OSCE in Brazil: history, foundations, and perspectives for the assessment of clinical competencies

Introduction:   Competency-based medical education requires methods capable of assessing students’ clinical performance in a valid and reliable manner. The Objective Structured Clinical Examination (OSCE) has become internationally established as one of the main instruments for assessing the shows how level of Miller’s pyramid.

Development:   This essay discusses the role of the OSCE in the assessment of clinical competencies, reviews its international and Latin American trajectory, highlights the pioneering Brazilian contribution to the introduction of the method in Latin America, and analyses its use in formative, summative, informative (diagnostic), and proficiency assessments. We argue that the current Brazilian debate should not frame the need for practical assessment as incompatible with the logistical impracticality of a single nationwide centralized OSCE. Given the extremely large number of medical schools in Brazil, together with marked institutional heterogeneity, a hybrid model appears more feasible: a national cognitive assessment combined with decentralized assessment of clinical skills conducted within individual medical schools or regional consortia, but under a national competency framework, standardized documentation requirements, and strict external regulation and auditing. We further argue that the historical experience of the OSCE in Brazil, particularly the pioneering initiatives developed at the Ribeirão Preto Medical School, University of São Paulo, provides valuable evidence regarding both the strengths and limitations of the method, including operational costs, the need for faculty development, standardized patient training, blueprinting, standard setting, and psychometric analysis.

Conclusion:  We contend that the future of practical assessment in Brazil depends less on the mere quantitative expansion of the OSCE and more on the establishment of a national quality governance structure based on shared station banks, interinstitutional consortia, post-implementation review, and integration of the examination into programmatic assessment systems.

Keywords:
Educational Measurement; Clinical Skill; Clinical Competence; Students