Discussion
The clinical skill test is an integral part of the physician qualification exam in China. At present, the clinical skill test mainly takes the form of on-site examiner scoring. However, the traditional examiner grading model has certain shortcomings. The test process cannot be reproduced, and test scores cannot be traced back and verified. Some examiners are not strictly controlled, which could lead to undesirable validity and consistency. The organization of assessments requires a large number of experienced physicians to serve as examiners, which brings considerable pressure to the clinical work of local hospitals. Clinical skills test uses a multi-channel OSCE test station, which makes it difficult to achieve homogeneity of evaluation. Examiners in the same test group have to evaluate multiple examination questions, which causes the examiner to be more stressed.Video rating is a digital examination evaluation mode that records the student’s performance process in a clinical skill test. This progress is then played back through network and multimedia equipment, and the examiner performs comprehensive scoring according to structured scoring standards. The aim of video rating is to subjectively eliminate the examination view of emphasizing results and neglecting process, establish an examination view that emphasizes both results and process, and appropriately highlight process. During our study, we found that video-based rating offers potential advantages in OSCE. One of these advantages is that the recorded video can be used as effective learning resource for students to intuitively understand the problems that occur during OSCE. Another advantage of video rating is quality control. Due to traceability and detailed inspection, examiners can assess exam skills according to standardized grading criteria, which can improve the objectivity of assessments.One of the most important factors of OSCEs scoring is reliability. Vivekananda-Schmidt et al. investigated the inter-rater reliability of OSCE stations for shoulder and knee examinations of 95 third-year medical students between real-time and video-recorded evaluations and found that the scores may not be equivalent [When designing video recording, vital issues, such as necessary equipment and professional knowledge, need to be considered to obtain high-quality audio and video data. Nanjing Medical University has continuously improved the audio and video collection programs and technologies. This study used a 360-degree surround video camera supplemented by three independent pickups to collect stable and clear pictures, high-quality sounds, and wide angles to meet the needs of examination evaluation. In addition, video recording could be an essential reference material for students to improve their operational skills. However, the performance of students may be affected by the video recording process [Furthermore, this study identified additional advantages of video rating. Examiner evaluations and student examinations did not need to be performed simultaneously, increasing flexibility in scheduling and reducing time constraints. The efficiency of video-based rating was also higher than that of on-site rating, alleviating pressure on examiners. Each examiner was assigned only one type of examination question via video-based rating method, significantly reducing the pressure of scoring and improving assessment efficiency. Additionally, each examination question was independently evaluated by two examiners, and the system automatically submitted any differences exceeding the threshold to the chief examiner for confirmation evaluation, enhancing evaluation homogeneity.