{"id":72975,"date":"2025-10-07T08:30:46","date_gmt":"2025-10-07T00:30:46","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=72975"},"modified":"2026-01-06T09:10:27","modified_gmt":"2026-01-06T01:10:27","slug":"online-medical-interview-training-in-preclinical-medical-education-educational-outcomes-comparable-to-face-to-face-training","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/online-medical-interview-training-in-preclinical-medical-education-educational-outcomes-comparable-to-face-to-face-training\/","title":{"rendered":"Online medical interview training in preclinical medical education: Educational outcomes comparable to face-to-face training"},"content":{"rendered":"<p><span lang=\"EN-GB\">Submitted: 24 October 2024<br \/>\r\n<\/span><span lang=\"EN-GB\">Accepted: 5 July 2025<br \/>\r\n<\/span><span lang=\"EN-GB\">Published online: <\/span><span lang=\"EN-US\">7 October, TAPS 2025, <\/span><span lang=\"EN-US\">10(4), 26-34<br \/>\r\n<\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.29060\/TAPS.2025-10-4\/OA3552\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.29060\/TAPS.<\/span>2025-10-4<span lang=\"EN-GB\">\/OA3552<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Shoko Horita<sup>1,2<\/sup>, Masashi Izumiya<sup>2<\/sup>, Satoshi Kondo<sup>2,3,4<\/sup>, Junki Mizumoto<sup>2,5,6<\/sup>, Hiroko Mori<sup>6,7<\/sup> &amp; Masato Eto<sup>2<\/sup><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of Medical Education, School of Medicine, Teikyo University, Itabashi-ku, Tokyo, Japan; <sup>2<\/sup>Department of Medical Education Studies, International Research Centre for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; <sup>3<\/sup>Department of Medical Education, Graduate School of Medicine, University of Toyama, Toyama, Japan; <sup>4<\/sup>Center for Medical Education and Career Development, Graduate School of Medicine, University of Toyama, Toyama, Japan; <sup>5<\/sup>Department of Family Practice, Ehime Seikyo Hospital, Matsuyama, Ehime, Japan; <sup>6<\/sup>Center for General Medicine Education, School of Medicine, Keio University, Shinjuku, Tokyo, Japan; <sup>7<\/sup>Professional Development Centre, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan<\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><b><span lang=\"EN-GB\">Abstract <\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Introduction<\/span><\/b><span lang=\"EN-GB\">: Conventionally, face-to-face education has been prevalent in medical education because it can help medical students learn interpersonal skills, including medical interviews and physical examination. However, because of the coronavirus disease 2019 pandemic, face-to-face education was suspended to prevent the spread of the infection. As face-to-face classes in Japan were discontinued when the pandemic began in the spring of 2020, we developed an online education program to develop medical interview skills. We were interested in determining the educational outcomes between face-to-face and online medical interview classes. Therefore, we compared them before and after the pandemic.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Methods<\/span><\/b><span lang=\"EN-GB\">: Fourth-year students of the University of Tokyo Medical School took medical interview classes. Under consent, the score of the medical interview area of the preclinical clerkship, Objective Structured Clinical Examination (OSCE), as a high-stakes examination, which falls at the top level of the Kirkpatrick\u2019s model, was compared by year or before and after the pandemic.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Results<\/span><\/b><span lang=\"EN-GB\">: The online group showed higher item-wise scores of the medical interview of the preclinical clerkship OSCE than the face-to-face group. In terms of the global score, no signi\ufb01cant di\ufb00erence was observed. In the computer-based test (CBT), the online group had higher scores compared with the face-to-face group.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Conclusion<\/span><\/b><span lang=\"EN-GB\">: The educational outcomes of online medical interview classes were not inferior to those of conventional face-to-face classes, as revealed by high-stakes examination preclinical clerkship OSCE. Similar to face-to-face education, online education is a viable option for developing interpersonal skills.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Keywords<\/span><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\"> \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <i>COVID-19 Pandemic, Medical Interview, OSCE, Educational Outcome, Online Education, Interpersonal Skills, Communication Skills<\/i><\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Practice Highlights <\/span><\/strong><\/p>\r\n<ul>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Due to the COVID-19 pandemic, we shifted medical interview classes from face-to-face to online.<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">The online group had interview global OSCE scores non-inferior to those of the face-to-face group.<\/span><\/li>\r\n\t<li><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">The online group had higher interview elementary OSCE scores than the face-to-face group.<\/span><\/li>\r\n<\/ul>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">I. <\/span><span lang=\"EN-GB\">INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The coronavirus disease 2019 (COVID-19) pandemic severely restricted face-to-face teaching and affected almost all levels and \ufb01elds of education, including undergraduate preclinical medical education (Bastos et al., 2022; Crawford et al., 2020). Moreover, it resulted in drastic changes in medical education. Globally, face-to-face learning was forcibly discontinued as part of infection control. Thus, to continue medical education, online or remote learning was rapidly introduced (Daniel et al., 2021; Gordon et al., 2020). Various instrumental trans communication devices, including video conferencing tools, simulation, virtual reality, and augmented reality, were used to facilitate online learning. However, this rather hasty shift from face-to-face to online learning brought some confusion into the \ufb01eld of medical education. In the UK, Dost et al. (2020) reported that medical students were unsatis\ufb01ed with online classes compared with face-to-face classes.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Globally, tele-education is increasingly being encouraged around the world (American Medical Association, 2016). In the \ufb01eld of medical interview (Budako\u011flu et al., 2021; Hammersley et al., 2019; Zaccariah et al., 2022), telemedicine is gradually becoming common, showing favourable results. However, because of technical problems, tele-education did not spread smoothly (Zaccariah et al., 2022). Additionally, the educational outcomes of both strategies have not been satisfactorily studied (Khamees et al., 2022). Recently, some reports showing that the educational outcome of online classes are equal or more effective than traditional face-to-face education, however, they are restricted mainly in knowledge-based education (Alshaibani et al., 2023; Basuodan, 2024; Saad et al., 2023). Furthermore, few studies have compared high-stakes examination, including the Objective Structured Clinical Examination (OSCE), and no study has compared the educational results between face-to-face classes and tele-education (online) using the top level of Kirkpatrick\u2019s model (Kirkpatrick, 1996).