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Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/57772, first published .
Knowledge Mapping and Global Trends in the Field of the Objective Structured Clinical Examination: Bibliometric and Visual Analysis (2004-2023)

Knowledge Mapping and Global Trends in the Field of the Objective Structured Clinical Examination: Bibliometric and Visual Analysis (2004-2023)

Knowledge Mapping and Global Trends in the Field of the Objective Structured Clinical Examination: Bibliometric and Visual Analysis (2004-2023)

Authors of this article:

Hongjun Ba1 Author Orcid Image ;   Lili Zhang1 Author Orcid Image ;   Xiufang He1 Author Orcid Image ;   Shujuan Li1 Author Orcid Image
Article Authors Cited by Tweetations Metrics

    Original Paper

    Department of Pediatric Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Corresponding Author:

    Shujuan Li, MD

    Department of Pediatric Cardiology

    First Affiliated Hospital of Sun Yat-sen University

    58# Zhongshan Road 2

    Guangzhou, 510080

    China

    Phone: 86 13430329103

    Email: lishuj2@mail.sysu.edu.cn


    Background: The Objective Structured Clinical Examination (OSCE) is a pivotal tool for assessing health care professionals and plays an integral role in medical education.

    Objective: This study aims to map the bibliometric landscape of OSCE research, highlighting trends and key influencers.

    Methods: A comprehensive literature search was conducted for materials related to OSCE from January 2004 to December 2023, using the Web of Science Core Collection database. Bibliometric analysis and visualization were performed with VOSviewer and CiteSpace software tools.

    Results: Our analysis indicates a consistent increase in OSCE-related publications over the study period, with a notable surge after 2019, culminating in a peak of activity in 2021. The United States emerged as a significant contributor, responsible for 30.86% (1626/5268) of total publications and amassing 44,051 citations. Coauthorship network analysis highlighted robust collaborations, particularly between the United States and the United Kingdom. Leading journals in this domain—BMC Medical Education, Medical Education, Academic Medicine, and Medical Teacher—featured the highest volume of papers, while The Lancet garnered substantial citations, reflecting its high impact factor (to be verified for accuracy). Prominent authors in the field include Sondra Zabar, Debra Pugh, Timothy J Wood, and Susan Humphrey-Murto, with Ronaldo M Harden, Brian D Hodges, and George E Miller being the most cited. The analysis of key research terms revealed a focus on “education,” “performance,” “competence,” and “skills,” indicating these are central themes in OSCE research.

    Conclusions: The study underscores a dynamic expansion in OSCE research and international collaboration, spotlighting influential countries, institutions, authors, and journals. These elements are instrumental in steering the evolution of medical education assessment practices and suggest a trajectory for future research endeavors. Future work should consider the implications of these findings for medical education and the potential areas for further investigation, particularly in underrepresented regions or emerging competencies in health care training.

    JMIR Med Educ 2024;10:e57772

    doi:10.2196/57772

    Keywords

    Objective Structured Clinical Examination; OSCE; medical education assessment; bibliometric analysis; academic collaboration; health care professional training; medical education; medical knowledge; medical training; medical student 


    Objective Structured Clinical Examinations (OSCEs) have emerged as indispensable tools for assessing health care professionals, providing structured evaluations of clinical competencies, communication skills, and decision-making abilities [1,2]. Despite their widespread adoption since the 1970s, the landscape of OSCE research remains multifaceted and dynamic, reflecting ongoing innovations in medical, nursing, and allied health education [3].

    While numerous studies have explored various aspects of OSCEs, gaps persist in our understanding of the overarching trends and global dynamics shaping this field. A comprehensive review of the existing literature highlights the need for a systematic approach to mapping the knowledge landscape and identifying emerging trends through bibliometric analysis [4-6]. By applying quantitative methods to scholarly publications, bibliometric analysis offers a unique opportunity to uncover hidden patterns, elucidate research trajectories, and forecast future directions in OSCE research.

