Keywords

Introduction

We can no longer conceptualise the higher education workforce as consisting solely of traditional academic and non-academic roles. The traditional binary divide is becoming less relevant and indeed unhelpful in understanding the human resourcing requirements of universities capable of meeting diverse needs of the twenty-first century (Whitchurch 2009). These needs are driven by reduced government funding, massification, new information technologies, and increased governance and accountability pressures that have resulted in rapid changes to the higher education (HE) landscape (Australian Higher Education Industrial Association [AHEIA] 2016; Rowlands 2013).

One area in which increased accountability impacts is assessment. Academics are increasingly shouldering responsibility for student outcomes (Blackmore 2009), including being able to justify to external accrediting bodies assessment decisions around competency (Koenen et al. 2015) as HE moves toward standards-based regulatory frameworks (Bosco and Ferns 2014). At the same time, there is an increasing expectation to provide opportunities for students to demonstrate competency through assessment that resembles the real world of the professional, that is, authentic (Gulikers et al. 2008).

The objective structured clinical exam or OSCE can be considered one such authentic assessment activity. In an OSCE, students move through a number of timed stations where they demonstrate their clinical competence under simulated conditions (Khan et al. 2013b). Students are commonly scored by examiners (usually clinicians) using criterion-referenced score sheets. In many health disciplines, the OSCE is considered a valid and reliable assessment of clinical competency (Rushforth 2007), often situated at key checkpoints in a course to determine a student’s eligibility to progress to the next stage, or graduate, thus present a high-stakes assessment activity.

Conducting an OSCE is a complex and dynamic process that requires more than just academic input due to the intricate logistical and technical requirements needed to ensure rigor of the assessment process. Such complexity necessitates the involvement of non-academic or professional staff (PS), who take a leadership role in planning and conducting the OSCE itself, often having direct contact with students leading up to and during the exam. The OSCE thus presents a situation where the traditional boundaries between academic staff (AS) and PS must be loosened and the binary divide crossed for the philosophy of the OSCE to be realised. However, the importance of the PS role is hidden within the broader OSCE literature.

It is within this context that this case study highlights the integral role PS play in all aspects of the organisation and implementation of an OSCE. Further, it moves beyond viewing the work of PS in the OSCE as being primarily supportive, generalist and task focussed. Instead it explores the changing relationship between academic and professional staff that has resulted in a shared leadership approach to organising and implementing a successful OSCE, the specialist expertise and skill set that PS bring to the OSCE, and the impact that PS have on student outcomes through the student assessment experience.

OSCEs at Our Institution

The OSCE was developed by Harden in the early 1970s (Khan et al. 2013a) and has become one of the most widely used methods of assessing clinical competency in healthcare education (Gormley 2011). The philosophy behind the OSCE is that as all students are presented with the same clinical task, completed in the same time, using the same marking scheme (Gormley 2011), it therefore provides equity, reliability, and validity to the assessment process. The structure of an OSCE at our institution sees students move through a circuit of ten active “stations” in individual rooms. Students will stand at the door of the station, read the task instructions, enter the room, and complete the task (which usually involves a trained actor, i.e., a standardised patient (SP)) while being assessed. Students are kept to time as they move through the circuit by a series of coordinated bells and whistles.

The biggest OSCE at our institution examines approximately 135 students across four circuits simultaneously, over three sessions. This entails recruiting 65 examiners, 40 SPs, and 25 personnel to assist. As you can envisage, it involves significant planning, organisation, and oversight on the day in order to ensure the OSCE runs smoothly. Much of which is undertaken by PS, yet this fact is not reflected in the OSCE literature.

The Invisibility of Professional Staff in the OSCE Literature

Approximately half of the staff working in Australian universities are classified as non-academic (Australian Government Department of Education and Training 2015), yet historically they have been largely invisible in the HE discourse, often being recognised in terms of what they are not (i.e., non-academic), rather than what they are (Conway and Dobson 2003; Dobson 2000). The academic/non-academic classifications have led to HE institutions being descried as binary, with an associated them and us culture (Dobson 2000; Whitchurch 2012).

