Rethinking assessment for practice readiness: policy implications of the OSCE-practice mismatch in Malaysia.

Abstract

Background: Experiential learning is central to pharmacy education, yet the translation of clinical skills from simulated examinations to actual practice remains under-researched. This study utilised mystery shopping to evaluate how well clinical competencies transfer when students move from university Objective Structured Clinical Examinations (OSCEs) to independent community pharmacy placements, shedding light on systemic barriers to clinical care integration.

Methods: Using a sequential explanatory mixed-methods design, 57 third-year undergraduate pharmacy students were covertly evaluated during their placements by mystery shoppers reenacting clinical scenarios identical to those used in the primary-care component of their university OSCEs. Scores were compared using Wilcoxon signed-rank tests and Spearman's correlation. Additionally, semi-structured interviews explored students' perspectives on the performance gap and the systemic obstacles that prevent successful skill transfer.

Results: Real-world performance was markedly lower than examination scores, with mystery shopping scores dropping to a median of 0% versus 91.67% in the OSCE (p < 0.001). No significant correlation existed between simulated success and independent execution (r_s = 0.14, p = 0.2934). Qualitative analysis identified three main drivers for this mismatch: the disconnect between structured examinations and fluid retail practice; environmental distractions; and restrictive public expectations that actively discouraged thorough clinical counselling.

Conclusion: Simulated clinical competence does not reliably translate to independent practice. This performance drop illustrates how national policy and retail realities constrain a student's actual clinical output. Integrating independent workplace assessments, such as mystery shopping, may provide a more direct, unsupervised measure of readiness. Bridging this gap will likely require coordinated efforts among academic institutions, practising pharmacists, and regulatory bodies. These findings may offer preliminary insights relevant to other developing health systems navigating similar transitions in clinical pharmacy practice, pending further research across diverse settings.