    Building on this rationale, our study aims to bridge these gaps by conducting a bibliometric analysis of OSCE literature from 2004 to 2023. We hypothesize that this analysis will reveal distinct patterns of publication output, collaboration networks, and thematic clusters within the OSCE research domain. Specifically, we seek to (1) identify key research themes, including but not limited to assessment methodologies, educational interventions, and technological innovations in OSCEs; (2) map the global distribution of OSCE research, highlighting geographic hotspots and areas of collaboration; and (3) explore the interconnections between different disciplines within medical education, shedding light on interdisciplinary collaborations and knowledge diffusion.

    By elucidating these aspects, our study aims to provide stakeholders in medical education with valuable insights into the current state and future directions of OSCE research. Ultimately, this knowledge mapping exercise seeks to inform evidence-based decision-making, guide educational practices, and stimulate further research in the field of clinical skills assessment.


    Data Acquisition and Search Strategy

    The bibliographic accuracy of literature types in the Web of Science Core Collection (WoSCC) database is superior to any other database, making it the optimal choice for conducting literature analysis [7,8]. Therefore, we opted to perform our search within this database. We conducted a search in the Web of Science (WoS) for all relevant papers published between January 1, 2004, and December 31, 2023. The search formula “(TS=(The Objective Structured Clinical Examination)) or TS=(OSCE)” was used. The literature screening for this study was based on the inclusion criteria: (1) full-text publications related to the OSCEs; (2) papers and review manuscripts written in English; and (3) papers published between January 1, 2004, and December 31, 2023. The exclusion criteria included (1) topics not related to the OSCEs and (2) papers in the form of conference abstracts, news briefs, and so on. A plain text version of the papers was exported.

    General Data

    Figure 1 shows the process of literature searching and bibliometric analysis. The results indicate that from January 1, 2004, to December 31, 2023, there were a total of 5268 publications related to the OSCE in the WoSCC database, including 1800 papers (84.96%) and 384 reviews (15.04%). The literature involved 133 countries and regions, 5291 institutions, and 24,478 authors.

    ‎
    Figure 1. The workflow of data collection and bibliometric analysis.

    Data Analysis

    To depict annual publication trends and the distribution of national contributions, we used GraphPad Prism (version 8.0.2; Dotmatics). For the bibliometric analysis and the visualization of scientific knowledge maps, the study used both CiteSpace (6.2.4R, 64 bit advanced edition; Chaomei Chen, Drexel University) [9] and VOSviewer (version 1.6.18; Leiden University) [10]. These tools were selected for their robustness in handling extensive bibliometric data and their ability to graphically represent complex networks.

    VOSviewer, a Java-based software pioneered by van Eck and Waltman [9] in 2009, facilitates the construction of various types of network maps, such as bibliographic coupling, cocitation, and coauthorship networks. CiteSpace, developed by Professor Chaomei Chen, provides a dynamic and computer-based platform for identifying and visualizing patterns and trends in scientific literature, thereby enabling the exploration of knowledge domains and predictive analysis of research trajectories [10].

    Our methodological approach within these applications involved setting specific parameters for network density, threshold values for the inclusion of nodes, and time-slicing techniques to analyze temporal changes. The references corresponding to the software applications were verified against our citation list to ensure accuracy [9,10].

    In our study using VOSviewer and CiteSpace software tools for bibliometric analysis, the criteria for defining country-based collaborations were established based on specific considerations. Collaborations were determined by considering the first authors and corresponding authors listed in the paper bylines. This approach was chosen to ensure inclusivity and to capture the entirety of collaborative efforts between researchers from different countries.

    The burst detection in CiteSpace is based on the Kleinberg algorithm, which is based on modeling the stream using an infinite-state automaton to extract a meaningful structure from document streams that arrive continuously over time [11]. These analyses can show the fast-growing topics that last for multiple years as well as a single year.

    Rationale for Analysis Selection

    The aforementioned techniques were chosen a priori due to their widespread use and effectiveness in bibliometric studies. They provide robust and complementary insights into productivity, impact, and collaborative patterns within the research field.


