE on students' performance in the national OSCE. Final-year students participated in OSCE training stations and peer-led OSCE design study groups. Online questionnaires collected data on baseline characteristics, satisfaction and anxiety. Multiple linear regression analysis was applied, adjusting for confounding variables such as age, academic background, and prior tutoring experience. Results: Of the 238 students who participated in the national OSCE, 167 (70%) completed at least one OSCE training station and joined an OSCE design study group. This participation in Perform’OSCE was significantly associated with higher national OSCE scores (β=0.57, 95% CI [0.175,0.97], p=0.005). Increased engagement in OSCE training stations correlated with improved exam performance (R = 0.42, p < 0.05). Satisfaction levels were elevated: 4.73/5 (SD 0.56) among students and 4.65/5 (SD 0.48) among teachers with no significant change in student anxiety over the year. Conclusion: The Perform’OSCE tutoring program was associated with improved national OSCE performance among final-year medical students, highlighting the effectiveness of structured, formative OSCE training for high-stakes assessments. Given the high participation rates and positive feedback, this program supports the value of a collaborative, student-teacher approach in medical education. Further research is needed to evaluate the broader impact of Perform’OSCE on academic and professional outcomes, and its potential for implementation across other institutions. OSCE Medical education Student-Teacher Collaboration Tutoring performance improvement co-construction Figures Figure 1 Figure 2 Figure 3 BACKGROUND Objective Structured Clinical Examinations (OSCEs) are a well-established worldwide tool to assess practical competencies, both for training purposes and in summative assessments. OSCEs allow students to practice in a simulated environment and can include direct performance feedback. They are used in formal university exams to standardize the evaluation of clinical performance of health students [1–5]. In France, final year (6th year) medical students nationwide take part in medical examinations over the same two days (May 2024, 28-29th) to complete training and determine their national ranking. This high-stakes ranking determines the students' choice of speciality training and location for the next four to six years. Despite OSCEs being introduced to medical studies in 2021 in France, 2024 is the first year they were included in the national summative OSCE involving 32 medical schools and over 8000 students, a logistical accomplishment requiring a harmonized format across the country [6]. The national summative OSCE consists of two 1-hour circuits of five stations (each station lasting 8 minutes), with the final score being the sum of the points obtained at each station [7] . This OSCE result accounts for 30% of the final score used to rank the students for entry to speciality training. Students requested additional training to better prepare and improve their results. However, few formative OSCEs are conducted due to their cost and the administrative involvement required [8]. Most clinical placements offer training sessions on formative OSCE stations, most performed in front of student spectators. The use of near-peer tutoring for OSCE training and evaluation has been developed in many countries [9, 10], including the first year of medical studies in France [11]. Peer tutoring significantly improved students’ academic performance according to a meta-analysis [12], and was valued by both peer learners and teachers [13, 14]. Challenges of near-peer tutoring were peer tutors having inconsistent teaching skills and varying levels of knowledge, which can be detrimental to tutees [15]. Co-constructed tutoring programs, including both students and teachers, emerged to help students to develop their own OSCE stations [16, 17]. However, there is limited literature on tutoring programs that integrate formative, physician-assessed OSCE stations with an introduction to OSCE station design. Additionally, no studies have evaluated the impact of an OSCE tutoring program jointly led by peers and faculty members on high-stake national OSCE. We set up a non-mandatory tutoring program for OSCE preparation (called “Perform’OSCE”) for final-year students (6 th year). The program was co-constructed with second and third-year medical students and medical teachers. We aimed to evaluate the impact of our collaborative OSCE tutoring program on the performance of final year medical students’ in the national summative OSCE. METHODS Study Setting and program design We conducted a prospective monocentric cohort study at the Medical Faculty of Montpellier-Nîmes (University of Montpellier, France), from October 2023 to May 2024. Summative OSCEs are conducted annually starting in the 4 th year. OSCE training primarily takes place during clinical or surgical placements but this training is not uniform across all placements, and there are variations in OSCE knowledge, preparation and skill levels among students. One year before the first French national summative OSCE, a steering committee co-constructed a tutoring program called “Perform’OSCE” to standardize and harmonize OSCE training for all final year students. The steering committee was composed of four students’ representatives from the Tutoring Association, four medical teachers, one resident, an educational engineer and two administrative staff, involving one hour weekly meetings from June 2023 to April 2024. The committee’s objectives included defining the educational content, recruiting and training standardized patients, coordinating and managing the overall evaluation process. Standardized patients were recruited from second- and third-year students enrolled in an optional course. These volunteers received, over two days, specialized training in acting techniques to realistically simulate clinical cases and were briefed on the goals and procedures of the OSCEs. “Perform’OSCE” consisted of two main components: “OSCE training stations” and “OSCE design study groups,” held between November 2023 to April 2024. The steering committee established five OSCE stations, each led by a supervising teacher, in charge of station design evaluator recruitment and coordination. Before each session, the supervising teacher briefed the standardized patients on the station’ objectives. Each station was set up for two hours each day for one week. Four student flows were carried out at the same time. Final year students received personalized feedback from a senior evaluator at the end of each session, providing constructive comments on their performance. Additionally, general feedback was held online once all students had completed a station, discussing the station and evaluation criteria. The “OSCE design study groups” began with a lecture on OSCE station design. Students then formed groups of three to six and were assigned to a clinical scenario and teacher supervisor. After drafting their OSCE stations, students submitted them for review to their supervisor. Once they were approved, stations were tested and enacted by other student groups. Study participants Inclusion criteria were all final year student volunteers through online registration from the Medical Faculty of Montpellier-Nîmes who participated in the French national summative OSCE in May 2024. No selection system was applied. Exclusion criteria included refusal to participate, and students who did not attend the summative OSCE. This was an observational study with no required sample size. Outcome measures The primary outcome was the performance in the national OSCE based on the summative global score, among final year students participating in “Perform’OSCE” (defined by participating in at least one OSCE training station and in an OSCE design study group). The secondary outcomes were to assess i) the association between the level of participation in “Perform’OSCE” (based on the number of training stations) and the summative global score in the national OSCE; ii) the anxiety levels over the academic year (based on a 0-5 Likert scale); iii) the satisfaction of 6 th year students, teachers and 2 nd and 3 rd year students who participated in “Perform’OSCE” (based on a 0-5 Likert scale). We followed the STROBE guidelines (Supplementary Material 1). Data collection We collected data corresponding to confounding factors identified in the literature [18–21]: socio-demographic status (such as age, gender, personal issues impacting studies, employment alongside studies), academic status (distinction obtained in the French baccalaureate (secondary school leaving examination), repeating a year during medical studies, admission to medical studies via a Graduate Entry Program), usual study methods (participation in peer tutoring during their studies, participation in peer-led study groups during their studies, preference for theoretical versus practical learning, opinion on the need of an OSCE tutoring program), prior OSCE training (formative OSCEs during placements, enrollment in private training OSCE sessions). Four online self-administered questionnaires using secured and pseudonymized Microsoft Forms® were used for data collection (Supplementary Material 2) : a questionnaire for baseline characteristics and level of anxiety (Likert scale from 0: not anxious at all to 5: very anxious)), satisfaction questionnaires (Likert scale from 0: not satisfied at all to 5: very satisfied) distributed after the completion of the evening OSCE stations to final year students, teachers and 2 nd and 3 rd year students, a mid-year questionnaire (anxiety levels) distributed three months before the national summative OSCE and an end-of-year questionnaire (satisfaction with OSCE design study groups and level of anxiety) one month before the national summative OSCE. The questionnaires were developed with experts (resident, experienced OSCE examiners, methodologists) to consider confounding variables. Each questionnaire was tested and validated with a group of students. The first online questionnaire was collected using a QR code at the first lecture of the year and the following were diffused by email. The questionnaires included multiple-choice questions, Likert scales (ranging from 0: strongly disagree to 5: strongly agree), and open-ended text questions. Data on the national summative OSCE score were collected for all participants. The national written exam score (undertaken at the beginning of the 6 th year in France) was also collected for the participants who answered the baseline questionnaire. These data were provided by the faculty administration after student consent. Data were pseudonymized using a unique identification number, allowing us to link each student's scores. Statistical analysis Two groups were compared: students who participated in “Perform’OSCE” and those who did not. Quantitative variables were presented as means [standard deviation (SD)] or medians (interquartile range) and compared using either the Student's t-test for normally distributed variables or the Wilcoxon test for non-normally distributed variables. Qualitative variables were reported as counts (%) and compared using the Chi-square test or Fisher's exact test, as appropriate. The normality of data distribution was tested using the Shapiro-Wilk test. The significance level was fixed at 5%. A multiple linear regression analysis was performed to evaluate the relationship between the national summative OSCE exam scores and a set of predictor variables, including participation in the “Perform’OSCE” program. Predictor variables were selected based on clinical relevance and previous research [18–21], and/or those showing a univariate significance level < 20% were included in the final model. Satisfaction data from Likert scales were expressed as mean and standard deviation. All analyses were performed using the software program R version 4.2.2 (2022-10-31). Ethics approval and consent to participate All procedures were in accordance with ethical standards of research. The Ethics Committee of the University of Montpellier approved this research (Ref UM 2023-036bis, supplementary material 3) respecting the reference methodology MR004 of the French National Commission for Informatics and Freedoms (CNIL). Consent to participate was implied by the voluntary completion of the questionnaire. Clinical trial number: not applicable. RESULTS The steering committee recruited 30 standardized participants (2 nd and 3 rd year students). Five supervising teachers wrote OSCE training stations, 120 evaluators were involved, and 924 sessions were conducted. Twenty-six OSCE design study groups were created and 23 wrote an approved OSCE station. Figure 1 provides a flow chart of student enrolment, follow-up and analysis. Two hundred and forty-five final year medical students were enrolled at the Faculty, and 238 students were included in our study. A total of 239 students attended the national OSCE in May 2024. We received one request for non-participation. Two hundred and nineteen students (92%) participated in at least one OSCE training station, and 171 (72%) in the OSCE design study groups. One hundred and sixty-seven students (70%) participated both in at least one OSCE training station and OSCE design study group (i.e. most active participants to “Perform’OSCE”). Over 80% of students participated in 3 or more training stations (194/238, 82%). Fifteen students (6%) did not participate at all in the tutoring program. Among the 238 students included in our study, 190 (80%) completed the Baseline Questionnaire: of which 144 participated in “Perform’OSCE” and 46 did not. The students' socio-demographic data are described in Table 1. Baseline characteristics of students who participated in “Perform'OSCE” and those who did not were comparable except regarding age. Seventy students (29%) completed the Mid-year Questionnaire, and 48 (20%) completed the Final Questionnaire. The median National OSCE score, out of a score of 20, was 14.22 [IQR 2.06]. Table 1 Baseline Characteristics of the 190 students who completed the Baseline Questionnaire according to their participation in Perform’OSCE. Categories Perform’OSCE criteria (≥ 1 training station + OSCE design study group) p-value YES N = 144 (%) NO N = 46 (%) Gender 1.000 Female 101 (70.1) 32 (69.6) Male 43 (29.9) 14 (30.4) Age** 23.0 [23.0;24.0] 24.0 [23.0;24.0] 0.013 Obtained Highest Distinction in the French baccalaureate 0.109 Yes 100 (69.9) 25 (55.6) No 43 (30.1) 20 (44.4) Graduate entry 0.139 Yes 6 (4.2) 5 (10.9) No 138 (95.8) 41 (89.1) Repeated a year (other than the first year) 0.747 Yes 10 (6.94) 4 (8.70) No 134 (93.1) 42 (91.3) Peer-tutoring as a tutor 0.857 Yes 70 (48.6) 21 (45.7) No 74 (51.4) 25 (45.7) Number of years of peer tutoring** 2.00 [1.00;2.00] 2.00 [1.00;2.00] 0.292 Learning styles 0.362 Theoretical 32 (22.2) 15 (32.6) Practical 19 (13.2) 5 (10.9) Balanced theoretical / practical 93 (64.6) 26 (56.5) OSCE practice during placements 1.000 Yes 140 (97.2) 45 (97.8) No 4 (2.78) 1 (2.17) Private OSCE practice 1.000 Yes 9 (6.2) 3 (6.5) No 135 (93.8) 43 (93.5) Opinion on usefulness of the tutoring program 0.427 No opinion 6 (4.2) 0 (0.0) Useful 50 (34.7) 19 (41.3) Necessary 88 (61.1) 27 (58.7) Employment alongside study 0.093 Yes 30 (20.8) 15 (32.6) No 112 (77.8) 29 (63.0) Prefer not to say 2 (1.39) 2 (4.35) Personal issues impacting studies 0.263 Yes 42 (29.2) 17 (37.0) No 90 (62.5) 23 (50.0) Prefer not to say 12 (8.33) 6 (13.0) National written exam score** 16.4 [15.5;17.4] 16.3 [15.2;16.9] 0.176 ** median [IQR 25-75] Primary Outcome Table 2 demonstrates the predictor variables significantly associated with National OSCE scores in unadjusted univariate analysis, included the participation in “Perform’OSCE” (𝜒2(1) = 14.46, p < 0.001, Fig. 2). In the adjusted regression model, seven variables were included in the model, and three significantly associated with the summative OSCE scores (Table 2). The model was statistically significant, F (8,178) = 17.25, p < 0.001 (adjusted R² = 0.41). The model was checked for collinearity and all variance inflation factors were <1.4. “Perform’OSCE” active participation was significantly associated with higher national summative OSCE scores (β = 0.57, 95% CI [0.175,0.97], p = 0.005), suggesting that students who participated actively in “Perform’OSCE” scored on average 0.57 points (out of 20 points) higher than those who did not. In addition, students who scored higher on the national written exam (performed in October 2023) had higher national OSCE scores (β = 0.61, 95% CI [0.481,0.737], p < 0.001). Students who were peer tutors throughout their studies had significantly higher national OSCE scores (β = 0.36, 95% CI [0.003,0.72], p = 0.048). Sensitivity analysis using subgroups of students who only participated in OSCE design study groups, or only OSCE evening training confirmed our results (Supplementary Material 4). Table 2 Impact of predictor variables on national OSCE score in univariate and multiple linear regression analysis. Predictor variables (n) National OSCE score Median [IQR] / Spearman correlation coefficient (R) Univariate analysis p-value Multiple linear regression coefficient (β) 95% CI Multivariate p-value Perform’OSCE <0.001* 0.57 [0.175,0.97] 0.005 Yes (167) 14.39 [13.45,15.26] No (71) 13.4 [12.39,14.67] Gender 0.512 Female (132) 14.175 [12.88,15.078] Male (57) 14.26 [13.24,15.11] Age (years) 24 [23,24] R= -0.22 0.002* -0.015 [-0.08,0.05] 0.671 National written exam score 16.39 [15.51,17.29] R= 0.61 <0.001* 0.61 [0.481,0.737] <0.001 Highest Distinction in the French baccalaureate <0.001* 0.22 [-0.19,0.62] 0.292 Yes (125) 14.49 [13.64,15.47] No (63) 13.36 [12.47,14.62] Graduate entry 0.540 Yes (11) 14.09 [13.30,14.74] No (179) 14.24 [13.06,15.12] Repeated a year (other than the first year) 0.081* 0.40 [-0.29,1.08] 0.254 Yes (14) 13.39 [12.41,14.63] No (176) 14.255 [13.06,15.11] Peer-tutoring as a tutor 0.067* 0.36 [0.003,0.72] 0.048 Yes (91) 14.38 [13.18,15.39] No (99) 14.09 [12.74,15.00] Number of years of peer tutoring 2.00 [1.00- 2.00] R= 0.11 0.140* 0.005 [-0.16,0.17] 0.956 Learning styles 0.381 Theoretical (47) 14.49 [13.495,15.09] Practical (24) 14.28 [12.665,15.19] Balanced theoretical / practical (119) 14.09 [12.935,15.085] OSCE practice during placements 0.356 Yes (185) 14.25 [13.06,15.11] No (5) 13.29 [12.53,14.09] Private OSCE practice 0.202 Yes (12) 13.55 [12.6,14.475] No (178) 14.255 [13.073,15.11] Opinion on usefulness of the tutoring program 0.453 No opinion (6) 13.205 [12.175,14.737] Useful (69) 14.16 [13.11,15.05] Necessary (115) 14.26 [12.985,15.17] Employment alongside study 0.405 Yes (45) 