The assessment of clinical competence in medical students during the COVID-19 pandemic: a scoping review.

BACKGROUND

The COVID-19 pandemic necessitated unprecedented changes to clinical education and assessment. Restrictions on in-person clinical encounters led to rapid adoption of digital assessment modalities, raising concerns about graduate preparedness and the validity of pandemic-adapted assessment approaches. Wojniusz, [40].

OBJECTIVES

This scoping review aimed to: (1) map approaches to assessing clinical competence in medical students during COVID-19; and (2) evaluate the validity, reliability, feasibility, and acceptability of pandemic-adapted assessments.

METHODS

Following Arksey and O'Malley's framework, we systematically searched six databases (PubMed/MEDLINE, Scopus, Web of Science, EMBASE, ERIC, Google Scholar) for peer-reviewed empirical studies published March 2020-March 2023 examining clinical competence assessment in final-year medical students. Studies were analyzed using Van der Vleuten's utility framework (validity, reliability, feasibility, acceptability) and Miller's Pyramid to categorize competency levels assessed.

RESULTS

From 1,247 references, 13 studies met inclusion criteria, representing 8 countries. Virtual OSCEs were the predominant assessment method (n = 8, 62%). Study designs were predominantly weak: surveys (n = 6), evaluative case studies (n = 4), and observational studies (n = 2), with only three cohort studies providing stronger evidence. Most studies (92%) focused on feasibility and acceptability rather than validity or psychometric properties. Physical examination and procedural skills assessment remained a critical unresolved limitation across all digital modalities. No studies employed generalizability theory or Kane's validity framework.

CONCLUSIONS

A paucity of rigorous research on pandemic-adapted assessment validity exists. Published studies employed weak designs producing non-generalizable findings focused on feasibility over validity. Urgent research priorities include: longitudinal cohort studies comparing pandemic-trained graduates to pre-pandemic cohorts; psychometric validation of hybrid assessment models now institutionalized; application of contemporary validity frameworks to digital assessments; and equity analysis of differential impacts across student populations. The field requires systematic validity evidence before permanently adopting pandemic-adapted approaches.