    Publication Trend

    Since 2004, there has been a gradual increase in the number of papers published annually (Figure 2A). We have divided this into 3 periods: from 2004 to 2010, there was a slow growth, with fewer than 150 papers published per year, indicating that the field had not yet captured researchers’ attention. From 2011 to 2018, the volume of publications gradually increased, indicating growing interest in the field. After 2019, there was a rapid rise in the number of publications, peaking in 2021, which suggests that the field has received widespread attention since then.

    ‎
    Figure 2. Trend chart of publications in the past 20 years. (A) Annual publication count chart. (B) Line chart of national publication count. (C) Heatmap of national publication count.

    Country or Region and Institution Contributions

    Figure 2B and C show the annual number of publications from the top 10 countries over the past decade. The top 5 countries in the field are the United States, the United Kingdom, Canada, Germany, and China, respectively. The United States accounts for 30.86% (1626/5268) of the total volume of publications, significantly surpassing other countries.

    Among the top 10 countries or regions in terms of the number of published papers, the United States had a citation count of 44,051, far exceeding all other countries or regions. Its citation-per-publication ratio (27.13) ranks third among all countries or regions, which suggests a generally high quality of the published papers. The United Kingdom had the second-highest number of published papers (576 papers) and ranked second in terms of citation count (15,929 citations). The cooperation network, as shown in Figure 3A, indicates close collaboration between the United States and the United Kingdom, which are the highest producers.

    A total of 5291 institutions have systematically published papers related to the OSCE. Among the top 10 institutions in terms of publication volume, 6 are from the United States, 2 are from the United Kingdom, and 2 are from Canada (Figure 3B).

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    Figure 3. Network graph of national and institutional collaborations. (A) Network graph of national collaborations. (B) Network graph of institutional collaborations. The bubble size represents the number of publications. WoS: Web of Science.

    Journals’ Contributions

    Tables 1 and 2 list the top 10 journals with the highest outputs and the most citations, respectively. BMC Medical Education, with 227 out of 5268 papers, accounting for 4.31% of publications in the field, is the journal with the most published papers, followed by Medical Teacher (179/5268, 3.40%), Medical Education (132/5268, 2.51%), and Journal of Surgical Education (66/5268, 1.25%). Among the top 10 most productive journals, Annals of the Rheumatic Diseases has the highest impact factor at 27.6. All journals are categorized within either Q1 or Q2 quartiles.

    The influence of a journal is determined by the frequency with which it is cocited, which indicates whether the journal has made a significant impact on the scientific community. According to Table 2, the most commonly cocited journal is Medical Education with 1868 citations, followed by Academic Medicine with 1775 citations, and Medical Teacher with 1597 citations. Among the top 10 journals by cocitation count, The Lancet was cited 697 times and has the highest impact factor of 168.9 within these top journals. All journals within the most cocited list are in the Q1 or Q2 zone.

    Table 1. Top 10 most productive journals.
    RankJournalsPapers (N=5268), n (%)IFaQuartile in category
    1BMC Medical Education227 (4.31)3.6Q1
    2Medical Teacher179 (3.40)4.7Q1
    3Medical Education132 (2.51)7.1Q1
    4Journal of Surgical Education66 (1.25)2.9Q2
    5Academic Medicine64 (1.21)7.4Q1
    6Patient Education and Counseling64 (1.21)3.5Q2
    7Advances in Health Sciences Education60 (1.14)4.0Q1
    8American Journal of Pharmaceutical Education59 (1.12)3.3Q2
    9PLoS One59 (1.12)3.7Q2
    10Nurse Education Today56 (1.06)3.9Q1

    aIF: impact factor.