14.38 [13.36,15.22] No (141) 14.16 [12.9,15.04] Personal issues impacting studies 0.433 Yes (59) 14.13 [13.055,15.025] No (113) 14.34 [13.29,15.11] Prefer not to say (18) 13.855 [12.565,15.177] Writing an OSCE station <0.001 NA Yes (171) 14.38 [13.43,15.255] No (67) 13.4 [12.385,14.665] 3 or more OSCE evening training stations <0.001 NA Yes (194) 14.4 [13.3;15.2] No (44) 13.1 [11.7,14.1] Univariate analysis was Kruskall wallis test or Spearman correlation coefficient * indicates inclusion in the multiple regression analysis Adjusted R 2 of the multiple regression model = 0.41 NA : Not accurate Secondary outcomes A positive correlation was noted between the National summative OSCE score and the number of OSCE training stations performed by the students (R = 0.42, p < 0.05, Fig. 3). The median beginning-of-year anxiety level was 4.00/5.00 (IQR [3.00;4.00]), mid-year anxiety was 4.00/5.00 (IQR [4.00: 5.00]) and end-of-year anxiety was 4.00/5.00 (IQR [4.00 : 5.00]). Anxiety levels did not significantly change over the year but were lower at the beginning of the year independently from participation in “Perform’OSCE”. Out of 924 OSCE training sessions, we collected 442 (48%) responses to the 6 th year students’ satisfaction questionnaire. The reported satisfaction after completing the five stations was 4.73/5 (SD 0.56). The 48 students who answered the end-of-year questionnaire regarding the OSCE design study groups reported a satisfaction of 3.52 (SD 0.71). Senior evaluators’ satisfaction was 4.65/5 (SD 0.48) out of 40 answers to our questionnaire. Second- and third-year students reported a satisfaction of 4.73/5 (SD 0.52). Among them, 29/30 (97%) felt more confident about the OSCE. DISCUSSION This was the first time a national OSCE has been implemented as a summative evaluation for final year medical students in France. We successfully co-constructed a student-teacher OSCE tutoring program for final year students with high levels of participation, high levels of satisfaction and a positive impact on the national OSCE scores. Students who participated in “Perform'OSCE” had an estimated increased score of 0.57/20 points when considering other confounding variables of age, national written exam score, repeating a year and peer tutoring as tutor. This increase of 0.57 is notable, especially considering the small distribution of the National OSCE scores and the small interquartile range (2.06), with a probable impact on the final students’ ranking, although final ranking scores were not analysed. Additionally, increased participation in OSCE training sessions was associated with improved performance in the national OSCE. The findings indicate that participation in “Perfom’OSCE”, previous experience as a peer tutor, and having high scores in the national written exam are positively associated with better performance on the national summative OSCE. Active participation in additional educational activities and strong academic background significantly contribute to exam success, consistent with previous literature [22]. Previous studies have focused on formative OSCE organized and assessed by student tutors (near-peer) and their impact on student performance [8, 23, 24]. As early as 2010, a study highlighted the benefits of OSCE training for student nurses. In 2020, Schwill et al. described an OSCE exam conducted by student tutors and concluded that there was strong student adherence to being evaluated by peers, particularly appreciating the feedback received [8]. Recently, Stretton et al. evaluated student-led OSCEs (with immediate oral feedback and written feedback from peers) in a mixed method study [24]. The study showed that student-led OSCEs probably had a positive impact on faculty-led OSCEs and could help students gain confidence and adjust study behaviours. In our study, evaluators were medical teachers to provide students with a setting that closely resembled exam conditions and provide them with a structured homogenous feedback. Recently, Cosker et al. described a training similar to our OSCE design study groups with high student appreciation [16]. Unlike us, the authors did not evaluate the influence of this training on the students' academic performance. Heinke et al. [17] highlighted improved student results for those who had participated in the design and testing of OSCE stations. This is consistent with our results: students who design stations better understand what is expected of them in an exam setting. Conversely, one study did not show an improvement in the results of students who participated in the construction of a formative OSCE, stating that students have poor recollection of immediate feedback and that their mock OSCE content might differ from the summative one [25]. Humphrey-Murto et al. highlighted that students tend to forget post-station feedback over time [26] and that formative OSCE did not cover the same topics as summative OSCE. As suggested by a recent study from Ezanno et al. we also found that learning styles do not significantly impact OSCE performance [27]. Conversely to a recent work [19] we did not identify any statistically significant impact on National OSCE scores with other personal variables such as personal issues or gender. OSCE exams are known to have a high anxiety impact on students [28]. Data from the international literature shows that the use of formative OSCE usually helps students to feel more relaxed about the summative OSCE [29, 30]. Conversely, and as expected, we observed an increase in anxiety throughout the year which may be related to the summative French exams heavily determining the choice of postgraduate training, enhancing the need for student exam preparation and support. The student-teachers “Perform'OSCE” training program is innovative and unique in France. This structured program provided constructive feedback to final-year medical students from medical teachers in optional training stations and valuable experience in OSCE design. This enhances preparation for the national OSCE while fostering collaboration across different levels of medical training (tutees, tutors, teachers). To our knowledge, no other French university offers a tutoring program organized by both students and teachers with as much senior implication. We did not find any other tutoring program where OSCE stations with immediate performance feedback were combined with group-based station design and autonomous training. “Perform’OSCE” model is feasible and practical for students, cost-effective for the faculty, but it also requires significant participation and organization from volunteer faculty members, which could limit its implementation in other medical faculties. There are limitations to our study. First, its monocentric design prevents comparisons and limits the generalizability of the results. In addition, we studied the impact on the final national summative OSCE score, not the impact on students’ ranking (in France, students are ranked based on their national written exam score, OSCE score and academic progression). Even if the small interquartile range of the national OSCE scores suggests that an improvement of 0.57 points might have altered the student’s ranking, assessing the real impact on their ranking would provide further information on the practical impacts of “Perform’OSCE”. We were also unable to measure if, or to what extent, students practiced with the stations developed during the OSCE design study groups. Memory bias in the students’ questionnaire answers may also have affected our final model and explain the R 2 coefficient. Finally, the observational nature of this study, as opposed to a randomized design, limits the ability to establish causality. To ensure fairness, given the high stakes of the national OSCE score, the 'Perform’OSCE' program was made available to all students. The “Perform'OSCE” training program was a success and will be further developed and improved. The final model R² value suggests that additional predictors, potentially related to personal study habits or other academic influences, should be explored in future studies to better explain exam performance. This program only involved 6th-year students, it may be worth considering similar training earlier in the curriculum. Further research is needed to assess the broader impact of “Perform’OSCE” on long-term academic and professional outcomes, as well as the potential for implementing similar models across other institutions. It would be relevant to conduct further studies comparing the academic impact of our tutoring model with those implemented in other French universities. To date, we have not found any other published article evaluating student performance in French national summative OSCE. CONCLUSION The implementation of national summative evaluations by OSCEs for the first time in France required innovative tutoring programs for previously OSCE-naive students and teachers. A consistent, student-teacher dynamic team was able to implement a non-mandatory OSCE tutoring program including direct feedback from medical teachers in optional training sessions and group authoring sessions. The tutoring program increased the national OSCE scores for final year medical students in France with high participation and high satisfaction scores from both students and teachers. References Khan KZ, Ramachandran S, Gaunt K, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide 81. Part I: An historical and theoretical perspective. Med Teach. 