I was first exposed to OSCEs in 2013, when I took up a middle management PS position at an Australian university. Part of my role was to support the OSCE academic lead through coordinating and leading the PS support team. I was overwhelmed by my first OSCE experience: the work AS required of my team to develop stations, the intricate organisation and planning required by PS, and the roller coaster of emotions and physicality of the day itself.

In a quest to improve my team’s part in the OSCE (and having had previous roles in academia), I turned to the scholarly literature for guidance. Here I found a wealth of information regarding the psychometric properties of OSCEs and good practice guidelines. For example, OSCE stations should be well written and workshopped, an appropriate method of standard setting selected (Friedman Ben-David 2000), marking checklists and global rating scales constructed (Gormley 2011), and the importance of having well-trained examiners and actors (SPs) (Collins and Harden 1998; Kachur et al. 2013; Khan et al. 2013a, b).

While such considerations are paramount to ensuring the reliability and validity of the OSCE, through my experience, they were not the only aspects of an OSCE that were worthy of attention. Missing were details around the tasks PS were responsible for and an acknowledgment of the specialist knowledge and skill set required to organise and implement a successful OSCE. For example, the intricate logistics around the movement of students and SPs, effective relationship management of examiners and SPs, structure of the circuit and coordination on the day were from my perspective also vital to a successful OSCE. Not to mention the collaboration, leadership and problem solving that occurred on a minute-by-minute basis on OSCE day.

Even with a more thorough search of the literature, I discovered a paucity of discussion around such PS considerations. While Harden (1990) emphasises that careful organisation and planning is needed for the potential of the OSCE to be realised, there were few current articles that had these considerations as their primary focus. Indeed where the non-academic aspects of an OSCE were referred to, the main focus was on cost analysis; organisation was considered secondary to the importance of the exam content, or the text gave the impression that these were overseen by the academic lead.

For example, Carpenter (1995, p. 832) includes secretarial and support needs as part of the personnel costs in his OSCE cost analysis and concludes with the sentence “Finally, enthusiastic support of the school’s administrative team is crucial to the success of such a program.” And more recently Kachur et al.’s (2013, p. 7) chapter on organising OSCEs in ten steps does provide a comprehensive breakdown of the logistical requirements of an OSCE and identifies the individual staffing needs; it also falls short of acknowledging the expertise of professional staff, “For those involved in the actual OSCE implementation the most basic job requirements are availability, interest in the project, and stamina.” Both of these imply that PS OSCE expertise is unnecessary and by extension not viewed as an important skill set of those PS whose primary responsibility is to provide such support.

Khan et al.’s (2013a) article on OSCE organisation and administration goes some way to acknowledge the amount of administrative work an OSCE requires, “…and by ensuring there is adequate administrative support to meet these needs, the OSCE lead will have more time to address academic considerations [emphasis added]” (p. 1448) and goes on to provide a list of “Common administrative tasks for OSCE” (p. 1456). However, this serves to put clear boundaries around the type of role the administrator plays, i.e., supportive, and the types of tasks they are responsible for, i.e., administrative.

And finally, in Sudan et al.’s (2015) paper that reviewed the costs and logistics of implementing a formative surgical OSCE, the authors reported administrative costs (44 h, total $2200) as the second most expensive item behind the cost of experts who developed stations and examined students. In this study, stations were supplied externally; thus, Sudan et al. underestimate the significant amount of administrative support required if new stations are developed – which was the case at our institution. In addition, as it uses a monetary value to define cost, it further hides the contribution of PS due to differences in wages between PS and AS.