    Table 2. Top 10 journals with the highest number of cocitations. Cocited journals refer to 2 or more journals that are simultaneously cited in the reference lists of other research papers.
    RankCited journalsCocitations, nIFa (2020)Quartile in category
    1Medical Education18684.7Q1
    2Academic Medicine17757.4Q1
    3Medical Teacher15974.7Q1
    4BMC Medical Education9413.6Q1
    5JAMA—Journal of American Medical Association931120.7Q1
    6British Medical Journal827107.7Q1
    7Advances in Health Sciences Education8024.0Q1
    8The Lancet697168.9Q1
    9New England Journal of Medicine694158.5Q1
    10Teaching and Learning Medicine5992.5Q3

    aIF: impact factor.

    Authors and Cocited Authors' Contributions

    Among all authors who have published literature related to OSCE, Tables 3 and 4 list the top 10 authors with the most published papers. Together, these top 10 authors have published 185 papers, accounting for 3.51% of all papers (N=5268) in the field. Sondra Zabar has 26 publications, which is the highest number of published research papers, followed by Debra Pugh with 22, Timothy J Wood with 20, and Susan Humphrey-Murto with 19. Further analysis indicates that among the top 10 ranked authors, 4 are from the United States, 3 are from Canada, 2 are from Australia, and 1 is from China. CiteSpace visualizes the network of relationships between authors (Figure 4).

    Table 4 displays the top 10 authors who have been cocited and cited the most, respectively. A total of 148 authors have been cited more than 50 times, indicating that their research has a high reputation and influence. The largest nodes are associated with the authors who have been cocited the most, including Ronald M Harden with 751 citations, Brian D Hodges with 330 citations, and George E Miller with 222 citations.

    Table 3. Top 10 most productive authors.
    RankAuthorsPapers, nLocations
    1Zabar, Sondra26United States
    2Pugh, Debra22Canada
    3Wood, Timothy J20Canada
    4Humphrey-Murto, Susan19Canada
    5Gillespie, Colleen17United States
    6Shulruf, Boaz17Australia
    7Yang, Ying-Ying17China
    8Durning, Steven J16United States
    9Fuller, Richard16Australia
    10Park, Yoon Soo15United States
    Table 4. Top 10 most cocited authors.
    RankCocited authorsCitations, n
    1Harden, Ronald M751
    2Hodges, Brian D330
    3Miller, George E222
    4Epstein, Ronald M194
    5van der Vleuten, Cees PM173
    6Wass, Valerie172
    7Khan, Kamran Z164
    8Regehr, Glenn162
    9Cook, David A160
    10Downing, Steven M156
    ‎
    Figure 4. Network diagram of author collaborations. The bubble size represents the number of publications.

    Analysis of Highly Cited References

    Over the time span from 2004 to 2023, the cocitation network comprised 1053 nodes and 3508 links (Figure 5). According to the top 10 papers by cocitation frequency (Table 5), the most cocited reference is from the journal Advances in Medical Education and Practice (impact factor=2.0), titled “An evaluative study of Objective Structured Clinical Examination (OSCE): students and examiners perspectives” [12]. The first author of this paper is Md Anwarul Azim Majumder. The paper posits that OSCE is the gold standard and universal form for assessing medical students’ clinical competence in a comprehensive, reliable, and effective manner.

    ‎
    Figure 5. Network diagram of cocited references.
    Table 5. Top 10 highest cited references.
    RankTitlesJournalsIFa (2021)First authorsTotal citations, n
    1An evaluative study of Objective Structured Clinical Examination (OSCE): students and examiners perspectives [12]Advances in Medical Education and Practice2.0Majumder, Md Anwarul Azim38
    2Implementing an online OSCE during the COVID-19 pandemic [13]Journal of Dental Education2.3Kakadia, Rahen31
    3Diagnostic and statistical manual of mental disorders [14]Psychiatry Research11.3Mittal, Vijay A31
    4A systematic review of the reliability of Objective Structured Clinical Examination scores [15]Medical Education7.1Brannick, Michael T30
    5Twelve tips for developing an OSCE that measures what you want [16]Medical Teacher4.7Daniels, Vijay John30
    6Is the OSCE a feasible tool to assess competencies in undergraduate medical education? [17]Medical Teacher4.7Patricio, Madalena F29
    7Techniques for measuring clinical competence: Objective Structured Clinical Examinations [18]Medical Education7.1Newble, David26
    8Assessment in medical education [19]New England Journal of Medicine158.5Epstein, Ronald M26
    9Assessing communication skills of medical students in Objective Structured Clinical Examinations (OSCE)-a systematic review of rating scales [20]PLoS One3.7Cömert, Musa26
    10Twelve tips for conducting a virtual OSCE [21]Medical Teacher4.7Hopwood, Jenny26

    aIF: impact factor.