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The OSCE (Harden et al., 1975) has been widely accepted as a form to assess clinical performance in medical education. Currently, OSCEs are used worldwide to appraise medical students\u2019 communication and clinical skills. Various educational methods have been evaluated using OSCE as one of the indicators of educational outcomes (Guetterman et al., 2019). In Japan, passing the preclinical clerkship (pre-CC) OSCE has become legally obligatory as one of the elements for promotion to the CC course since the spring of 2023. In 2023, the pre-CC OSCE in Japan is conducted in at least eight areas, which are medical interview, \u201cBasic Clinical Procedure\u201d, \u201cBasic Life Support\u201d, and physical examinations of \u201chead and neck\u201d, \u201cchest\u201d, \u201cvital signs\u201d, \u201cabdomen\u201d, and \u201cneurological examinations\u201d.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In the present study, we aimed to determine the educational outcomes between face-to-face and online medical interview classes. We provided medical interview classes to fourth-year medical students before taking the pre-CC OSCE, face-to-face classes before 2019, and tele-education (online) after 2020. We decided to conduct research in medical interview, other than the other areas of the pre-CC OSCE, because of the importance of the medical interview as the basis of medical practice. Moreover, it was inevitable that the medical interview classes had to be implemented as online classes to protect the simulated patients form the risk of infection, which was another main reason for selecting medical interview for this research. In another point of view, medical interview classes were able to implement via online. As mentioned above, no prior studies have compared face-to-face and online medical interview training using both high-stakes OSCE score and Kirkpatrick\u2019s top-level outcomes, our study would have significant importance.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">II. <\/span><span lang=\"EN-GB\">METHOD<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><em><span lang=\"EN-GB\">A.<\/span><\/em><i><span lang=\"EN-GB\"> Participants<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study was approved in 2021 by the ethics committee of the University of Tokyo (UTokyo) Faculty of Medicine (Approval No. 2021005NI). All methods were performed in accordance with the relevant guidelines and regulations. Moreover, the data of students who provided consent for the secondary use of their data (Approval No. 11763) in another research approved in 2017 were included.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">B. Sample Population<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Students in the UTokyo Faculty of Medicine were asked if they were willing to participate in \u201cA Study of the Educational E\ufb00ectiveness of Online \u201cMedical interviewing Practice\u201d in the post-class reflection questionnaire of the \u201cOnline medical interview classes or the waiting period after the pre-CC OSCE. Out of 229 students (2021 and 2022), 87 students participated in this study. A summary of the annual participants is shown in Appendix 1. In early 2020 almost all the classes in UTokyo were stopped due to the COVID-19 pandemic, which made it difficult to contact students face-to-face and to obtain participants in the previous research (Approval No. 11763); and as this research started in 2021, it was practically difficult to obtain consent to participate in this study in 2020. In 2020 the online medical interview classes have just been launched, which significantly improved in 2021. Hence, we thought that it would be better to exclude the small participants of 2020 from the analysis to keep the validity of this study. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\"><em>C.<\/em> <\/span><i><span lang=\"EN-GB\">Details of Medical Interview Classes<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Before 2019, the medical interview classes were performed as follows: Early in their fourth year, students joined classes introducing the outline of medical interview. A few days before the class, students watched an instructional video of a medical interview performed by the Common Achievement Tests Organization (CATO) (2005) in Japan. Afterward, students in a group of eight to nine faced the simulated patient in a classroom in the UTokyo and performed a medical interview roleplay. Thereafter, feedback about the technical factor of the medical interview as well as rapport status and nonverbal communications such as faces and gesture was provided by the students themselves, other students, simulated patients, and teachers. Since 2020, most face-to-face classrooms, including those in the present study, were closed because of the COVID-19 pandemic and were replaced with online classes. The present face-to-face class was also held online with the simulated patients and teachers using Zoom(R). Using the \u201cClose-Up\u201d function of Zoom(R), the simulated patient and student were faced with each other, whereas other participants (e.g., other students, other simulated patients, and the teacher) were not on the television (Appendix 2). After the roleplay was over, all students and the teacher came back on the television and provided feedback to the student, similar to face-to-face classes. Moreover, the class was recorded using the function of Zoom(R) and provided to students exclusively for review. After the class students reflected on the reflection sheet (until 2019) or the Learning Management System (from 2020) which was reviewed and commented on by teachers. The contents of the reflections were used for this study to investigate the impressions of the students.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">D. Pre-CC OSCE and Computer-Based Test (CBT)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In Japan, medical students usually take the pre-CC OSCE in the fourth year, prior to the two-year CC course. Before 2022, the minimum assessment factors were medical interview, physical examinations (including head and neck, chest, abdomen, neurological examinations), basic clinical procedure, and basic life support. The examinations were administered by CATO. The evaluation criteria are not publicly available because of CATO policy. Two scores are used in the evaluation: global score (GS) which means the evaluation as a total performance and item-wise score (IS) which means scores by checklist. Before 2023, the borderline was set by each institute. At least one certified evaluator per area was responsible, and each evaluator was a faculty member. Moreover, CATO sent at least one external evaluator per area and an external supervisor. After each performance, each examinee was evaluated by two or three evaluators per room. The pre-CC OSCE is one of the examinations that students must pass to proceed to the CC course.