A New Way of Conceptualizing the HE Workforce

Rather than the contemporary HE workforce being conceived in binary terms, Whitchurch (2008a) conceptualises it as more complex, with managerial-level roles existing in-between this dichotomy, in what Whitchurch terms the “third space” (p. 378). The third space is characterised by partnerships between academic and professional staff, not hierarchies, and those working in this space often have both professional and academic backgrounds, leading to new typologies of professional identities not reflected in current position descriptions. For instance, the blended professional, with both academic credentials and other types of experience, may interpret their non-academic/professional role more academically (Whitchurch 2012). Graham (2014) builds on Whitchurch’s concept, suggesting that the third space is not restricted to management-level professionals, but junior-level roles also exist in this space, and that roles within HE should be envisaged in terms of a two-dimensional academic/management matrix rather than dichotomy or continuum of professional-academic.

This has implications for the identity of PS as the boundaries between traditional roles in HE become blurred (Whitchurch 2008a). Reconceptualising the academic-professional staff relationship as a partnership within this third space was a useful lens through which to examine my OSCE experience, as it allowed for a more balanced view of the contribution that all staff make to the OSCE to be described.

It became apparent that the contemporary role of the PS member was not reflected in the current OSCE literature; indeed PS were being undervalued and their invisibility reinforced by it. The PS involved in OSCEs needed a voice within this literature – hence the inspiration for this study.

The Case Study

The role of PS in OSCEs was explored through a case study analysing the opinions of PS (n = 7) and AS (n = 17) involved in running OSCEs at an Australian university from 2013 to 2015. The research was approved by the institution’s ethics committee, with qualitative comments collected via online anonymous questionnaire. A thematic analysis was then conducted (following Braun and Clarke 2006), with themes relevant to the research questions developed and combined with the author’s autobiographical reflections of her OSCE experience from the perspective of a middle management PS member. The disadvantages associated with being an insider in this research are acknowledged (c.f Mercer 2007), and potential bias in the author’s own account was countered by the inclusion of other’s viewpoints (Birds 2015); however, being an insider has allowed for the invisible role of PS to be brought to light.

The Contemporary Role of Professional Staff in OSCEs

PS key responsibilities. Figure 1 shows the key areas of responsibility when organising an OSCE at our institution and the subtasks within these that were the responsibility of either PS, AS, or both. As is evident, PS play a role in all aspects of the OSCE, and while some areas of the OSCE show overlap of both AS and PS responsibility, in a majority of areas, PS play a predominant role.

Fig. 1
figure 1

A comparison of key areas of responsibility of PS and AS in the OSCE (bold italics denotes shared tasks)

Full size image

Some of these areas were identified by participants as being crucial to a successful OSCE. For example, AS identified the quality of the station content, in terms of having high content validity, authenticity, and well-constructed marking rubrics. PS noted the importance of having adequate personnel, role clarity, and clear timelines. Both staff groups identified as crucial, engagement with external stakeholders (examiners and SPs) and exam logistics:

Adequate staff ie examiners, actors, support staff. (PS)

1. Longer-term planning 2. Well organised before the event 3. Cases peer reviewed at least twice (preferably at least three times). 4. Clear instructions for candidates, examiners, [standardised] patients and support staff. 5. Agreed, emergency, back-up strategies. (AS)

From my perspective, one of the crucial factors contributing to a successful OSCE was the ability to have robust pedagogical discussions. Consistent with Whitchurch’s (2008b, 2012) suggestion around role interpretation in the third space, I interpreted my non-academic role more academically than it was formally defined, and as such I was particularly interested in contributing to these discussions. For example, in relation to new courses adopting OSCEs, I contributed to deliberations around the appropriate time within the curriculum to schedule the OSCE, the consideration of appropriate marking scales and cut scores, the number of stations to ensure a reliable exam, and the structures needed to be in place to ensure consistency and objectivity of the exam.