    Keyword Analysis

    Through the analysis of keywords, we can quickly understand the situation and development direction of a field. Based on the co-occurrence of keywords in VOSviewer, the hottest keyword is “education” (n=677 occurrences), followed by “performance” (n=536), “competence” (n=458), and “skills” (n=449; Table 6).

    Table 6. Top 20 keywords co-occurrence frequencies.
    RankKeywordsCo-occurrences, n
    1Education677
    2Performance536
    3Competence458
    4Skills449
    5Reliability371
    6Assessment342
    7Students337
    8Validity329
    9Simulation284
    10Medical education264
    11Diagnosis228
    12Care217
    13Prevalence207
    14Medical students197
    15Management196
    16Medical education171
    17Curriculum168
    18Communication161
    19Impact156
    20Clinical skills147

    The Burst of Cocited References and Keywords

    With CiteSpace, we identified 50 of the most reliable citation bursts in the field related to OSCE [12,13,15-62]. The most frequently cited reference, with a burst strength of 15.91, is a paper published in Medical Education titled “A systematic review of the reliability of Objective Structured Clinical Examination scores” [15], whose first author is Michael T Brannick. The paper suggests that OSCEs consist of a series of simulated tasks to assess medical practitioners’ skills in diagnosing and treating patients. Of the 50 references, 47 (94%) were published between 2004 and 2023, indicating that these papers have been frequently cited over nearly 20 years. Notably, 24 of these papers are currently at a citation peak (Figure 6A [12,13,15-62]), meaning that research related to OSCE is expected to continue receiving significant attention in the future.

    Among the 768 strongest emerging keywords in the field, we focused on the 50 with the most significant surges (Figure 6B), representing the current hotspots in the field and likely future research directions.

    ‎
    Figure 6. Citation burst graph (A), and keyword burst graph (B; sorted by the beginning year of the burst). The blue bars mean the reference has been published; the red bars mean citation burstness.

    Principal Findings

    This study is pioneering in its bibliometric approach to OSCE, encapsulating a comprehensive view of the dynamic research trends in this field. By analyzing the bibliometric data internationally, we have mapped out collaboration networks, identified prevailing research directions, and forecasted potential future developments in OSCE scholarship. The surge in OSCE-related publications since 2019 underscores the recognition of OSCEs as essential for evaluating health care practitioners, meeting the demands of modern medicine for more robust and comprehensive assessment methods to gauge clinical competency [22,63].

    Despite this growth, the concentration of research output in countries like the United States, the United Kingdom, and Canada may reflect deeper issues of resource allocation and priority setting in medical education globally [64,65]. This suggests a need for a more nuanced discussion on the uneven geographical spread of OSCE research and its implications. The disparity in research contribution could hinder the global exchange of innovative practices and perspectives in medical education [66,67].

    Furthermore, the bibliometric data point to the importance of technology in OSCEs, particularly the integration of virtual and augmented reality. However, to fully understand the implications of technological advances, a more detailed analysis is warranted. This should include how technology shapes the development of OSCEs, its impact on the validity and reliability of assessments, and the potential barriers to its widespread adoption [68-70].

    The high concentration of publications in Q1 and Q2 quartile journals, especially those with a significant impact factor, attests to the intersection of OSCE research with impactful clinical education and outcomes. The association with prestigious journals underlines the extensive influence and critical importance of OSCEs across multiple medical specialties [71-73].