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Aside from the pre-CC OSCE, students must also pass the CBT. The CBT corresponds to the assessment of medical knowledge prior to the CC (Horita et al., 2021). In 2023, the pre-CC OSCE and CBT have been made official, and students must pass both examinations before they can take the national board examination in Japan.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">E. Data Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The pre-CC OSCE scores were analysed using R, Rstudio, JMP version17.0 (SAS Institute, N.C., USA) and Microsoft Excel (Microsoft Corporation, W.A., USA). Non-paired T test, Mann-Whitney U test, and Steel-Dwass test were used respectively, for parametric or non-parametric comparisons.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">A. Year-to-Year Comparison of the Pre-CC OSCE Results in the Medical Interview area and CBT Results<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">First, we compared the year-to-year results of the pre-CC OSCE in the medical interview area. Table 1 and Figure 1 shows a statistical summary of the pre-CC OSCE scores in 2022, 2021, 2019, and 2018. The results of non-parametric tests revealed that the p-values in the IS between 2022 and 2019, 2022 and 2018, and 2021 and 2018 were below 0.05, whereas no signi\ufb01cant di\ufb00erence was observed in the GS.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"height: 0px; width: 100%; border-style: solid; border-color: #000000;\">\r\n<tbody>\r\n<tr style=\"height: 56px;\">\r\n<td style=\"width: 42.2273px; height: 56px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Year<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 49.4545px; height: 56px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">IS\/GS<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 68.0795px; height: 56px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Average<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 37.7841px; height: 56px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">SD<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 33.7614px; height: 56px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">SE<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 87.3523px; height: 56px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Bottom 95<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 77.625px; height: 56px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Upper 95<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td rowspan=\"2\" style=\"width: 42.2273px; height: 112px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">2022<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 49.4545px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">IS<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 68.0795px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">85.67<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.7841px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">9.19<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 33.7614px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">1.18<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 87.3523px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">83.32<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 77.625px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">88.02<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td valign=\"top\" style=\"width: 49.4545px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">GS<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 68.0795px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.41<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.7841px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.68<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 33.7614px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.09<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 87.3523px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.24<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 77.625px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.58<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td rowspan=\"2\" style=\"width: 42.2273px; height: 112px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">2021<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 49.4545px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">IS<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 68.0795px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">82.69<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.7841px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">9.71<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 33.7614px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">1.90<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 87.3523px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">78.77<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 77.625px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">86.61<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td valign=\"top\" style=\"width: 49.4545px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">GS<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 68.0795px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.62<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.7841px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.75<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 33.7614px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.15<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 87.3523px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.31<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 77.625px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.92<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td rowspan=\"2\" style=\"width: 42.2273px; height: 112px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">2019<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 49.4545px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">IS<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 68.0795px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">79.04<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.7841px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">10.19<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 33.7614px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">1.07<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 87.3523px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">76.92<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 77.625px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">81.16<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td valign=\"top\" style=\"width: 49.4545px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">GS<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 68.0795px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.33<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.7841px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.89<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 