Although this contribution was not explicitly referred to by the staff in this study (which may have been a result of the questions asked, or participants not being privy to such discussions), one AS member did describe the importance of the PS input into critiquing the OSCE:

A concerted effort between admin and academic staff to use their respective skills to produce a quality product. Attention to detail, a willingness to critique and accept critical input. (AS)

Figure 2 illustrates the expertise and skill sets participants identified as those they brought to the OSCE. These can be viewed as complementary to achieving a successful OSCE; however, it is the commonalities that highlight the importance of both PS and AS OSCE expertise. For example, although the OSCE day needs to be organised down to the finest detail, flexibility in both attitudes and schedule are paramount in the event that problems arise on the day, and solutions result in changes being made.

Fig. 2
figure 2

Expertise and skills that AS and PS bring to the OSCE, overlap showing commonalities

Full size image

The problem solving and subsequent solutions require a holistic understanding of the OSCE process; this specialist knowledge is shared by both AS and PS. Further, implementing these solutions requires high-level communication skills so that changes can be efficiently and effectively communicated to those affected so that the OSCE can proceed. Thus it is clear that PS have skills and expertise above those required to complete 'traditional' administrative tasks as suggested by the OSCE literature.

Surprisingly PS didn’t identify leadership as part of their skill set, although coordination and teamwork were reported. This may be due to those PS in formal leadership positions (such as myself) not participating in the questionnaire or PS not viewing teamwork and coordination as forms of leadership. In my experience, leadership was a key skill possessed by PS involved in the OSCE as they usually led the planning and organisation process and partnered in the leadership on OSCE day. It is to the idea of partnership that I now turn.

Working relationships . Participants were asked to comment on the nature and change in the working relationship between PS and AS leading up to and on OSCE day. Regarding the nature of the relationship with PS, AS described it as positive, collegial, and cooperative, which allowed issues to be identified and addressed quickly without impacting on the OSCE itself. They believed the most important aspect of the relationship was ongoing and effective communication, particularly on OSCE day:

Daily emails, phone calls and the odd lunch became the norm in the weeks before the exams. Again, we kept in close communication [on OSCE day] and we kept each other informed. (AS)

PS commented that the relationship with AS leading up to the OSCE was strong, again characterised by extensive communication and trust:

I need to have a very strong working relationship with the academics involved in the OSCE as they are entrusting our team to run their clinical examination. (PS)

Across 2013–2015, the number of OSCEs in the school doubled as new courses were implemented and OSCEs adopted as part of their assessment regime. During this time, PS set a schedule of timelines, facilitated relationships between AS from different disciplines, and drew on previous OSCE expertise to ensure best practice OSCE processes that they had established and refined were implemented:

Despite being an experienced examiner, this was the first OSCE that I have organised. I was most impressed and appreciative of the relationship and support between the academic and administrative staff. (AS)

I am far more dependent on the knowledge and experience of the professional staff than the other way around in conducting a successful OSCE. (AS)

Such expertise will be increasingly important as more effective OSCE processes, which still ensure rigor, will need to be developed to cater for the growth in OSCE use and massification of HE. It is therefore important that managers undertake appropriate succession planning with staff who hold OSCE expertise (both professional and academic), so that OSCEs run smoothly as it is known that small errors in organisation can have dramatic and cascading effects on OSCE day (Abdulghani et al. 2014).

The additional OSCE workload also puts pressure on working relationships. Although the quality of the relationship was described as overwhelming positive, sources of tension around PS setting deadlines and AS adhering to these were identified, as was a perceived lack of recognition of the impact last minute changes AS made to the exam:

Deadlines are often resented by academic staff by they do recognise the need for them and respect the right of the professional staff in setting these. (AS)

Generally ok – again small changes on the day can have a huge impact. I am not sure there is an awareness of the work that goes on for both sides. (PS)

At times this can be uncomfortable. There is an obvious level of anticipation and anxiety associated with an increase in workload. (AS)

I become as mad as a cut snake – terrible fear of a disaster or major omission. (AS)

