The OSCE includes a series of test stations where students performing specific clinical skills such as taking a history, performing a physical examination, interpreting a laboratory/Para clinical test result, or performing a clinical procedure (16, 17). At each station, the supervisor evaluates the students' performance by using a specific checklist that includes the required standards of students' essential skills (18). An Actor-patient provides verbal and behavioral responses to students who arrive at the station for evaluation, to create the same clinical experiences at each station (19). Such an approach can practically provide, performance appraisal and assurance of the achievement of minimum professional standards for future physicians, and test the student's ability by interacting with standard supervisors and patients in clinical skills centers (20). Iranian medical students are assessed for clinical skills in the areas of problem solving, communication skills, practical action (procedures and critical skills), taking the history, and performing physical examinations. The questions of this exam are designed in the form of stations and students are tested in terms of clinical competence by the assessor while performing a "complex clinical task" in the stations. It is necessary to explain that clinical competence refers to the prudent application of technical and communication skills, knowledge, clinical reasoning, emotions, and values in clinical settings. Clinical competence is the capability to perform an activity that consists of knowledge (coded applied knowledge and experience-based tacit knowledge), skill (technical and cognitive), and conceptual ability. This capability is habitual, stable, task-dependent, observable and measurable, independent, knowledge-based and context-dependent, and is a key component of the medical profession. In the current study, clinical competence refers to participants' performance in terms of problem solving, communication skills, practical action (procedures and critical skills), taking the history, and performing physical examinations. Problem solving is the recognition and application of knowledge and skills that lead to correct responses to the situation or achieving the desired goal by the learners. The key point of problem solving is applying the knowledge and skills already learned, in new situations. Decision-making, reasoning, and problem solving skills are that the learner must be able to identify a problem and its dimensions while facing it, have the ability to collect and evaluate relevant information from the best available sources, identify and evaluate different solutions, be able to estimate the probable consequences of each one, and finally choose the most appropriate option according to the uncertainty conditions when making a decision. To make the final decision, he or she must be able to integrate this capability with his or her information in other areas, such as the priorities and values accepted by clients and society, as well as the cost-effectiveness of possible solutions. Communication skills that exist in both verbal and non-verbal types can be categorized into skills that are necessary for interpersonal, work-related, and correspondence situations. These learnable skills will improve relationships the quality of life in different situations. Interpersonal communication is an exchange process, purposeful, multidimensional, irreversible, and possibly inevitable. A medical student must have the ability to communicate effectively with patients, patient companions, and colleagues. Also, he must be able to demonstrate his competence in communicating in all areas orally, in writing, electronically, or by telephone. Procedure is a treatment or medical operations (21). The general medicine graduate must have the necessary competence in a wide range of clinical skills, perform practical procedures, and conducting laboratory tests, according to the set standards. Taking a history and performing the examination is the knowledge of understanding and recognizing medical signs and symptoms of the disease, which can be recognized by ordinary five senses without the need of special medical equipment or on the patient's bedside and can be diagnosed by a physician on the patient’s first examination. It should be noted that taking a clinical history is the most important part of the examination.
In the current descriptive cross-sectional study, the data of 266 general medical students in the last in six periodicities of the national clinical competency test which conducted in May 2018, July 2018, August 2018, November 2018, February 2019, and May 2019, were collected by census sampling method at Mashhad University of Medical Sciences. Obviously, the data were extracted by analyzing the scores of the different stations of the exams from recorded checklists of the assessors, the confidentiality of information was ensured. It should be noted that the clinical competency test is conducting nationally, simultaneously, and centrally in qualified centers in the health areas of Iran. These centers are accredited according to the standards approved by the General Medical Board and by the Secretariat of the General Medical Education Council.
We assessed, compared and evaluated the knowledge, practice, and clinical competency of the general medical students before entering the field of clinical activities in terms of problem solving, communication skills, practical actions (procedures and critical skills), taking the history, performing the physical examination, and critical and non-critical indicators. The data were analyzed by using descriptive statistics (frequency, mean and standard deviation) and inferential statistics including independent t-test and one-way and two-way analysis of variance through SPSS.