Clinical Exam Model

Redesigning Assessment: The ABHS Model for Final Residency Exams

Summary

This article presents the comprehensive framework used by the Arab Board of Health Specializations (ABHS) to design its final residency exams. These exams are intended not just as gateways to certification, but as rigorous, multidimensional assessments that ensure candidates are prepared to deliver safe, ethical, and community-oriented care across 18 member countries.

Recognizing that each specialty advances at its own pace, the ABHS model fosters a spirit of collaboration and continuous growth—empowering every discipline to contribute meaningfully to a shared vision of excellence, integrity, and innovation in assessment.

Key focus areas include:

• Clinical competence

• Patient safety

• Ethical professionalism and communication

• Commitment to public health priorities

• Decision-making and teamwork

• Organizational and leadership readiness

ABHS integrates internationally recognized assessment methods—such as OSCEs, simulations, structured oral exams, and workplace-based tools—while contextualizing them to the regional healthcare landscape. By doing so, ABHS ensures that certified specialists are not only knowledgeable, but also socially responsible and system ready.

 Introduction

Final residency exams under the Arab Board of Health Specializations (ABHS) mark a pivotal stage in certifying physicians' readiness for safe, independent practice across its 18-country network. These exams must uphold the highest standards to ensure the preparation of specialists capable of delivering high-quality, ethical, and community-responsive healthcare. While specialties vary in how they implement different components of the exam model, the ABHS provides a unifying vision—encouraging each field to adopt the most impactful methods in a way that honors their specific context.

Drawing from international models while addressing regional realities, the ABHS adopts a multidimensional approach in exam design—emphasizing competency, fairness, and relevance.

The following standards represent key dimensions that ABHS final residency exams must incorporate to ensure the development of competent, trusted physicians:

1. Clinical, Diagnostic, and Therapeutic Competence

ABHS exams are structured to rigorously assess candidates’ ability to gather clinical history, perform physical examinations, formulate differential diagnoses, and construct evidence-based treatment plans. Like the Canadian Royal College model, ABHS uses blueprinting to ensure exam content aligns with each specialty’s scope of practice. Exams typically include a written cognitive component (e.g., MCQs or short-answer questions) complemented by performance-based assessments like OSCEs.

In some specialties, the ABHS incorporates structured case-based discussions and practical assessments involving real or simulated patients—mirroring the Australian model—to ensure readiness in real-world diagnostic and therapeutic settings.

2. Patient Safety and Error Reduction

In line with global health priorities, ABHS integrates patient safety principles into its exam framework. This includes evaluating physicians' knowledge of safe clinical practices such as infection prevention, medication safety, and emergency protocols. Where applicable, simulated emergency stations are included in OSCEs or clinical exams to test performance under stress, effective teamwork, and adherence to checklists.

Like US specialty boards and German oral exams, ABHS examiners probe decision-making processes to assess candidates' ability to apply clinical judgment while minimizing harm and upholding safety standards.

3. Professional Ethics and Communication

ABHS places significant emphasis on ethical professionalism and effective communication, especially given the cross-cultural and multilingual diversity of its member states. Clinical exams include OSCE stations and structured interviews that assess empathy, informed consent, respect for confidentiality, and the handling of ethical dilemmas.

Drawing from models such as the UK MRCGP and CanMEDS frameworks, the ABHS ensures that scenarios reflect regional ethical challenges while also adhering to global principles such as autonomy, justice, beneficence, and non-maleficence.

4. Readiness to Serve Community Health Priorities

ABHS final exams incorporate questions and scenarios related to public health, disease prevention, and health promotion tailored to the Arab region. This aligns with the “Health Advocate” role in CanMEDS and “systems-based practice” in the ACGME framework, ensuring candidates understand their role in addressing population-level challenges such as non-communicable diseases, pandemics, and underserved populations.

By contextualizing questions around community priorities, the ABHS ensures that its certified specialists are not only clinically competent but also socially responsive.

5. Clinical Decision-Making and Teamwork

Given the increasing complexity of care delivery, ABHS assessments focus on evaluating the candidate’s decision-making under uncertainty, coordination with interdisciplinary teams, and ability to lead or contribute within clinical units. OSCEs and simulations are used to assess collaborative skills, handover protocols, and emergency teamwork.

These are aligned with international competencies found in CanMEDS (“Collaborator”) and ACGME frameworks, reinforcing the need for teamwork and sound clinical judgment.

6. Organizational and Managerial Skills

To prepare physicians for system-based practice, ABHS exams may include components that assess organizational awareness, documentation quality, patient discharge planning, resource use, and basic leadership responsibilities within healthcare institutions. Inspired by the UK’s inclusion of practice management in exams like the MRCGP, ABHS encourages scenarios requiring the planning of safe transitions of care and the use of institutional protocols.

These assessments support the broader ABHS vision of developing not only clinical experts but also competent healthcare leaders.

Assessment Tools Supporting ABHS Exams

ABHS leverages a mix of internationally validated tools adapted to its structure:

• OSCE (Objective Structured Clinical Examination): Used across specialties to evaluate hands-on clinical, ethical, and communication skills.