It is imperative that they [AS] are forthcoming with the information in a timely manner thus creating pressure to adhere to guidelines set...Constant badgering is sometimes (always) required!! (PS)

It appeared that stress and anxiety associated with OSCEs impacted working relationships, and the well-being of some staff. Having appropriate support for staff during these potentially stressful times is essential. Birds (2015) suggests that as role boundaries in the third space become blurred, staff may find it uncomfortable and challenging as clear distinctions around task responsibilities become unclear. This blurring may have been a contributing factor to feelings of unease in this study; however, we know that OSCEs are highly stressful for students (Brand and Schoonheim-Klein 2009; Brannick 2013), and this study suggests that they are also highly stressful events for staff. With an increased use of OSCEs in allied health disciplines, the impact this assessment type has on staff is worthy of further exploration, particularly if multiple OSCEs are concurrently managed by certain staff members.

In order to ensure a sustainable OSCE program within our expanding school, it became necessary to blur the traditional boundaries between academic and professional staff, and a 'whole of school' strategic approach was initiated that directed all staff, regardless of classification, to be involved in some capacity in the OSCE program. This effectively authorised PS to recruit AS into roles within the OSCE that would traditionally be considered non-academic (e.g., examiner check-in and timing).

This directive reflected a recognition that a successful OSCE required a collaborative approach, and fostered a culture of partnership between all staff, a culture of “both and also” rather than us and them (Zeichner 2008 as cited in Birds 2015). It is suggested that conceptualising a third space is necessary to effectively manage the complexities of conducting an OSCE in the contemporary HE environment. Indeed the AHEIAs (2016) most recent report proposes that the future workforce will need to be more collaborative, requiring a changing dynamic between AS and PS such that everyone works towards a common goal. Such an attitude was reflected in this study:

There is a real feeling of the whole faculty pulling together to get the students through the day successfully. (AS)

The whole team supports [the students] on OSCE days and it is a great feeling. (PS)

The AHEIA report also predicts the need for greater engagement of HE institutions with the broader community and industry. The OSCE is a situation where these can occur, as community members (SPs) and industry (clinicians/examiners) become involved in a core university function – assessment. The OSCE provides AS and PS an opportunity to facilitate this engagement and promote the value propositions of the university. Harvey and Radomski (2011) advocate that it is essential to nurture relationships with SPs if OSCEs are to be sustainable in regional areas. It is easy to see how this could equally extend to clinicians, given the large number required to examine a single cohort of students.

For instance, when asked about their role in facilitating relationships with externals, although the majority of AS reported minimal involvement, those that did engage believed positive relationships made it easier to recruit examiners:

I drew from my network of colleagues to recruit the most suitable examiners. (AS)

While PS who had contact with external stakeholders believed it was important to ensure that the relationship was positive, and staff made an effort to build rapport with SPs and clinicians, encouraging them to provide feedback on the OSCE process:

It is very important that we display the School in the best light… I try to develop a rapport with external/casual staff members by learning their names and encouraging feedback. (PS)

…I am acutely aware that if they [externals] have a bad experience with me it may have negative implications in their future involvement with the school, including OSCEs. (PS)

As part of the OSCE organisation, PS also fostered relationships with other key internal stakeholders. Figure 3 illustrates the range of PS interactions and demonstrates the central role PS play in internal and external relationship management .

