Student assessment
Before the testing each student was given a Test-effort Short Scale (TESS). Our clinical progress test is a low-stakes test, which scores not only mirror students’ ability but also depend on their test-taking effort. Therefore, the TESS scale was used to assess test taker effort. It comprises three items measuring attainment value (the importance of doing well), intrinsic value (the enjoyment of engaging with the task) and utility value (the relevance of a test to test-taker). The questionnaire included 3 questions (I want to achieve the best possible results in the test; I think the progress test is useful; The test is a valuable part of my education) and 5-point Likert scale was used with the anchors 1 “fully disagree” to 5 “fully agree”.18
Students were assessed by peer tutors trained to act as clinical skills peer-teachers and OSCE assessors. Each tutor was given identical instructions on the required skills. In history taking the assessor was also the patient.
Assessment was done with a checklist that was developed by present authors based on the peer-tutors study material and reviewed by an expert in the clinical field. The tutors scored the checklists based on the instructions received before the study.