33.7614px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.09<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 87.3523px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.14<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 77.625px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.51<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td rowspan=\"2\" style=\"width: 42.2273px; height: 112px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">2018<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 49.4545px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">IS<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 68.0795px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">73.63<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.7841px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">9.94<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 33.7614px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">1.10<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 87.3523px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">71.43<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 77.625px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">75.83<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td valign=\"top\" style=\"width: 49.4545px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">GS<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 68.0795px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.26<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.7841px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.79<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 33.7614px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.09<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 87.3523px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.09<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 77.625px; height: 56px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.44<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 1. Averages of IS and GS of the medical interview area per the pre-CC OSCE implementation year. <\/span><span lang=\"EN-GB\">IS, item-wise score; GS, global score; SD, standard deviation; SE, standard error<\/span><\/p>\r\n<p align=\"center\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/09\/OA3552-Figure-1-300x92.png\" alt=\"\" class=\"wp-image-72976 aligncenter\" width=\"616\" height=\"189\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/09\/OA3552-Figure-1-300x92.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/09\/OA3552-Figure-1-768x235.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/09\/OA3552-Figure-1.png 963w\" sizes=\"auto, (max-width: 616px) 100vw, 616px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Figure 1. Average of IS and GS. The error bar shows standard error<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"height: 0px; width: 100%;\">\r\n<tbody>\r\n<tr>\r\n<td style=\"width: 41.2955px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Year<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 66.5795px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Average<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 48.1591px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">SD<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 40.4659px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">SE<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 85.4545px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Bottom 95<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 75.875px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Upper 95<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 41.2955px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">2022<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 66.5795px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">566.62<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 48.1591px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">121.03<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 40.4659px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">15.50<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 85.4545px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">535.63<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 75.875px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">597.62<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 41.2955px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">2021<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 66.5795px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">576.07<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 48.1591px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">106.64<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 40.4659px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">20.52<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 85.4545px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">533.89<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 75.875px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">618.26<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 41.2955px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">2019<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 66.5795px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">565.02<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 48.1591px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">119.91<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 40.4659px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">12.71<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 85.4545px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">539.76<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 75.875px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">590.28<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 41.2955px;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">2018<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"width: 66.5795px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">529.72<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 48.1591px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">116.34<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 40.4659px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">12.93<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 85.4545px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">503.99<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 75.875px;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">555.44<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 2. Year-by-year score distribution of CBT (IRT score)<\/span><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">B. Comparison Before and After the Pandemic<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The medical interview classes were held face-to-face before the pandemic (2018 and 2019) and online after the pandemic (2021 and 2022). We compared the results of pre-CC OSCE medical interview and CBT before and after the pandemic. A summary of the results is shown in Table 3 and Figure 2. The results of statistical analyses revealed a signi\ufb01cant di\ufb00erence in the medical interview IS and CBT between the face-to-face group and the online group (p &lt; 0.001 and 0.032 respectively). However, no significant di\ufb00erence in GS was observed.