Discussion
In this study, early formative OSCE dedicated to pre-clinical medical students was associated with improved subsequent performance compared to the standard teaching program. Our results highlight the positive impact of early formative OSCE on performance, as there was improvement only for the topics covered by the formative stations in the summative OSCE. Although the positive effect of formative OSCEs on summative outcomes is well described [In our study, we found that the positive impact of early formative OSCEs did not extend to areas not covered by the formative OSCE program. It is possible that a summative OSCE assessing skills not covered by the training may have a destabilizing effect, in which the student trained on a specific aspect and facing an unknown exercise does not know how to use his/her knowledge and skills better than an untrained student. This is corroborated by our qualitative study, showing that the formative session unexpectedly requiring new skills from students was particularly disrupting. This may require diversification of the formative sessions, with the limitation of having to increase committed human resources.The number of formative OSCE sessions appears to be an important consideration for the optimization of resource allocation to such a program. In our study, we found a positive effect of four formative sessions on the summative OSCE. A recent study assessing the impact of a single formative OSCE did not find any effect on subsequent performance [Indeed, we confirmed that students positively accepted early formative OSCE with a feeling of increased competence and decreased stress. We believe that these results are partially related to the design of our study. Before each session, a short briefing was given to explain the skills assessed during the session and it has been previously shown that formative OSCEs are most effective when students understand the end goal and perceive the outcome as being aligned with the stated expectations of the summative OSCE [We show this program to be feasible and acceptable to all parties. It was carried out with existing resources as an integral part of the activity of university physicians. For its transferability to be ensured in other contexts, a balance must be found between the available time of university physicians, available resources, the number of involved students, and the optimal number of sessions to be planned.This study had several limitations. First, our intervention group could be considered as being small (20 students). However, it was calculated In conclusion, this study suggests that an early formative OSCE program dedicated to the pre-clinical years of medical education may be associated with improved subsequent performance. These findings favor the early implementation of formative OSCEs to develop essential pre-clinical skills, such as learning to communicate with the patient, conducting a structured medical interview, and learning the basics of semiology. Further studies are needed to replicate these results and explore the value of early formative OSCE assessments in other core competency areas in medical studies.