Effect of coping interventions on performance of medical students during objective structured clinical examination: A randomized controlled trial.

Purpose: Objective Structured Clinical Examination (OSCE) is a stressful exam assessing medical competencies. Stress coping strategies are expected to enhance students' performance during OSCE. The objective was to determine the effect of short preventive coping interventions on performance of medical students.

Materials and methods: Double-blinded, randomized controlled trial with multiple arms and a superiority hypothesis. Enrolment was proposed to each fourth-year undergraduate medical student convened to the Lyon Est University OSCE in 2022. There was no exclusion criterion. Students were randomized to one of four groups: standardized breathing with cardiac biofeedback (BFB), mindfulness-based intervention (MBI), positive psychology intervention (PPI), or control (CTRL). Each intervention was video-guided, lasted six minutes, and occurred just before starting the OSCE. The primary outcome was the academic OSCE score, assessed through specific grids by university examiners blinded to the interventions. Secondary outcomes included specific performance scores, and student perception of the influence of the intervention on their performance.

Results: A total of 482 students were included. No difference was found between BFB (-0.17 [95%CI, -1.20 to 0.86], p = .749), MBI (0.32 [95%CI, -0.71 to 1.36], p = .540), or PPI groups (-0.25 [95%CI, -1.29 to 0.79], p = .637) on the academic OSCE score compared to the control group, nor regarding the specific performance scores. Compared to the control group, the students perceived that the intervention influenced more positively their performance (BFB +3 [95%CI, 0-8]), p < .001; MBI +4 [95%CI, 1-9], p = .040; PPI +1 [95%CI, 0-4], p = .040]).

Conclusions: A single six-minute cardiac biofeedback, mindfulness, or positive psychology intervention performed by fourth-year medical students just before an OSCE did not improve their following academic performance. Still, students reported that the interventions helped them to enhance their performance. Future research should aim to further explore the perception of intervention on performance and potential long-term effects for students.

Trial registration: The study protocol was registered on ClinicalTrials.gov Identifier: NCT05393219.