2013;35:e1437–46. Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part II: Organisation & Administration. Med Teach. 2013;35:e1447–63. Pugh D, Bhanji F, Cole G, Dupre J, Hatala R, Humphrey-Murto S, et al. Do OSCE progress test scores predict performance in a national high-stakes examination? Med Educ. 2016;50:351–8. Pugh D, Desjardins I, Eva K. 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Factors predicting students’ performance in the final pediatrics OSCE. PLoS ONE. 2020;15:e0236484. Bouchghoul H, Teboul J-L, Senat M-V, Vigoureux S. Does socioeconomic status have any influence on success at the national ranking exam? a prospective survey. BMC Med Educ. 2020;20:402. Rashid MS, Sobowale O, Gore D. A near-peer teaching program designed, developed and delivered exclusively by recent medical graduates for final year medical students sitting the final objective structured clinical examination (OSCE). BMC Med Educ. 2011;11:11. Stretton B, Montagu A, Kunnel A, Louise J, Behrendt N, Kovoor J, et al. Perceived and actual value of Student-led Objective Structured Clinical Examinations. Clin Teach. 2024;21:e13754. Madrazo L, Lee CB, McConnell M, Khamisa K, Pugh D. No observed effect of a student-led mock objective structured clinical examination on subsequent performance scores in medical students in Canada. J Educ Eval Health Prof. 2019;16:14. Humphrey-Murto S, Mihok M, Pugh D, Touchie C, Halman S, Wood TJ. Feedback in the OSCE: What Do Residents Remember? Teach Learn Med. 2016;28:52–60. Ezanno A-C, Pirot F, Lavolé J, Gall GL, Mestiri R, Delattre C, et al. Does learning style influence performance in objective structured clinical examinations? BMC Med Educ. 2024;24:1086. Brand HS, Schoonheim-Klein M. Is the OSCE more stressful? Examination anxiety and its consequences in different assessment methods in dental education. Eur J Dent Educ. 2009;13:147–53. Taylor D, Quick S. Students’ perceptions of a near-peer Objective Structured Clinical Examination (OSCE) in medical imaging. Radiography. 2020;26:42–8. Braier-Lorimer DA, Warren-Miell H. A peer-led mock OSCE improves student confidence for summative OSCE assessments in a traditional medical course. Med Teach. 2022;44:535–40. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial1StrobeStatement.docx SupplementaryMaterial2Questionnaires.docx SupplementaryMaterial3Ethicscommitteeapprovalofthestudy.docx SupplementaryMaterial4Sensitivityanalysis.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6092093","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":425491185,"identity":"9e91b12d-ab36-422a-9913-3098aa34acc1","order_by":0,"name":"Lola 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09:34:39","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":16980,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial4Sensitivityanalysis.docx","url":"https://assets-eu.researchsquare.com/files/rs-6092093/v1/1d962e73ac1d75e159549eb3.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Co-construction of a student-teacher tutoring program improves the performance of medical students in the first French national OSCE exam","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eObjective Structured Clinical Examinations (OSCEs) are a well-established worldwide tool to assess practical competencies, both for training purposes and in summative assessments. OSCEs allow students to practice in a simulated environment and can include direct performance feedback. They are used in formal university exams to standardize the evaluation of clinical performance of health students [1\u0026ndash;5].\u003c/p\u003e\n\u003cp\u003eIn France, final year (6th year) medical students nationwide take part in medical examinations over the same two days (May 2024, 28-29th) to complete training and determine their national ranking. This high-stakes ranking determines the students\u0026apos; choice of speciality training and location for the next four to six years. Despite OSCEs being introduced to medical studies in 2021 in France, 2024 is the first year they were included in the national summative OSCE involving 32 medical schools and over 8000 students, a logistical accomplishment requiring a harmonized format across the country [6]. The national summative OSCE consists of two 1-hour circuits of five stations (each station lasting 8 minutes), with the final score being the sum of the points obtained at each station [7]\u003cem\u003e.\u003c/em\u003e This OSCE result accounts for 30% of the final score used to rank the students for entry to speciality training. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudents requested additional training to better prepare and improve their results. However, few formative OSCEs are conducted due to their cost and the administrative involvement required [8]. Most clinical placements offer training sessions on formative OSCE stations, most performed in front of student spectators. The use of near-peer tutoring for OSCE training and evaluation has been developed in many countries [9, 10], including the first year of medical studies in France [11]. Peer tutoring significantly improved students\u0026rsquo; academic performance according to a meta-analysis [12], and was valued by both peer learners and teachers [13, 14]. Challenges of near-peer tutoring were peer tutors having inconsistent teaching skills and varying levels of knowledge, which can be detrimental to tutees [15]. Co-constructed tutoring programs, including both students and teachers, emerged to help students to develop their own OSCE stations [16, 17]. However, there is limited literature on tutoring programs that integrate formative, physician-assessed OSCE stations with an introduction to OSCE station design. Additionally, no studies have evaluated the impact of an OSCE tutoring program jointly led by peers and faculty members on high-stake national OSCE.\u003c/p\u003e\n\u003cp\u003eWe set up a non-mandatory tutoring program for OSCE preparation (called \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo;) for final-year students (6\u003csup\u003eth\u003c/sup\u003e year). The program was co-constructed with second and third-year medical students and medical teachers. We aimed to evaluate the impact of our collaborative OSCE tutoring program on the performance of final year medical students\u0026rsquo; in the national summative OSCE.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Setting and program design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a prospective monocentric cohort study at the Medical Faculty of Montpellier-N\u0026icirc;mes (University of Montpellier, France), from October 2023 to May 2024. Summative OSCEs are conducted annually starting in the 4\u003csup\u003eth\u003c/sup\u003e year. OSCE training primarily takes place during clinical or surgical placements but this training is not uniform across all placements, and there are variations in OSCE knowledge, preparation and skill levels among students.\u003c/p\u003e\n\u003cp\u003eOne year before the first French national summative OSCE, a steering committee co-constructed a tutoring program called \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; to standardize and harmonize OSCE training for all final year students. The steering committee was composed of four students\u0026rsquo; representatives from the Tutoring Association, four medical teachers, one resident, an educational engineer and two administrative staff, involving one hour weekly meetings from June 2023 to April 2024. The committee\u0026rsquo;s objectives included defining the educational content, recruiting and training standardized patients, coordinating and managing the overall evaluation process. Standardized patients were recruited from second- and third-year students enrolled in an optional course. These volunteers received, over two days, specialized training in acting techniques to realistically simulate clinical cases and were briefed on the goals and procedures of the OSCEs.