Objective Structured Clinical Examinations (OSCEs) have become ubiquitous as a form of assessment in medical education but involve substantial resource demands and considerable local variation. A detailed understanding of the processes by which OSCEs are designed and administered could improve feasibility and sustainability. This exploration of OSCE design is informed by Practice Theory, which suggests assessment design processes are dynamic, social and situated activities. The overall purpose is to provide insights that inform on-the-ground OSCE administration. Fifteen interviews were conducted with OSCE academics and administrators from three medical schools in Australia, the United Kingdom and Canada. Drawing from post-qualitative inquiry, Schatzki's Practice Theory was used both as a sensibility and as an analytic framework. OSCE design was characterised by planning activities, administration activities, negotiation activities and bureaucratic activities; it involves significant and resource-intensive effort in negotiation and coordination. There was considerable local variation but at the same time activities were remarkably consonant across national boundaries. There was a tension between general understandings such as reliability and validity that underpin the OSCE and the improvisational practices associated with design and administration. Our findings highlighted the role of blueprints as a key coordinating artefact but with too many rules and procedures prompting cycles of bureaucracy and complexity. Emphasising coordination rather than standardisation might ease workloads, support adaptation to local environments and prevent an overly reductive approach to this assessment format.

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设计客观结构化临床考试的隐藏工作：实践理论研究

客观结构化临床考试 (OSCE) 作为医学教育中的一种评估形式已变得普遍存在，但涉及大量资源需求和相当大的地方差异。详细了解欧安组织的设计和管理流程可以提高可行性和可持续性。这种对 OSCE 设计的探索以实践理论为基础，实践理论表明评估设计过程是动态的、社会的和情景化的活动。总体目的是提供见解，为实地欧安组织行政部门提供信息。对来自澳大利亚、英国和加拿大三所医学院的 OSCE 学者和管理人员进行了 15 次采访。从后定性调查中汲取灵感，沙茨基的实践理论被用作敏感性和分析框架。欧安组织设计的特点是规划活动、行政活动、谈判活动和官僚活动；它涉及谈判和协调方面的大量资源密集型工作。地方差异很大，但与此同时，跨国界的活动却非常一致。支撑 OSCE 的可靠性和有效性等一般理解与与设计和管理相关的即兴实践之间存在紧张关系。我们的研究结果强调了蓝图作为关键协调人工制品的作用，但过多的规则和程序会引发官僚主义和复杂性的循环。强调协调而不是标准化可能会减轻工作量，