Fig. 3
figure 3

Relationships with internal and external stakeholders that PS manage as part of the OSCE

Full size image

When reflecting on how working relationship between academic and professional staff had changed over the last few years, the majority of both staff groups stated that PS had a greater degree of involvement in the OSCE, with the development of higher levels of collaboration and appreciation of each others' skill sets. This change was viewed by both groups as beneficial, with trust and mutual respect being features of the relationship:

[W]e have been guided by general staff in order to streamline the process and provide a more controlled and organ[ised] environment. (AS)

I do feel the relationship is one now where the academic staff fully appreciate the efforts of the general staff in preparation for the day and during the day for their organisational skills. (AS)

The general staff do the majority of the planning and in about 15 minutes worth of interaction let me know what I need to do and how I need to do it” (AS)

There is a lot of trust involved…a lot of the responsibility for running an OSCE is put onto the general staff. (PS)

The culmination of this collaboration was clearly demonstrated on OSCE day, when both AS and PS shared leadership roles. There was a general consensus that strong leadership from both AS and PS members was required and that the leadership on the day was viewed as a partnership:

Both academic and administrative leadership on the day is well coordinated; the two sides of the process work seamlessly together to ensure the best outcome for all involved. (AS)

People are clear about their roles and I feel that leadership on the day is provided by those that have organised it. (AS)

In contrast to the supporting role of PS that the OSCE literature implies, AS commented that they were happy for PS to take the lead on OSCE day:

I rely on general staff to drive the PROCESS and concentrate on watching student performance and adhering to rubrics. (AS)

Happy to be managed by general staff provided instructions are clear. Work as peers as much as anything, each recognising the other‘s strengths. (AS)

This demonstrates a recognition of the expertise of PS and the importance of both academic and professional roles to the implementation of a successful OSCE. It also suggests that the partnership between staff impacts positively on the student experience.

The impact of PS on the student experience . Student experience includes aspects of teaching, engagement, representation, complaints and appeals, academic support, feedback, and experience of the assessment process (Kandiko 2013). While most students view OSCEs as an authentic and fair method of assessment (Yap et al. 2012), OSCEs also elicit greater amounts of test anxiety compared to other traditional forms of assessment (Brand and Schoonheim-Klein 2009; Brannick 2013).

While test anxiety shows a general negative relationship to performance (O’Carroll and Fisher 2013), Brannick (2013) claims the relationship between test anxiety and OSCE performance shows mixed results. He suggests that anxiety may dissipate after the OSCE begins and that a certain level of test anxiety actually increases the authenticity of the OSCE, as emotional arousal is likely to be present under real-life situations when the task is performed (Brannick 2013). Nonetheless it may be argued that if a student’s performance is overly influenced by test anxiety, the OSCE may become an unreliable method of assessing the true competency of the student.

Students’ perceptions of the factors that increase their anxiety and reduce performance during an OSCE relate to their preparation, examiners, and the environment (Nicholson and Forrest 2009). PS have a central role in impacting the OSCE environment through the organisation and management of logistics and their interactions with students on OSCE day.

Regarding the management of logistics, AS viewed the contribution that PS made to the student experience as significant, although perhaps largely unnoticed. They described the organisation and planning leading up to, and on the day of the exam as essential to ensuring a smoothly run and fair exam, as it allowed examiners and students to focus solely on the examination:

[V]ery significant. A well organised OSCE with friendly faces makes the assessment less daunting and more academically sound. (AS)

They are key to ensuring that the environment is as relaxed as possible, while maintaining maximum time efficiency. (AS)

PS also saw their contribution resulting in students being given the best opportunity to pass, as they did not have to worry about complicated logistics:

…enabl[ing] the students to feel a sense of calm and support on the day and unaware of any hassles behind the scenes. To the students it should feel [seam]less and organised. (PS)

Recognising that the OSCE is a highly stressful event, both AS and PS reported trying to keep students calm, here again the organisation of the OSCE was seen as having a positive influence:

If everything is planned well and runs smoothly then this should reduce student stress and anxiety and students can just concentrate on the OSCE assessment. (AS)

The big impact comes in the days leading up to the OSCE. The familiarity of familiar faces I’m sure adds value to their experience. Having the comfort and support of a familiar face walking between stations, waiting before and after the rotation through the stations (AS)

They are the conduit of information and the overseers of the day. They provide calmness. (AS)

My role is to ensure students know where they need to go, abide by the rules and if possible help keep them calm. (PS)

This case study adds to the growing body of evidence that PS play a considerable role in student learning outcomes (Graham 2013), and of an alignment between professional and academic values, that is, of wanting students to achieve. This study did not seek students’ opinions on the impact of PS on their OSCE experience; however, investigating this may be warranted as even the smallest influence on performance in such a high-stakes exam is worthy of attention.