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; consisted of two main components: \u0026ldquo;OSCE training stations\u0026rdquo; and \u0026ldquo;OSCE design study groups,\u0026rdquo; held between November 2023 to April 2024. The steering committee established five OSCE stations, each led by a supervising teacher, in charge of station design evaluator recruitment and coordination. Before each session, the supervising teacher briefed the standardized patients on the station\u0026rsquo; objectives. Each station was set up for two hours each day for one week. Four student flows were carried out at the same time. Final year students received personalized feedback from a senior evaluator at the end of each session, providing constructive comments on their performance. Additionally, general feedback was held online once all students had completed a station, discussing the station and evaluation criteria. The \u0026ldquo;OSCE design study groups\u0026rdquo; began with a lecture on OSCE station design. Students then formed groups of three to six and were assigned to a clinical scenario and teacher supervisor. After drafting their OSCE stations, students submitted them for review to their supervisor. Once they were approved, stations were tested and enacted by other student groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria were all final year student volunteers through online registration from the Medical Faculty of Montpellier-N\u0026icirc;mes who participated in the French national summative OSCE in May 2024. No selection system was applied. Exclusion criteria included refusal to participate, and students who did not attend the summative OSCE. This was an observational study with no required sample size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome was the performance in the national OSCE based on the summative global score, among final year students participating in \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; (defined by participating in at least one OSCE training station and in an OSCE design study group). The secondary outcomes were to assess i) the association between the level of participation in \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; (based on the number of training stations) and the summative global score in the national OSCE; ii) the anxiety levels over the academic year (based on a 0-5 Likert scale); iii) the satisfaction of 6\u003csup\u003eth\u003c/sup\u003e year students, teachers and 2\u003csup\u003end\u003c/sup\u003e and 3\u003csup\u003erd\u003c/sup\u003e year students who participated in \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; (based on a 0-5 Likert scale). We followed the STROBE guidelines (Supplementary Material 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe collected data corresponding to confounding factors identified in the literature [18\u0026ndash;21]: socio-demographic status (such as age, gender, personal issues impacting studies, employment alongside studies), academic status (distinction obtained in the French baccalaureate (secondary school leaving examination), repeating a year during medical studies, admission to medical studies via a Graduate Entry Program), usual study methods (participation in peer tutoring during their studies, participation in peer-led study groups during their studies, preference for theoretical versus practical learning, opinion on the need of an OSCE tutoring program), prior OSCE training (formative OSCEs during placements, enrollment in private training OSCE sessions).\u003c/p\u003e\n\u003cp\u003eFour online self-administered questionnaires using secured and pseudonymized Microsoft Forms\u0026reg; were used for data collection (Supplementary Material 2) : a questionnaire for baseline characteristics and level of anxiety (Likert scale from 0: not anxious at all to 5: very anxious)), satisfaction questionnaires (Likert scale from 0: not satisfied at all to 5: very satisfied) distributed after the completion of the evening OSCE stations to final year students, teachers and 2\u003csup\u003end\u003c/sup\u003e and 3\u003csup\u003erd\u003c/sup\u003e year students, a mid-year questionnaire (anxiety levels) distributed three months before the national summative OSCE and an end-of-year questionnaire (satisfaction with OSCE design study groups and level of anxiety) one month before the national summative OSCE.\u003c/p\u003e\n\u003cp\u003eThe questionnaires were developed with experts (resident, experienced OSCE examiners, methodologists) to consider confounding variables. Each questionnaire was tested and validated with a group of students. The first online questionnaire was collected using a QR code at the first lecture of the year and the following were diffused by email. The questionnaires included multiple-choice questions, Likert scales (ranging from 0: strongly disagree to 5: strongly agree), and open-ended text questions.\u003c/p\u003e\n\u003cp\u003eData on the national summative OSCE score were collected for all participants. The national written exam score (undertaken at the beginning of the 6\u003csup\u003eth\u003c/sup\u003e year in France) was also collected for the participants who answered the baseline questionnaire. These data were provided by the faculty administration after student consent.\u003c/p\u003e\n\u003cp\u003eData were pseudonymized using a unique identification number, allowing us to link each student\u0026apos;s scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo groups were compared: students who participated in \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; and those who did not. Quantitative variables were presented as means [standard deviation (SD)] or medians (interquartile range) and compared using either the Student\u0026apos;s t-test for normally distributed variables or the Wilcoxon test for non-normally distributed variables. Qualitative variables were reported as counts (%) and compared using the Chi-square test or Fisher\u0026apos;s exact test, as appropriate. The normality of data distribution was tested using the Shapiro-Wilk test. The significance level was fixed at 5%. A multiple linear regression analysis was performed to evaluate the relationship between the national summative OSCE exam scores and a set of predictor variables, including participation in the \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; program. Predictor variables were selected based on clinical relevance and previous research [18\u0026ndash;21], and/or those showing a univariate significance level \u0026lt; 20% were included in the final model. Satisfaction data from Likert scales were expressed as mean and standard deviation. All analyses were performed using the software program R version 4.2.2 (2022-10-31).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were in accordance with ethical standards of research. The Ethics Committee of the University of Montpellier approved this research (Ref UM 2023-036bis, supplementary material 3) respecting the reference methodology MR004 of the French National Commission for Informatics and Freedoms (CNIL). Consent to participate was implied by the voluntary completion of the questionnaire. Clinical trial number: not applicable.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe steering committee recruited 30 standardized participants (2\u003csup\u003end\u003c/sup\u003e and 3\u003csup\u003erd\u003c/sup\u003e year students). Five supervising teachers wrote OSCE training stations, 120 evaluators were involved, and 924 sessions were conducted. Twenty-six OSCE design study groups were created and 23 wrote an approved OSCE station.\u003c/p\u003e\n\u003cp\u003eFigure 1 provides a flow chart of student enrolment, follow-up and analysis. Two hundred and forty-five final year medical students were enrolled at the Faculty, and 238 students were included in our study. A total of 239 students attended the national OSCE in May 2024. We received one request for non-participation. Two hundred and nineteen students (92%) participated in at least one OSCE training station, and 171 (72%) in the OSCE design study groups. One hundred and sixty-seven students (70%) participated both in at least one OSCE training station and OSCE design study group (i.e. most active participants to \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo;). Over 80% of students participated in 3 or more training stations (194/238, 82%). Fifteen students (6%) did not participate at all in the tutoring program.\u003c/p\u003e\n\u003cp\u003eAmong the 238 students included in our study, 190 (80%) completed the Baseline Questionnaire: of which 144 participated in \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; and 46 did not. The students\u0026apos; socio-demographic data are described in Table 1. Baseline characteristics of students who participated in \u0026ldquo;Perform\u0026apos;OSCE\u0026rdquo; and those who did not were comparable except regarding age. Seventy students (29%) completed the Mid-year Questionnaire, and 48 (20%) completed the Final Questionnaire. The median National OSCE score, out of a score of 20, was 14.22 [IQR 2.06].\u003c/p\u003e\n\u003cp\u003eTable 1 Baseline Characteristics of the 190 students who completed the Baseline Questionnaire according to their participation in Perform\u0026rsquo;OSCE.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"658\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 37.6442%;\"\u003e\n \u003cp\u003eCategories\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 41.7933%;\"\u003e\n \u003cp\u003ePerform\u0026rsquo;OSCE\u0026nbsp;criteria\u003c/p\u003e\n \u003cp\u003e(\u0026ge; 1 training station + OSCE design study group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.0267%;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003cp\u003eN = 144 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003cp\u003eN = 46 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp;Female\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e101 (70.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e32 (69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp;Male\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e43 (29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e14 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge**\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e23.0 [23.0;24.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e24.0 [23.0;24.