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"height: 0px; width: 100%;\">\r\n<tbody>\r\n<tr style=\"height: 56px;\">\r\n<td valign=\"top\" style=\"height: 56px; width: 35.2365%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">\u00a0<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 8.97227%; text-align: center;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Group<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.5824%; text-align: center;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Number<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.2561%; text-align: center;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Average<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 5.70962%; text-align: center;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">SE<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 14.3556%; text-align: center;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Bottom 95<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 12.7243%; text-align: center;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Upper 95<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td rowspan=\"2\" style=\"height: 112px; width: 35.2365%;\">\r\n<p align=\"center\" style=\"text-align: center;\"><b><span lang=\"EN-GB\">OSCE (medical interview)<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><b><span lang=\"EN-GB\">IS<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 8.97227%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">F-to-F<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.5824%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">164<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.2561%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">76.18<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 5.70962%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.79<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 14.3556%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">74.62<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 12.7243%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">77.74<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td style=\"height: 56px; width: 8.97227%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">online<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.5824%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">85<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.2561%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">84.71<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 5.70962%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">1.10<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 14.3556%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">82.54<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 12.7243%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">86.87<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td rowspan=\"2\" style=\"height: 112px; width: 35.2365%;\">\r\n<p align=\"center\" style=\"text-align: center;\"><b><span lang=\"EN-GB\">OSCE (medical interview)<\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><b><span lang=\"EN-GB\">GS<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 8.97227%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">F-to-F<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.5824%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">164<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.2561%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.28<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 5.70962%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.06<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 14.3556%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.15<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 12.7243%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.40<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td style=\"height: 56px; width: 8.97227%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">online<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.5824%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">85<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.2561%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.47<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 5.70962%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.09<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 14.3556%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.30<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 12.7243%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4.64<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 57px;\">\r\n<td rowspan=\"2\" style=\"height: 113px; width: 35.2365%;\">\r\n<p align=\"center\" style=\"text-align: center;\"><b><span lang=\"EN-GB\">CBT (IRT score)<\/span><\/b><\/p>\r\n<\/td>\r\n<td style=\"height: 57px; width: 8.97227%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">F-to-F<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 57px; width: 11.5824%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">162<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 57px; width: 11.2561%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">546.5<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 57px; width: 5.70962%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">9.39<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 57px; width: 14.3556%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">528.1<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 57px; width: 12.7243%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">565.0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td style=\"height: 56px; width: 8.97227%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">online<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.5824%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">86<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 11.2561%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">569.7<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 5.70962%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">12.9<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 14.3556%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">544.3<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 56px; width: 12.7243%; text-align: center;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">595.1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p style=\"text-align: center;\">Table 3. Comparison of pre-CC OSCE (IS and GS respectively) and CBT results between the face-to-face (F-to-F) group and the online group<\/p>\r\n<\/div>\r\n<div align=\"center\">\r\n<p align=\"center\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/09\/OA3552-Figure-2-300x87.png\" alt=\"\" class=\"wp-image-72977 aligncenter\" width=\"624\" height=\"181\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/09\/OA3552-Figure-2-300x87.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/09\/OA3552-Figure-2-768x222.