    The prominence of a core group of scholars leading OSCE research suggests a centralization of expertise that could be diversified through broader international collaboration. Such collaboration could introduce various cultural and pedagogical perspectives into the OSCE discourse, thereby enriching both the practice and the research of OSCEs worldwide [74,75].

    The keyword analysis reflects a continual focus on the foundational elements of clinical education, such as “education,” “performance,” “competence,” and “skills,” which are at the heart of the OSCE methodology. Emerging research trends suggest a shift toward the integration of innovative educational technologies and methodologies, enhancing both the OSCE process and its outcomes [76,77].

    Comparison to the Literature

    Our findings align with those of Lim et al [78], who identified issues with construct, content, and predictive validity in OSCEs in pharmacy education, as well as significant resource challenges. These concerns are echoed in our analysis, where similar validity issues and logistical constraints were observed. Other studies, such as those by Hodges et al [79], have highlighted persistent challenges in psychiatric OSCEs, emphasizing the need for continuous refinement and adaptation. Our study extends these discussions by mapping global trends and collaboration networks, underscoring the necessity for continuous re-evaluation and innovation in OSCE methodologies.

    Implications of Findings

    The challenges associated with OSCEs suggest a need for evolving assessment methods that incorporate simulations, peer assessments, and reflective practices. The resource-intensive nature of OSCEs underscores the necessity for scalable and sustainable alternatives, such as virtual simulations. Policymakers and educators should leverage global collaboration networks to share best practices and develop adaptable, technology-enhanced assessment frameworks. This approach will help address validity concerns and logistical constraints, ensuring that educational assessments remain robust and relevant in the ever-evolving landscape of health care education.

    Limitations

    Our bibliometric analysis has limitations that may affect our findings. We only used data from the WoSCC database, potentially excluding studies not indexed there and leading to bias toward English-language literature. This limits the scope of our analysis and overlooks valuable contributions from non-English sources.

    Suggestions

    To address this, future research should involve a wider range of databases and languages [80,81]. Moreover, the data quality in our study may vary, affecting the credibility of our knowledge mapping. Therefore, caution is needed when interpreting results, and complementary research methods should be considered for a more comprehensive understanding of the field. Longitudinal studies are crucial to assess the impact of OSCEs on medical performance, connecting educational assessments with clinical practice and patient care [82,83].

    Moreover, understanding how OSCEs adapt to different health care systems, cultural contexts, and specializations will provide insights into their scalability and adaptability. This is particularly relevant as the health care sector grapples with rapid changes and as medical education seeks to prepare health care professionals for diverse practice environments [19,84].

    Conclusions

    In conclusion, this bibliometric study not only reaffirms the enduring importance and evolutionary path of OSCEs within medical education but also emphasizes the need for OSCEs to evolve in step with broader health care transformations. The data-driven insights from this analysis should inform future research directions, influence policymaking, and refine educational strategies. By doing so, OSCEs can continue to serve as a dynamic, relevant, and innovative tool in the arsenal of clinical education and evaluation methods.

    Data Availability

    All data generated or analyzed during this study are included in this published article.

    Authors' Contributions

    HB conceived and designed the ideas for the paper. HB, LZ, XH, and SL participated in all data collection and processing. HB was the major contributor in organizing records and drafting the manuscript. All authors proofread and approved the manuscript.

    Conflicts of Interest

    None declared.

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    ‎
    OSCE: Objective Structured Clinical Examination
    WoS: Web of Science
    WoSCC: Web of Science Core Collection

    Edited by B Lesselroth; submitted 26.02.24; peer-reviewed by S Alkan, W Chou; comments to author 15.05.24; revised version received 17.05.24; accepted 19.08.24; published 30.09.24.

    Copyright

    ©Hongjun Ba, Lili Zhang, Xiufang He, Shujuan Li. Originally published in JMIR Medical Education (https://mededu.jmir.org), 30.09.2024.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Education, is properly cited. The complete bibliographic information, a link to the original publication on https://mededu.jmir.org/, as well as this copyright and license information must be included.