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObtained Highest Distinction in the French baccalaureate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e100 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e25 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e43 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e20 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGraduate entry\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e6 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e5 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e138 (95.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e41 (89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRepeated a year (other than the first year)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e10 (6.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e4 (8.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e134 (93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e42 (91.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeer-tutoring as a tutor\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e70 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e21 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e74 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e25 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of years of peer tutoring**\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e2.00 [1.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e2.00 [1.00;2.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLearning styles\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Theoretical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e32 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e15 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Practical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e19 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e5 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Balanced theoretical / practical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e93 (64.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e26 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOSCE practice during placements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e140 (97.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e45 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e4 (2.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e1 (2.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrivate OSCE practice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e9 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e3 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e135 (93.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e43 (93.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpinion on usefulness of the tutoring program\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No opinion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e6 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Useful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e50 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e19 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Necessary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e88 (61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e27 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment alongside study\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e30 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e15 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e112 (77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e29 (63.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Prefer not to say\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e2 (1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e2 (4.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonal issues impacting studies\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e42 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e17 (37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e90 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e23 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Prefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e12 (8.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e6 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNational written exam score**\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e16.4 [15.5;17.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e16.3 [15.2;16.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37.6442%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e**\u003c/strong\u003emedian [IQR 25-75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.6175%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.8876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary Outcome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 demonstrates the predictor variables significantly associated with National OSCE scores in unadjusted univariate analysis, included the participation in \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; (𝜒2(1) = 14.46, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001, Fig. 2). In the adjusted regression model, \u0026nbsp;seven variables were included in the model, and three significantly associated with the summative OSCE scores \u0026nbsp;(Table 2). The model was statistically significant, F (8,178) = 17.25, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001 (adjusted R\u0026sup2; = 0.41). The model was checked for collinearity and all variance inflation factors were \u0026lt;1.4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; active participation was significantly associated with higher national summative OSCE scores (\u0026beta; = 0.57, 95% CI [0.175,0.97], \u003cem\u003ep\u003c/em\u003e = 0.005), suggesting that students who participated actively in \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; scored on average 0.57 points (out of 20 points) higher than those who did not.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, students who scored higher on the national written exam (performed in October 2023) had higher national OSCE scores (\u0026beta; = 0.61, 95% CI [0.481,0.737], \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001). Students who were peer tutors throughout their studies had significantly higher national OSCE scores (\u0026beta; = 0.36, 95% CI [0.003,0.72], \u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.048). Sensitivity analysis using subgroups of students who only participated in OSCE design study groups, or only OSCE evening training confirmed our results (Supplementary Material 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 Impact of predictor variables on national OSCE score in univariate and multiple linear regression analysis.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"97%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictor variables (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eNational OSCE score\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMedian [IQR] / Spearman correlation coefficient (R)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003eUnivariate analysis\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eMultiple linear regression coefficient (\u0026beta;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerform\u0026rsquo;OSCE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.57\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[0.175,0.97]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eYes (167)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.39 [13.45,15.26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eNo (71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13.4 [12.39,14.67]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;Female (132)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.175 [12.88,15.078]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;Male (57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.26 [13.24,15.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e24 [23,24]\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eR= -0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e-0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[-0.08,0.05]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNational written exam score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e16.39 [15.51,17.29]\u003c/p\u003e\n \u003cp\u003eR= 0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.61\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[0.481,0.737]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest Distinction in the French baccalaureate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e[-0.19,0.62]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;(125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.49 [13.64,15.47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13.36 [12.47,14.62]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGraduate entry\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.09 [13.30,14.74]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No (179)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.24 [13.06,15.12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRepeated a year (other than the first year)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.081*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[-0.29,1.08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13.39 [12.41,14.63]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No (176)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.255 [13.06,15.