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2025\/09\/OA3552-Figure-2.png 916w\" sizes=\"auto, (max-width: 624px) 100vw, 624px\" \/><\/p>\r\n<div>\r\n<p align=\"center\"><span lang=\"EN-GB\">Figure 2. Comparison of pre-CC OSCE (IS and GS respectively) and CBT results between the face-to-face (F-to-F) group and the online group. The error bar shows standard error.<\/span><\/p>\r\n<\/div>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">We found no signi\ufb01cant negative e\ufb00ects in some of the important educational outcomes in medical students\u2019 scores of the medical interview due to online education caused by the COVID-19 pandemic. The quality of the medical interview after the emergence of the pandemic was no less than that before the pandemic. The same could be said for other indicators, including the CBT and other areas of the OSCE (data not shown).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">One of the reasons why the scores of the online classes were not inferior to those of face-to-face classes might be because of the availability of each student to review the video recordings. We provided each student with a recording of their own performance in the class for self-review, which was not always provided in face-to-face classes. We also provided students with feedback from the teacher and other students during online classes. This is consistent with the findings of a previous study, which found that video reviewing of the OSCE performance is e\ufb00ective (Mookherjee et al., 2019). Moreover, the students accepted online classes well, and their motivation for learning was not affected despite the lack of face-to-face communication with simulated patients. During the re\ufb02ection, some students noted that \u201cI learned a lot in this class, though the class was held online\u201d and that \u201cI thought that online classes are not so bad\u201d (data not shown). There were almost no complaints regarding online classes. We guess that in the environment that the face-to-face classes were restricted and the students experienced suspended classes the students felt satisfied for joining the classes even online. Further investigation will be needed regarding this point.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Recently, Khamees et al. (2022) pointed out the lack of control groups and poor transferability in numerous publications due to singularity of institution, department, and program. In the present study, the marks of students on high-stakes examinations before the pandemic were used as a comparison between face-to-face and online classes. Some studies have revealed that there are no signi\ufb01cant differences in educational outcomes between face-to-face and online classes in basic medicine (Omole et al., 2023), and pharmacological education (Aoe et al., 2023). However, when it comes to high-stakes examinations, it remains unclear whether online education is not inferior to face-to-face education. Saad et al (2023) have showed that in some areas (clinical reasoning and history taking) of pre-clinical OSCE, students showed no less than comparable results, arguing that these skills are amenable to online learning in a medical school in Australia. Their results in some areas like medical interview in Japanese OSCE support our results. However, in their study, it is not clear about the details of the OSCE assessment, whether the assessment is by item-wise or global. In recent years, the pre-CC OSCE results have been recognized as an important educational outcome also for educational institutions (Hirsh et al., 2012). Our result, the educational outcome in the high-stakes examination, can be considered to fall in the top tier, the result, in the Kirkpatrick\u2019s four-level model (Kirkpatrick, 1996). Moreover, our research is unique and important as few studies have directly compared the educational outcomes between face-to-face classes and online classes in high-stakes examination.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In Japan, the Medical Practitioners Act was revised in 2023, allowing medical students to perform some medical procedures under the supervision of a teaching physician after passing the pre-CC OSCE and CBT. This change also made the pre-CC OSCE a requirement for the national board examination. Hence, the pre-CC OSCE in Japan has become even more important, as much the responsibility for the education even greater. Our results show that online classes can contribute to the practice of \u201cMedical interviews\u201d.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">It must be noted that online classes are not a complete alternative to face-to-face classes. Many studies have indicated that online education has some negative aspects (e.g., the need for infrastructure and devices, high cost, lack of personal interaction, etc.) (Arja et al., 2022; Mortazavi et al., 2021; Shaiba et al., 2023). One of the most signi\ufb01cant elements that are di\ufb03cult to teach in online classes is nonverbal communication. However, as Ishikawa et al. (2010) reported, although students are capable of understanding nonverbal communication despite struggling to change their performance through educational intervention, it is well recognized that nonverbal communication is di\ufb03cult to teach even in face-to-face classes. Additionally, when it comes to procedural skills such as venipuncture, the educational outcomes in the online learning group were inferior to that of face-to-face learning group and students also felt that they were not taught satisfactorily (Dost et al., 2020; Saad et al., 2023). We should keep in mind that online education does not fully replace face-to-face education. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">We saw a lack of significant differences in GS, both in year-by-year comparison and comparison between face-to-face and online groups. Although the tasks allocated to each university by CATO differ every year, the checkpoints are essentially common in quite a few areas; so, a comparison was made for both year by year and before and after the pandemic. GS usually reflects holistic assessment, which is difficult to produce results via technical education, whereas it might be easier for learners and teachers to deal with item-wise assessment (Govaerts et al., 2011; Jonsson &amp; Svingby, 2007; Sadler, 2009). Moreover, in online classes, we used a checklist of the students\u2019 performance (not shown to the students, but comments were given according to the checklist), which might have contributed to the improvement of IS. As to CBT, it is standardized by the accumulated examinations and the Item Response Theory and is assessed basically by knowledge base. The educational strategies that mainly should impact on the assessment of CBT, based on the lecture, have not changed before and after the pandemic, in the face-to-face classes or online classes. During the pandemic, the extra-curricular activities of the students were restricted, and several articles argue that self-studying time of the students increased (Barton et al., 2021; Guluma &amp; Brandl, 2023). These might have contributed to the smaller elevation of CBT-IRT than the IS of pre-CC OSCE. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">We need to take into consideration the confounding of several factors such as the curriculum changes, instructor training, student characteristics and students\u2019 self-study time. While online classes have been a change in the curriculum, the rest remains unchanged. The instructors and students needed to become familiar with online classes, but there was no change in the educational goals of the class itself. Additionally, in the first year of the pandemic in 2020, we were unable to get enough data and the online class itself was implemented as \u201cbeing built\u201d. By 2021 and 2022, the class was almost stable. However, getting used to online classes of the instructors and students could be a confounding factor. The class tool (Zoom\u00ae) was continuously improved, which might be a minor confounding factor. Additionally, the students might have had excellent ITC skills, which might also be a confounding factor.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Some frameworks describing the evidence of online medical education outcome might contribute to generalizing our results (Martinengo et al., 2024; McGee et al., 2024; Wilcha, 2020). Needless to say, there are confrontations regarding the limitations of these generalizations, pointing out the context-depending factors, high heterogeneity among studies and \u201cThe Covid-19 Effects\u201d (Abdull Mutalib et al., 2022; Liu et al., 2016; Martinengo et al., 2024; McGee et al., 2024). However, these frameworks will be applicable in generalizing our results; although there are some potential confounding factors such as the students, the instructors, the educational resources and the \u201cpandemic era\u201d itself, the online medical interview education could be an effective educational curriculum for educating medical interview skills as well as some interpersonal skills.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">A. Limitations<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">One of the limitations of this study is that it was performed in a single institution. Hence, the generalizability of this study may be lower than that of multi-institutional studies. However, not much variation exists in the nature of students and in the educational curriculum they experience. Of course, to make the evidence more robust and further validate, multi-centred or multi-institutional studies are still needed. At the same time, these factors should not be too disparate as it is very di\ufb03cult to \ufb01nd a suitable population for these factors. In this regard, our participants and classes can be considered as a reasonable population.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Another limitation of this study is the number of participants. In 2020, we could not obtain enough participants because of the pandemic. After the pandemic, our students and sta\ufb00 shifted to online classes, and the number of face-to-face classes decreased. In 2021 and 2022, we decided to obtain consent for participation in this study in the waiting time after face-to-face OSCE examination as it was di\ufb03cult to obtain consent only during online classes. In this context, the participants may have a positive view of various aspects of student life including studies, which may be a potential bias of sample population. Additionally, the waiting time after the OSCE examination was short for some students, which might have made it difficult to think about understanding the concept of this research and whether consent should be given.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In this study, qualitative analyses investigating if the students were positive about the classes are limited to some extent. During the pandemic, the psychological situation and the learning behaviour of the students might have differed from that of before the pandemic. To investigate this aspect, qualitative studies will be needed.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Moreover, the evaluation criteria of the pre-CC OSCE are not open to the public due to CATO policy. This probably leads to a lack of transparency of the evaluation, causing another limitation of this study. However, Japanese OSCE evaluation criteria is similar to CANMED&#8217;s OSCE checklist (Kassam et al., 2016), which will support the validity of the results of Japanese OSCE and our results. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Finally, this study retrospectively compared the educational effect between students before and after the pandemic, which may limit the causal inferences of educational outcome effects of face-to-face versus online in medical interview OSCE. A randomized controlled trial will be needed to verify the results obtained in this study.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\">Because of the COVID-19 pandemic, we were forced to change our medical interview classes from face-to-face to be online. However, in high-stakes examinations such as the pre-CC OSCE and CBT, the results of the online group were not inferior to those of the face-to-face group. We consider this result extremely important because we directly compared the educational outcomes of high-stakes examinations between online and face-to-face groups who took the same medical interview classes, and because this evaluation falls in the top level of Kirkpatrick\u2019s model. Our results suggest that online education provides a viable option in teaching interpersonal skills and support the integration of online medical interview training into preclinical curricula, particularly in resource-constrained settings. Randomized controlled trials and multi-institutional studies are needed to further validate our results.<\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">SH and ME conducted the whole research. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">SH, MI, SK, JM, HM, and ME performed the classes and collected the data. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">SH performed data analyses. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">SH, MI, SK, JM, HM, and ME contributed to writing the manuscript.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study was approved by the ethics committee of the UTokyo Faculty of Medicine (Approval No. 2021005NI). All methods were performed in accordance with the relevant guidelines and regulations. Moreover, the data of students who provided consent to the secondary use of their data in another research, given by the ethics committee of the UTokyo Faculty of Medicine (Approval No. 11763), were included.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The data in this study are not publicly available because of confidentiality agreements with the participants, conditions obligating CATO, and confidential nature of the data.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Acknowledgement<br \/>\r\n<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">We thank the students of the UTokyo Medical School who participated in this study. We also thank the UTokyo Staff for their cooperation.<\/span><strong><span lang=\"EN-GB\"><\/span><\/strong><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study was funded by JSPS KAKENHI Grant Number 24K06092 and ACRO incubation grants of Teikyo University.