Operationalising readiness for practice in final OSCEs: insights from a mixed-methods study across five Australian medical schools

Readiness for practice (RFP) is a critical outcome for medical education, reflecting a graduate’s ability to transition from student to clinician. Objective Structured Clinical Examinations (OSCEs) play a pivotal role in evaluating RFP. This study aimed to investigate the conceptualisation and operationalisation of RFP within the OSCE context and evaluate the contribution of a newly developed RFP-focused rating tool compared to traditional OSCE scoring. Utilising a sequential explanatory mixed-methods approach, this study was conducted across five Australian medical schools. Quantitative data from final-year medical students’ OSCE results were analysed to examine correlations between RFP scores and components of a 5-item Process of Decision-Making (PDM) checklist: safety, reliability, trustworthiness, insight, and an organised/logical approach. In the qualitative phase, semi-structured interviews with OSCE examiners were analysed using inductive thematic analysis to explore their perceptions of RFP and decision-making processes. Quantitative analyses of 550 medical students’ OSCE performance datasets revealed that global rating had the strongest correlation with RFP scores, followed by safety and reliability components of the PDM checklist, whereas trustworthiness showed a weaker association. Failing students consistently scored poorly across all checklist components and RFP, with approximately half or fewer meeting individual checklist requirements. Qualitative analysis of nine examiners’ interviews produced a schema of What, How, and Why: What assessors viewed as RFP was the integration of clinical competence, safety, scope awareness, reasoning, and team readiness; How RFP was judged was through behaviours such as supervision-seeking, recognising unwell patients, attitudinal maturity, and structured consultations; Why RFP judgments were used included: to assess socio-relational skills, address workplace limitations, and make decisions, particularly on borderline performances. Readiness for practice is a complex, multi-dimensional construct that includes application of knowledge, technical skills, reliability, professional identity, safety and trustworthiness. While this study does not directly evaluate examiner training, understanding how examiners apply RFP frameworks may inform future efforts to enhance training consistency, fairness, and assessment utility.