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeer-tutoring as a tutor\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.067*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.36\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[0.003,0.72]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;(91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.38 [13.18,15.39]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No (99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.09 [12.74,15.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of years of peer tutoring\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e2.00 [1.00- 2.00]\u003c/p\u003e\n \u003cp\u003eR= 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.140*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[-0.16,0.17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLearning styles\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Theoretical (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.49 [13.495,15.09]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Practical (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.28 [12.665,15.19]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Balanced theoretical / practical (119)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.09 [12.935,15.085]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOSCE practice during placements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes (185)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.25 [13.06,15.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13.29 [12.53,14.09]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrivate OSCE practice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13.55 [12.6,14.475]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No (178)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.255 [13.073,15.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpinion on usefulness of the tutoring program\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No opinion (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13.205 [12.175,14.737]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Useful (69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.16 [13.11,15.05]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Necessary (115)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.26 [12.985,15.17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment alongside study\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.38 [13.36,15.22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No (141)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.16 [12.9,15.04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonal issues impacting studies\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.13 [13.055,15.025]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No (113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.34 [13.29,15.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Prefer not to say (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13.855 [12.565,15.177]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWriting an OSCE station\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes (171)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.38 [13.43,15.255]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No (67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13.4 [12.385,14.665]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 or more OSCE evening training stations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes (194)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e14.4 [13.3;15.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13.1 [11.7,14.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eUnivariate analysis was Kruskall wallis test or Spearman correlation coefficient\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e* \u0026nbsp; \u0026nbsp; indicates inclusion in the multiple regression analysis\u003c/p\u003e\n \u003cp\u003eAdjusted R\u003csup\u003e2\u003c/sup\u003e of the multiple regression model = 0.41\u003c/p\u003e\n \u003cp\u003eNA : Not accurate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA positive correlation was noted between the National summative OSCE score and the number of OSCE training stations performed by the students (R = 0.42, p \u0026lt; 0.05, Fig. 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe median beginning-of-year anxiety level was 4.00/5.00 (IQR [3.00;4.00]), mid-year anxiety was 4.00/5.00 (IQR [4.00: 5.00]) and end-of-year anxiety was 4.00/5.00 (IQR [4.00 : 5.00]). Anxiety levels did not significantly change over the year but were lower at the beginning of the year independently from participation in \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eOut of 924 OSCE training sessions, we collected 442 (48%) responses to the 6\u003csup\u003eth\u003c/sup\u003e year students\u0026rsquo; satisfaction questionnaire. The reported satisfaction after completing the five stations was 4.73/5 (SD 0.56). The 48 students who answered the end-of-year questionnaire regarding the OSCE design study groups reported a satisfaction of 3.52 (SD 0.71). Senior evaluators\u0026rsquo; satisfaction was 4.65/5 (SD 0.48) out of 40 answers to our questionnaire. Second- and third-year students reported a satisfaction of 4.73/5 (SD 0.52). Among them, 29/30 (97%) felt more confident about the OSCE.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis was the first time a national OSCE has been implemented as a summative evaluation for final year medical students in France. We successfully co-constructed a student-teacher OSCE tutoring program for final year students with high levels of participation, high levels of satisfaction and a positive impact on the national OSCE scores. Students who participated in \u0026ldquo;Perform\u0026apos;OSCE\u0026rdquo; had an estimated increased score of 0.57/20 points when considering other confounding variables of age, national written exam score, repeating a year and peer tutoring as tutor. This increase of 0.57 is notable, especially considering the small distribution of the National OSCE scores and the small interquartile range (2.06), with a probable impact on the final students\u0026rsquo; ranking, although final ranking scores were not analysed. Additionally, increased participation in OSCE training sessions was associated with improved performance in the national OSCE. The findings indicate that participation in \u0026ldquo;Perfom\u0026rsquo;OSCE\u0026rdquo;, previous experience as a peer tutor, and having high scores in the national written exam are positively associated with better performance on the national summative OSCE. Active participation in additional educational activities and strong academic background significantly contribute to exam success, consistent with previous literature [22].\u003c/p\u003e\n\u003cp\u003ePrevious studies have focused on formative OSCE organized and assessed by student tutors (near-peer) and their impact on student performance [8, 23, 24]. As early as 2010, a study highlighted the benefits of OSCE training for student nurses. In 2020, Schwill et al. described an OSCE exam conducted by student tutors and concluded that there was strong student adherence to being evaluated by peers, particularly appreciating the feedback received [8]. Recently, Stretton et al. evaluated student-led OSCEs (with immediate oral feedback and written feedback from peers) in a mixed method study [24]. The study showed that student-led OSCEs probably had a positive impact on faculty-led OSCEs and could help students gain confidence and adjust study behaviours. In our study, evaluators were medical teachers to provide students with a setting that closely resembled exam conditions and provide them with a structured homogenous feedback.\u003c/p\u003e\n\u003cp\u003eRecently, Cosker et al. described a training similar to our OSCE design study groups with high student appreciation [16]. Unlike us, the authors did not evaluate the influence of this training on the students\u0026apos; academic performance. Heinke et al. [17] highlighted improved student results for those who had participated in the design and testing of OSCE stations. This is consistent with our results: students who design stations better understand what is expected of them in an exam setting. Conversely, one study did not show an improvement in the results of students who participated in the construction of a formative OSCE, stating that students have poor recollection of immediate feedback and that their mock OSCE content might differ from the summative one [25]. Humphrey-Murto et al. highlighted that students tend to forget post-station feedback over time [26] and that formative OSCE did not cover the same topics as summative OSCE. As suggested by a recent study from Ezanno et al. we also found that learning styles do not significantly impact OSCE performance [27]. Conversely to a recent work [19] we did not identify any statistically significant impact on National OSCE scores with other personal variables such as personal issues or gender.