It also adds to the literature around PS perceptions of their impact on student outcomes. In a study looking at PS perceptions of their contribution to student outcomes in relation to institutional behaviour propositions, Regan et al. (2014) found a lack of consensus between PS at both the faculty and central level. However, Regan et al. (2014) suggested that PS may consider their contribution more significant if practical propositions and/or personal contributions were used as a reference point rather than those related to organisational culture or to the PS body as a whole. This study supports this proposition, as PS perceived they had a direct impact on the experience of students in positive ways when referenced to their individual contribution to a practical task, i.e., the OSCE.

Implications for the Future

This case study has proposed that PS play an integral role in the OSCE, a role that has been largely invisible in the broader OSCE discourse. It has not only explored the types of tasks that PS take responsibility for in the planning, organisation, and implementation of the OSCE but has explored the expertise, skills, and nature of the relationship between AS and PS involved in OSCEs.

It proposes that rather than the OSCE reinforcing the traditional binary divide between AS and PS, it provides an example of where the divide is bridged. A successful and sustainable OSCE program requires an approach where staff value each other’s strengths, maintain consistent and effective communication, and seek to proactively break down the traditional binary divide establishing culture of 'both and also', rather than 'us and them'. The OSCE illustrates a niche in which the notion of a third space is useful in describing the nature of the working environment and human resourcing requirements needed to effectively manage OSCEs in contemporary HE institutions.

Moreover, it has highlighted the role PS have on fostering positive relationships with internal and external stakeholders, and the valuable contribution they make to student outcomes through the student OSCE experience. These contributions should not be understated in the context of a PS member’s identity.

All participants regarded PS as having a positive influence on student outcomes through their expertise in OSCE organisation and implementation, resulting in a smooth exam experience for students. They believed that PS brought a sense of calmness to the OSCE environment which allowed students to better concentrate on the exam, aiding in student performance.

Student perceptions regarding the impact PS have on their OSCE experience are worthy of further exploration. As test anxiety impacts exam performance, exploring ways in which anxiety can be reduced should be beneficial to performance. In addition, when students are reconceptualised as customers, it is important the HE institutions explore the ways in which students’ overall experience can be enhanced. Further to this point, as OSCEs are known to evoke high levels of anxiety and stress in students, it is important that staff have the necessary skills to interact with students under stressful situations and is an area that may require targeted professional development.

While this case study has described an overwhelmingly positive experience resulting from the partnership between AS and PS, this relationship was not without strain. Tensions centered on timelines and adherence to deadlines, managing increased anxiety and stress associated with the organisation of the OSCE, and perhaps at times uncertainty around responsibilities as boundaries became blurred. Notably, not only do students find the OSCE highly stressful but so do staff. Supporting staff well-being during the lead up to an OSCE should be a priority. This can be aided by strategic support to establish a culture of collaboration and the adoption of strategies that facilitate communication around competing priorities and information sharing.

The limitations of this study relate to the focus on OSCEs as run by one Australian institution. In addition AS and PS groups were conceptualised as homogenous, with themes identified by individuals, with potentially varied roles, generalised across each group. Nonetheless, this case study has implications for other universities that utilise OSCEs in that it offers insights into the skills and expertise required by the team responsible for organising and implementing a successful and sustainable OSCE program.

It suggests that in the contemporary higher education context, in order for the philosophy of the OSCE to be realised as a fair and valid assessment of clinical competency, both professional and academic staff are equally important partners in the process. Envisaging this work within a third space may allow for this partnership to be realised.