Introduction
Clinical competence is a core outcome of medical education and a prerequisite for safe and effective patient care. It encompasses clinical reasoning, procedural proficiency, communication skills, and professional conduct competencies that require direct assessment in real or simulated clinical settings rather than reliance on written examinations alone [1-3]. Consequently, the assessment of clinical competence has become a critical concern in contemporary medical training.
Traditionally, medical schools have relied on the Traditional Clinical Examination (TCE), commonly structured around long and short cases. While this method provides exposure to real patients, it has been widely criticized for examiner subjectivity, inconsistency in case difficulty, limited sampling of competencies, and poor reliability across candidates [4].
In response to these limitations, the Objective Structured Clinical Examination (OSCE) was introduced as a standardized assessment format designed to evaluate a broad range of clinical and communication skills using predefined criteria and standardized patients. Evidence from recent studies indicates that OSCEs demonstrate greater objectivity, reliability, and content coverage compared to traditional examinations. They also align more closely with the principles of Competency-Based Medical Education (CBME) [5-7].
Despite the growing global acceptance of OSCEs, their implementation in low- and middle-income countries, including Nigeria, remains uneven. Many medical schools continue to use TCE either exclusively or alongside OSCE due to logistical, financial, and infrastructural constraints [8,9]. In Nigeria, several schools have focused on the pilot implementation of OSCE without adequately comparing it with the Traditional Clinical Examination or evaluating students’ perceptions of fairness, stress, and overall experience across the two assessment methods [10].
The choice of clinical assessment method is particularly important in Rivers State, which hosts accredited medical schools and teaching hospitals that meet the healthcare needs of the population on a daily basis. The absence of a comparative study evaluating students’ preferences and perceptions of OSCE and TCE creates a gap in evidence-based decision-making regarding necessary reforms in medical education at both institutional and policy levels.
Methods
Study Design
This study adopted a comparative cross-sectional design with a mixed-method approach. A comparative cross-sectional design is appropriate because it enables the researcher to assess and compare the perceptions and experiences of final-year medical students exposed to Traditional Clinical Examination (TCE) and Objective Structured Clinical Examination (OSCE) at a single point in time. It is particularly suitable in educational settings where random assignment is not feasible.
Study Area
The study was conducted in Rivers State, Nigeria, across three medical universities: the University of Port Harcourt, Rivers State University, and PAMO University of Medical Sciences.
Study Population
The study population consisted of final-year medical students from the University of Port Harcourt, Rivers State University, and PAMO University of Medical Sciences.
Sample Size
A total of 422 students (384 plus 10% attrition allowance) were enrolled in the study. The sample size was calculated using Cochran’s formula at a 95% confidence interval.
Sampling Technique
The study adopted a multistage sampling technique:
Stage 1: A purposive sampling technique was used to select medical schools in Rivers State that had implemented TCE, OSCE, or both. The selected schools were the University of Port Harcourt, Rivers State University, and PAMO University of Medical Sciences.
Stage 2: Final-year medical students in the selected institutions were stratified based on the type of clinical assessment they had been exposed to, using a stratified sampling technique.
Stage 3: Within each stratum, simple random sampling by balloting was used to select students enrolled in the study.
Method of Data Collection
Data were collected using a well-structured questionnaire administered to the study population. The questionnaire consisted of two sections: Section A and Section B. Section A contained questions on demographic characteristics, while Section B included questions on students’ preferences for TCE and OSCE.
Method of Data Analysis
Data collected were analysed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics such as frequencies and percentages were used to summarize the data, while inferential statistics, including chi-square tests, were employed to determine relationships between variables.
Ethical Considerations
Ethical approval was obtained from the relevant ethics committees of the participating institutions prior to the commencement of the study.
Results
3.1 Demographic characteristic of respondents
The results in Table 1 summarize the demographic characteristics of the 387 final-year medical students. More than half of the study population were males 214 (55.3%) while 173 (44.7%) were females. Students from the University of Port Harcourt constituted 41.9% of the respondents, those from Rivers State University accounted for 34.6% and PAMO College of Medical Sciences represented as 23.5%. The majority of the respondents have had an experience on OSCE (66.7%) and TCE (77.8%), while 33.3% and 22.2% had no prior experience on OSCE and TCE, respectively.
