Abstract
BACKGROUND: Objective structured clinical examinations (OSCEs) are used globally to assess health professional learners' clinical skills and applied knowledge. Despite innovations with simulated participants, manikin technology and real patient involvement, there remains a gap between 'real-life' practice and 'OSCE experience'. For example, although mobile phone use is increasingly common in clinical practice; however, it would represent a significant disruption to established assessment practices in OSCEs. We aimed to explore student use of mobile phones during OSCE assessment, with a focus on exam security, equity and relevance to practice. METHODS: Cultural Historical Activity Theory (CHAT) allows us to conceptualise and analyse complex systems such as those of OSCE assessment. We recruited a range of stakeholders in a UK medical school setting to participate in focus group interviews exploring our stated aim. Transcripts were analysed using CHAT as a theoretical lens to construct an activity system of assessment and identify emerging tensions around the use of a potentially disruptive technology: students' own mobile phones. FINDINGS: Seven examiners, 13 medical students, and two simulated participants participated in three focus groups. Three sources of tension were identified: between the tools of assessment and practice, of exam security and exam relevance, and of medical students as people and professionals. DISCUSSION AND CONCLUSION: This study exemplifies how a seemingly small disruption in a complex system (introducing a mobile phone-a tool used in everyday practice) can help us understand and describe the unwritten rules of assessment.