\u003c/p\u003e\n\u003cp\u003eOSCE exams are known to have a high anxiety impact on students [28]. Data from the international literature shows that the use of formative OSCE usually helps students to feel more relaxed about the summative OSCE [29, 30]. Conversely, and as expected, we observed an increase in anxiety throughout the year which may be related to the summative French exams heavily determining the choice of postgraduate training, enhancing the need for student exam preparation and support.\u003c/p\u003e\n\u003cp\u003eThe student-teachers \u0026ldquo;Perform\u0026apos;OSCE\u0026rdquo; training program is innovative and unique in France. This structured program provided constructive feedback to final-year medical students from medical teachers in optional training stations and valuable experience in OSCE design. This enhances preparation for the national OSCE while fostering collaboration across different levels of medical training (tutees, tutors, teachers). To our knowledge, no other French university offers a tutoring program organized by both students and teachers with as much senior implication. We did not find any other tutoring program where OSCE stations with immediate performance feedback were combined with group-based station design and autonomous training. \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; model is feasible and practical for students, cost-effective for the faculty, but it also requires significant participation and organization from volunteer faculty members, which could limit its implementation in other medical faculties.\u003c/p\u003e\n\u003cp\u003eThere are limitations to our study. First, its monocentric design prevents comparisons and limits the generalizability of the results. In addition, we studied the impact on the final national summative OSCE score, not the impact on students\u0026rsquo; ranking (in France, students are ranked based on their national written exam score, OSCE score and academic progression). Even if the small interquartile range of the national OSCE scores suggests that an improvement of 0.57 points might have altered the student\u0026rsquo;s ranking, assessing the real impact on their ranking would provide further information on the practical impacts of \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo;. We were also unable to measure if, or to what extent, students practiced with the stations developed during the OSCE design study groups. Memory bias in the students\u0026rsquo; questionnaire answers may also have affected our final model and explain the R\u003csup\u003e2\u003c/sup\u003e coefficient. Finally, the observational nature of this study, as opposed to a randomized design, limits the ability to establish causality. To ensure fairness, given the high stakes of the national OSCE score, the \u0026apos;Perform\u0026rsquo;OSCE\u0026apos; program was made available to all students.\u003c/p\u003e\n\u003cp\u003eThe \u0026ldquo;Perform\u0026apos;OSCE\u0026rdquo; training program was a success and will be further developed and improved. The final model R\u0026sup2; value suggests that additional predictors, potentially related to personal study habits or other academic influences, should be explored in future studies to better explain exam performance. This program only involved 6th-year students, it may be worth considering similar training earlier in the curriculum. Further research is needed to assess the broader impact of \u0026ldquo;Perform\u0026rsquo;OSCE\u0026rdquo; on long-term academic and professional outcomes, as well as the potential for implementing similar models across other institutions. It would be relevant to conduct further studies comparing the academic impact of our tutoring model with those implemented in other French universities. To date, we have not found any other published article evaluating student performance in French national summative OSCE.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe implementation of national summative evaluations by OSCEs for the first time in France required innovative tutoring programs for previously OSCE-naive students and teachers. A consistent, student-teacher dynamic team was able to implement a non-mandatory OSCE tutoring program including direct feedback from medical teachers in optional training sessions and group authoring sessions. The tutoring program increased the national OSCE scores for final year medical students in France with high participation and high satisfaction scores from both students and teachers.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhan KZ, Ramachandran S, Gaunt K, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide 81. Part I: An historical and theoretical perspective. Med Teach. 2013;35:e1437\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan KZ, Gaunt K, Ramachandran S, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part II: Organisation \u0026amp; Administration. Med Teach. 2013;35:e1447\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePugh D, Bhanji F, Cole G, Dupre J, Hatala R, Humphrey-Murto S, et al. Do OSCE progress test scores predict performance in a national high-stakes examination? 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Teach Learn Med. 2016;28:52\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEzanno A-C, Pirot F, Lavol\u0026eacute; J, Gall GL, Mestiri R, Delattre C, et al. Does learning style influence performance in objective structured clinical examinations? BMC Med Educ. 2024;24:1086.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrand HS, Schoonheim-Klein M. Is the OSCE more stressful? Examination anxiety and its consequences in different assessment methods in dental education. Eur J Dent Educ. 2009;13:147\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor D, Quick S. Students\u0026rsquo; perceptions of a near-peer Objective Structured Clinical Examination (OSCE) in medical imaging. Radiography. 2020;26:42\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraier-Lorimer DA, Warren-Miell H. A peer-led mock OSCE improves student confidence for summative OSCE assessments in a traditional medical course. Med Teach. 2022;44:535\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"OSCE, Medical education, Student-Teacher Collaboration, Tutoring, performance improvement, co-construction","lastPublishedDoi":"10.21203/rs.3.rs-6092093/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6092093/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn France, Objective Structured Clinical Examination (OSCE) was recently established as a mandatory evaluation for final-year medical students, with the first national OSCE conducted in 2024. Due to high costs, formative OSCEs are limited, prompting demand for more training. Few studies explore tutoring programs combining formative OSCE stations and station design, especially those jointly led by peers and teachers. We developed and evaluated the impact of a non-mandatory, student-teacher co-constructed tutoring program “Perform’OSCE” to prepare students for the national OSCE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective cohort study was conducted from October 2023 to May 2024 at the Medical Faculty of Montpellier-Nîmes to evaluate the impact of participation in Perform’OSCE on students' performance in the national OSCE. Final-year students participated in OSCE training stations and peer-led OSCE design study groups. Online questionnaires collected data on baseline characteristics, satisfaction and anxiety. Multiple linear regression analysis was applied, adjusting for confounding variables such as age, academic background, and prior tutoring experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 238 students who participated in the national OSCE, 167 (70%) completed at least one OSCE training station and joined an OSCE design study group. This participation in Perform’OSCE was significantly associated with higher national OSCE scores (β=0.57, 95% CI [0.175,0.97], p=0.005). Increased engagement in OSCE training stations correlated with improved exam performance (R = 0.42, p \u0026lt; 0.05). Satisfaction levels were elevated: 4.73/5 (SD 0.56) among students and 4.65/5 (SD 0.48) among teachers with no significant change in student anxiety over the year.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Perform’OSCE tutoring program was associated with improved national OSCE performance among final-year medical students, highlighting the effectiveness of structured, formative OSCE training for high-stakes assessments. Given the high participation rates and positive feedback, this program supports the value of a collaborative, student-teacher approach in medical education. Further research is needed to evaluate the broader impact of Perform’OSCE on academic and professional outcomes, and its potential for implementation across other institutions.\u003c/p\u003e","manuscriptTitle":"Co-construction of a student-teacher tutoring program improves the performance of medical students in the first French national OSCE exam","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-10 09:34:34","doi":"10.21203/rs.3.rs-6092093/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b8b7414-2ed5-4528-a34f-cf511b89b471","owner":[],"postedDate":"March 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-15T12:08:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-10 09:34:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6092093","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6092093","identity":"rs-6092093","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}