| Variable | Category | Frequency | Percentage (%) |
| Gender | Male | 214 | 55.3 |
| Female | 173 | 44.7 | |
| Total | 387 | 100 | |
| Institution | University of Port Harcourt | 162 | 41.9 |
| Rivers State University | 134 | 34.6 | |
| PAMO College of Medical Sciences | 91 | 23.5 | |
| Total | 387 | 100 | |
| Assessed Using OSCE | Yes | 258 | 66.7 |
| No | 129 | 33.3 | |
| Total | 387 | 100 | |
| Assessed Using Traditional Clinical Examination (TCE) | Yes | 301 | 77.8 |
| No | 86 | 22.2 | |
| Total | 387 | 100 |
3.2 Students’ Preferences for OSCE vs TCE
The data on students’ preferences and important criteria for clinical assessment, as shown in Table 2 & 3 respectively indicated that the majority of students preferred the OSCE method of clinical assessment, with 241 students (62.3%) selecting it, compared to 103 students (26.6%) who preferred TCE, and 43 students (11.1%) expressing no preference. Regarding the method that gives more confidence during examinations, 167 students (43.2%) favored OSCE, 142 students (36.7%) preferred TCE, and 78 students (20.2%) reported no difference. When considering which method better prepares students for real-life clinical practice, 198 students (51.2%) chose OSCE, 109 students (28.2%) preferred TCE, and 80 students (20.7%) felt both methods were equally effective. Finally, when ranking the most important criterion for evaluating clinical assessments, 134 students (34.6%) rated fairness as the top criterion, followed by validity with 112 students (28.9%), reliability with 87 students (22.5%), and stress/comfort level with 54 students (14%).
Furthermore, the Chi-square test showed no significant preference between OSCE and TCE as methods of clinical assessment, are presented in Table 3. For students’ preferred method of clinical assessment, 241 students chose OSCE, 103 chose TCE, and 43 reported no preference, yielding a total χ² of 36.84 with a p-value <0.001, indicating a significant preference for OSCE. Regarding the method that gives more confidence during examinations, 167 students preferred OSCE, 142 preferred TCE, and 78 indicated no difference, resulting in χ² = 6.71 and p < 0.05. In terms of which method better prepares students for real-life clinical practice, 198 favored OSCE, 109 preferred TCE, and 80 felt both were equally effective, producing χ² = 13.88 with p < 0.01. Finally, for the most important criterion when evaluating clinical assessment, 134 students ranked fairness highest, followed by 112 for validity, 87 for reliability, and 54 for stress/comfort level, with a total χ² of 7.96 and p < 0.05, suggesting that fairness was significantly prioritized.
| Variable | Category | Frequency | Percentage (%) |
| Preferred method of clinical assessment | OSCE | 241 | 62.3 |
| TCE | 103 | 26.6 | |
| No preference | 43 | 11.1 | |
| Total | 387 | 100 | |
| Method that gives more confidence during examinations | OSCE | 167 | 43.2 |
| TCE | 142 | 36.7 | |
| No difference | 78 | 20.2 | |
| Total | 387 | 100 | |
| Method that better prepares students for real-life clinical practice | OSCE | 198 | 51.2 |
| TCE | 109 | 28.2 | |
| Both equally | 80 | 20.7 | |
| Total | 387 | 100 | |
| Most important criterion when evaluating clinical assessment (Rank 1) | Fairness | 134 | 34.6 |
| Validity | 112 | 28.9 | |
| Reliability | 87 | 22.5 | |
| Stress/Comfort level | 54 | 14 | |
| Total | 387 | 100 |
| Variable | Category | Observed (O) | Expected (E) | χ² Contribution | Total χ² | p-value |
| Preferred method of clinical assessment | OSCE | 241 | 180 | 20.67 | 36.84 | <0.001 |
| TCE | 103 | 130 | 5.61 | |||
| No preference | 43 | 77 | 10.56 | |||
| Total | 387 | 387 | ||||
| Method that gives more confidence during examinations | OSCE | 167 | 150 | 1.93 | 6.71 | <0.05 |
| TCE | 142 | 140 | 0.03 | |||
| No difference | 78 | 97 | 4.75 | |||
| Total | 387 | 387 | ||||
| Method that better prepares students for real-life clinical practice | OSCE | 198 | 170 | 4.61 | 13.88 | <0.01 |
| TCE | 109 | 120 | 1.01 | |||
| Both equally | 80 | 97 | 8.26 | |||
| Total | 387 | 387 | ||||
| Most important criterion when evaluating clinical assessment (Rank 1) | Fairness | 134 | 120 | 1.63 | 7.96 | <0.05 |
| Validity | 112 | 105 | 0.47 | |||
| Reliability | 87 | 95 | 0.67 | |||
| Stress/Comfort level | 54 | 67 | 5.19 | |||
| Total | 387 | 387 |
Discussion
The findings from this study indicate a clear preference among final-year medical students for the Objective Structured Clinical Examination (OSCE) over the Traditional Clinical Examination (TCE). A majority of respondents (62.3%) preferred OSCE as a method of clinical assessment, compared with 26.6% who preferred TCE, while a smaller proportion expressed no preference. This preference pattern was further reflected in students’ perceptions of confidence during examinations and preparedness for real-life clinical practice, with OSCE consistently rated more favourably. These results suggest that students perceive OSCE not only as a more acceptable assessment format but also as one that better aligns with their learning needs and professional expectations.
