Alexandria faculty of medicine (AFM) adopted an integrated curriculum since 2012. In Our curriculum, basic sciences are integrated into the form of modules, each module represents a body system in the first 2 years with minimal clinical exposure in skills lab using simulation, in internal medicine and radiology departments to find relevance to the basic sciences. In response to this shift in our curriculum, there was a need for integration in our assessment. AFM used OSCE for a long time but it was isolated. We worked on designing an integrated OSCE exam for the first time in AFM. We tried to make full use of our limited resources to implement the Mega OSCE exam.

The exam passed by three phases: preparation, implementation, and evaluation. During preparation, a committee including representatives from all sharing departments was set up. They started by preparing a blueprint for the exam, then checklists were created and revised by the medical education department. The time assigned for stations was decided by experts’ opinions. Deciding the time required for each station was decided; the time assigned for each station was 2.5 minutes with a total exam time of 35 minutes, and 5 minutes was assigned for students to leave at the end of the exam. The physical space was a problem due to the increased number of students. A wide hall was divided into sections using mobile partitions to create space for 3 exam sets working at a time. Training of examiners was done by the medical education department. Printing papers and images of patients for the paper-based stations and checking high quality of colors. Answer sheets were prepared for each student to answer the paper-based stations. Clear instructions were provided to the students online before the exam and orally on exam day. Arrows to show the direction of rotation were prepared. The required task was written on signs at each station. Staff needed for the exam included: Secretary Staff who were recruited and trained to arrange students’ entry, rotation, and exit from the exam. Timekeeper who used stopwatch and bell to control time. Organizing faculty who were responsible for the dynamics of the exam. Assessors who were trained to use the checklist properly.

Then the implementation, the end of semester OSCE exam was set up on 3 days (20th, 21st, 22nd of January 2020) for 1400 second-year- students. The exam included clinical skills of radiology, internal medicine, urology and airway management skills. The exam started at 8 am till 3 pm. The exam was organized in three sets. Each set included 13 stations (3 internal medicine stations including trained real patients, 3 internal medicine stations using paper-based clinical scenarios with images of clinical cases, 3 radiology stations including radiological investigations, 2 urology stations on inserting urinary catheters using manikins, 2 stations on airway management skills using manikins, 1 station on nasogastric tube insertion using manikins). Paper-based stations were changed at the end of group-exam (13).