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.

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.

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.

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.

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 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).

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.

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.

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.

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).

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.

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].

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.

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.

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.

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].

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.