These findings are in line with recent studies in medical education, which report that students increasingly prefer OSCE due to its structured format, clarity of expectations, and perceived objectivity. Recent Nigerian and international studies have shown that OSCE enhances students’ confidence during examinations because tasks are clearly defined, assessment criteria are transparent, and examiner bias is minimized [11,12]. Similarly, evidence from Sub-Saharan Africa and other low- and middle-income settings indicates that students perceive OSCE as more reflective of real-life clinical practice, as it allows them to demonstrate practical skills, communication abilities, and clinical reasoning across multiple standardized scenarios [13, 14]. In contrast, TCE has been reported to generate anxiety related to unpredictability of cases and examiner subjectivity, which may explain the lower preference and confidence levels observed in the present study.
The finding that over half of the respondents perceived OSCE as better preparation for real-life clinical practice is consistent with recent literature emphasizing the role of OSCE in competency-based medical education. Contemporary studies highlight that OSCE stations are often designed to mirror real clinical encounters, thereby strengthening the link between assessment and workplace performance [15]. However, it is noteworthy that a considerable proportion of students still preferred TCE or expressed no difference in terms of confidence and preparedness, suggesting that traditional examinations may still hold educational value, particularly in assessing holistic patient management and long-case reasoning skills.
In ranking the most important criteria for clinical assessment, fairness emerged as the top priority for students, followed by validity and reliability. This ranking aligns with recent findings indicating that students value assessment systems they perceive as equitable and transparent, especially in high-stakes examinations [16]. The relatively lower importance assigned to stress and comfort level suggests that while examination anxiety is a concern, students are more willing to tolerate stress if they believe the assessment is fair, accurate, and consistent.
The result obtained from the Chi-square test indicated that final-year medical students do not demonstrate equal preference for OSCE and TCE, leading to the rejection of the null hypothesis. The statistically significant chi-square value for students’ preferred method of clinical assessment (χ² = 36.84, p < 0.001) showed a clear preference for OSCE over TCE, reflecting students’ inclination toward a more structured and standardized assessment format. Similarly, the significant difference observed in the method that provides greater confidence during examinations (χ² = 6.71, p < 0.05) suggests that OSCE is perceived as more reassuring, likely due to its transparency and reduced examiner bias. The finding that OSCE was also significantly favored as better preparation for real-life clinical practice (χ² = 13.88, p < 0.01) highlights students’ belief that OSCE more effectively assesses practical and applied clinical competencies. Furthermore, the significant prioritization of fairness as the most important criterion in clinical assessment (χ² = 7.96, p < 0.05) underscores students’ emphasis on equity and objectivity in high-stakes examinations. Overall, these results demonstrate that students hold distinct and statistically significant preferences regarding clinical assessment methods, with OSCE consistently rated more favourably than TCE across multiple dimensions.
The implications of these findings are significant for the current study and for clinical assessment practices in medical schools. First, the strong preference for OSCE reinforces its acceptability and perceived educational value among students, supporting its continued use and potential expansion in undergraduate medical assessment in Rivers State. Second, students’ emphasis on fairness, validity, and reliability highlights the need for assessment designs that prioritize transparency, standardization, and objectivity. Third, although OSCE is preferred, the continued relevance of TCE for some students suggests that a blended assessment approach may be beneficial, combining the strengths of both methods to provide a more comprehensive evaluation of clinical competence. Finally, these findings provide empirical support for on-going assessment reforms aimed at aligning clinical examinations with competency-based education and learner-cantered evaluation, thereby enhancing both the credibility and effectiveness of medical training outcomes.
Declarations
Availability of Data and Materials
All Study data are available from the corresponding author on reasonable request.
Author’s contribution
All authors have equal contribution.
Funding
None
Conflicting Interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Acknowledgements
None