Objective Structured Clinical Examinations (OSCEs) and Work Based Assessments (WBAs) are the mainstays of assessing clinical competency in health professions' education. Underpinned by the extrapolation inference in Kane's Validity Framework, the purpose of this study is to determine whether OSCEs translate to real life performance by comparing students' OSCE performance to their performance in real-life (as a WBA) using the same clinical scenario, and to understand factors that affect students' performance. A sequential explanatory mixed methods approach where a grade comparison between students' performance in their OSCE and WBA was performed. Students were third year pharmacy undergraduates on placement at a community pharmacy in 2022. The WBA was conducted by a simulated patient, unbeknownst to students and indistinguishable from a genuine patient, visiting the pharmacy asking for health advice. The simulated patient was referred to as a 'mystery shopper' and the process to 'mystery shopping' in this manuscript. Community pharmacy is an ideal setting for real-time observation and mystery shopping as staff can be accessed without appointment. The students' provision of care and clinical knowledge was assessed by the mystery shopper using the same clinical checklist the student was assessed from in the OSCE. Students who had the WBA conducted were then invited to participate in semi-structured interviews to discuss their experiences in both settings. Overall, 92 mystery shopper (WBA) visits with students were conducted and 36 follow-up interviews were completed. The median WBA score was 41.7% [IQR 28.3] and significantly lower compared to the OSCE score 80.9% [IQR 19.0] in all participants (p < 0.001). Interviews revealed students knew they did not perform as well in the WBA compared to their OSCE, but reflected that they still need OSCEs to prepare them to manage real-life patients. Many students related their performance to how they perceived their role in OSCEs versus WBAs, and that OSCEs allowed them more autonomy to manage the patient as opposed to an unfamiliar workplace. As suggested by the activity theory, the performance of the student can be driven by their motivation which differed in the two contexts.

中文翻译：

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将评估与现实生活实践联系起来——使用神秘顾客比较基于工作的评估和客观的结构化临床检查。

客观结构化临床考试（OSCE）和基于工作的评估（WBA）是评估卫生专业教育临床能力的支柱。在凯恩有效性框架中的外推推理的基础上，本研究的目的是通过使用相同的临床场景将学生的 OSCE 表现与他们在现实生活中（作为 WBA）的表现进行比较，以确定 OSCE 是否转化为现实生活中的表现，以及了解影响学生表现的因素。采用顺序解释性混合方法，对学生在 OSCE 和 WBA 中的表现进行等级比较。学生们是药学本科三年级学生，将于 2022 年在社区药房实习。WBA 是由一名模拟患者进行的，学生不知情，与真实患者没有区别，他前往药房寻求健康建议。在本手稿中，模拟患者被称为“神秘购物者”以及“神秘购物”的过程。社区药房是实时观察和神秘购物的理想场所，因为无需预约即可接近工作人员。神秘顾客使用 OSCE 评估学生的相同临床检查表对学生提供的护理和临床知识进行评估。参加过 WBA 的学生随后被邀请参加半结构化访谈，讨论他们在两种环境下的经历。总体而言，我们对学生进行了 92 次神秘顾客 (WBA) 拜访，并完成了 36 次后续访谈。所有参与者的 WBA 评分中位数为 41.7% [IQR 28.3]，显着低于 OSCE 评分 80.9% [IQR 19.0] (p < 0.001)。采访显示，学生们知道，与 OSCE 相比，他们在 WBA 中的表现不如 OSCE，但反映出他们仍然需要 OSCE 来帮助他们做好管理现实生活中患者的准备。许多学生将他们的表现与他们如何看待自己在 OSCE 和 WBA 中的角色联系起来，并且 OSCE 允许他们在管理患者方面拥有更多自主权，而不是在不熟悉的工作场所。正如活动理论所表明的，学生的表现可以由他们在两种情况下不同的动机驱动。