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The authors have no potential conflicts to disclose.<\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Abdull Mutalib, A. A., Md. Akim, A., &amp; Jaafar, M. H. (2022). 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The use of scoring rubrics: Reliability, validity, and educational consequences. <i>Educational Research Review<\/i>, <i>2<\/i>(2), 130\u2013144. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.edurev.2007.05.002\">https:\/\/doi.org\/10.1016\/j.edurev.2007.05.002<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Kassam, A., Cowan, M., &amp; Donnon, T. (2016). An objective structured clinical exam to measure intrinsic CanMEDS roles. <i>Medical Education Online<\/i>, <i>21<\/i>(1), 31085. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.3402\/meo.v21.31085\">https:\/\/doi.org\/10.3402\/meo.v21.31085<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Khamees, D., Peterson, W., Patricio, M., Pawlikowska, T., Commissaris, C., Austin, A., Davis, M., Spadafore, M., Griffith, M., Hider, A., Pawlik, C., Stojan, J., Grafton-Clarke, C., Uraiby, H., Thammasitboon, S., Gordon, M., &amp; Daniel, M. (2022). Remote learning developments in postgraduate medical education in response to the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 71. <i>Medical Teacher, 44<\/i>(5), 466\u2013485. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1080\/0142159x.2022.2040732\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1080\/0142159x.2022.2040732<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Kirkpatrick, D. (1996). Great ideas revisited. Techniques for evaluating training programs. Revisiting Kirkpatrick\u2019s Four-Level model. <i>Training &amp; Development<\/i>, <i>50<\/i>(1), 54\u201359. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/eric.ed.gov\/?id=EJ515660\">https:\/\/eric.ed.gov\/?id=EJ515660<\/a><\/span><span lang=\"EN-US\"> <u><\/u><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Liu, Q., Peng, W., Zhang, F., Hu, R., Li, Y., &amp; Yan, W. (2016). The effectiveness of blended learning in health professions: Systematic review and meta-analysis. <i>Journal of Medical Internet Research, 18<\/i>(1), e2. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.2196\/jmir.4807\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.2196\/jmir.4807<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">\u00a0<\/span><span lang=\"EN-GB\">Martinengo, L., Ng, M. S. P., De Rong Ng, T., Ang, Y., Jabir, A. I., Kyaw, B. M., &amp; Car, L. T. (2024). Spaced digital education for health professionals: A systematic review and meta-analysis (Preprint). <i>Journal of Medical Internet Research, 26<\/i>, e57760. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.2196\/57760\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.2196\/57760<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">McGee, R. G., Wark, S., Mwangi, F., Drovandi, A., Alele, F., &amp; Malau-Aduli, B. S. (2024). Digital learning of clinical skills and its impact on medical students\u2019 academic performance: A systematic review. <i>BMC Medical Education, 24<\/i>(1). <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-024-06471-2\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1186\/s12909-024-06471-2<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Mookherjee, S., Strujik, J., Cunningham, M., Kaplan, E., &amp; \u00c7oruh, B. (2018). Independent and mentored video review of OSCEs. <i>The Clinical Teacher, 16<\/i>(1), 23\u201329. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/tct.12755\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1111\/tct.12755<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Mortazavi, F., Salehabadi, R., Sharifzadeh, M., &amp; Ghardashi, F. (2021). Students\u2019 perspectives on the virtual teaching challenges in the COVID-19 pandemic. <i>Journal of Education and Health Promotion, 10<\/i>(1), 59. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.4103\/jehp.jehp_861_20\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.4103\/jehp.jehp_861_20<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Omole, A. E., Villamil, M. E., &amp; Amiralli, H. (2023). Medical education during COVID-19 pandemic: A comparative effectiveness study of face-to-face traditional learning versus online digital education of basic sciences for medical students. <i>Cureus<\/i>. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.7759\/cureus.35837\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.7759\/cureus.35837<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Saad, S., Richmond, C., King, D., Jones, C., &amp; Malau-Aduli, B. (2023). The impact of pandemic disruptions on clinical skills learning for pre-clinical medical students: Implications for future educational designs. <i>BMC Medical Education, 23<\/i>(1). <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-023-04351-9\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1186\/s12909-023-04351-9<\/span><\/a><\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Sadler, D. R. (2008). Indeterminacy in the use of preset criteria for assessment and grading. <i>Assessment &amp; Evaluation in Higher Education, 34<\/i>(2), 159\u2013179. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1080\/02602930801956059\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1080\/02602930801956059<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Shaiba, H., John, M., &amp; Meshoul, S. (2022). Female Saudi College students\u2019 e-learning experience amidst COVID-19 pandemic: An investigation and analysis. <i>Heliyon, 9<\/i>(1), e12768. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.heliyon.2022.e12768\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1016\/j.heliyon.2022.e12768<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Wilcha, R. (2020). Effectiveness of virtual medical teaching during the COVID-19 Crisis: Systematic review. <i>JMIR Medical Education, 6<\/i>(2), e20963. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.2196\/20963\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.2196\/20963<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Zaccariah, Z. R., Irvine, A. W., &amp; Lefroy, J. E. (2022). Feasibility study of student telehealth interviews. <i>The Clinical Teacher, 19<\/i>(4), 308\u2013315. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/tct.13490\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.1111\/tct.13490<\/span><\/a><\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: left;\">*Shoko Horita<br \/>\r\n2-11-1, Kaga, Itabashi-ku,<br \/>\r\nTokyo 173-8605, Japan<br \/>\r\nEmail: horitas-tky@umin.ac.jp<\/p>\r\n<\/div>\r\n<\/div>\r\n<\/div>","protected":false},"featured_media":0,"parent":0,"menu_order":3,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61897],"class_list":["post-72975","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-10-number-4-october-2025-2"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Online medical interview training in preclinical medical education: Educational outcomes comparable to face-to-face training - 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