• Simulation-Based Assessments: Applied in high-risk specialties to test acute care, leadership, and team response.

• Structured Oral Exams: Measure clinical reasoning, ethical decision-making, and depth of understanding.

• Workplace-Based Assessments (WBA): Under expansion in training centers, including Mini-CEX, DOPS, and 270° feedback.

Recognizing that each specialty has its own unique journey, the ABHS model is designed for flexible, phased

 adoption—empowering every discipline to implement the most impactful tools at the right time, while collectively

 advancing toward a shared vision of excellence in assessment.

Conclusion

The ABHS final residency exam is not merely a certification endpoint but a reflection of a physician’s journey toward safe, ethical, and community-committed practice. Drawing on global models while adapting to regional contexts, the ABHS builds its exams as tools of assurance—for the health systems, the professionals they accredit, and the populations they serve.

Through a balanced combination of written, practical, and performance-based components, the ABHS ensures that its specialists are both clinically capable and socially responsible—equipped not only with knowledge, but with wisdom, integrity, and readiness for real-world care.

Strategic Framework for the ABHS Final Clinical Examination: A Competency-Based Approach 

1. Introduction

The Arab Board of Health Specializations (ABHS) is committed to ensuring that candidates completing their residency programs demonstrate the comprehensive competencies required for independent clinical practice. The Final Clinical Exam is designed to systematically assess multiple domains of competency, ensuring a standardized, fair, and valid evaluation of candidates' readiness for professional practice.

This proposal outlines a structured assessment model that integrates best practices in medical education assessment, emphasizing clinical competence, patient safety, and professional conduct.

2. Competency Framework

The ABHS Final Clinical Exam evaluates candidates across six key competency domains, which are aligned with international medical education standards:

Domain

Description

1. Clinical Knowledge & Application

Demonstrating sound medical knowledge and applying it to patient care.

2. Clinical Reasoning & Decision-Making

Interpreting clinical data, forming differential diagnoses, and making informed decisions.

3. Patient Safety & Risk Management

Identifying critical situations, prioritizing interventions, and ensuring safe patient care.

4. Procedural Skills & Technical Competency

Performing essential clinical procedures safely and effectively.

5. Communication & Interpersonal Skills

Effectively communicating with patients, families, and healthcare professionals.

6. Professionalism & Ethical Practice

Upholding ethical standards, demonstrating integrity, and respecting patient rights.

These domains form the foundation of the Final Clinical Exam Blueprint, ensuring a holistic assessment of candidates' abilities.

3. Exam Structure

The Final Clinical Exam consists of two complementary components designed to comprehensively evaluate candidates' clinical competencies:

A. Objective Structured Clinical Examination (OSCE)

• Purpose: Evaluates practical clinical skills and decision-making.

• Format:

  • 8–12 structured stations covering diverse clinical scenarios.

  • Each station assesses a specific competency domain (e.g., history-taking, diagnosis, management).

  • Standardized patients, mannequins, or digital simulations may be utilized.

• Duration: 8–15 minutes per station.

• Scoring: Standardized checklists and rubrics.

B. Case-Based Discussion (CBD) [Replacing Oral Exam]

• Purpose: Assesses clinical reasoning, critical thinking, and decision-making in real-world contexts.

• Format:

  • Candidates analyze a set of clinical cases, interpret diagnostic results, and justify management plans.

  • Emphasis on evidence-based decision-making and patient-centered care.

• Duration: Structured discussion format per case.

• Scoring: Rubrics based on depth of reasoning, accuracy of conclusions, and adherence to clinical guidelines.

This dual-component approach ensures that both practical skills (OSCE) and critical reasoning (CBD) are thoroughly evaluated.

4. Standard Setting & Scoring

To maintain high reliability and validity, the Final Clinical Exam employs evidence-based standard-setting methods:

• Pre-test Angoff method: Expert consensus determines the passing standard based on expected candidate performance.

• Post-test Borderline Regression method: Candidate scores are adjusted based on real-time examiner assessments to refine pass/fail thresholds.

• Weighting of Exam Components:

  • OSCE: 70%

  • CBD: 30%

• Reliability Measures:

  • Inter-rater reliability analysis for CBD stations.

  • Post-exam psychometric analysis for OSCE stations to ensure fairness and consistency.

5. Digital Integration

The ABHS Final Clinical Exam leverages its dedicated digital platform to enhance efficiency, standardization, and security. Key digital integrations include:

·   Digital platform for item banking and exam blueprinting, ensuring systematic question selection and coverage of all competency domains.

·   Automated standard-setting tools to apply methodologies such as Angoff and Borderline Regression, reducing human bias..

·   Candidate and examiner feedback systems, generating structured reports for test-takers, examiners, and test developers to improve transparency and learning outcomes.

·   Live streaming and remote monitoring capabilities for secure exam administration and evaluation.

·   Digital dashboards for post-exam analysis, performance tracking, and quality assurance.

These technological advancements will streamline exam administration, enhance data accuracy, and improve candidate experience.

6. Validation & Quality Assurance

To ensure long-term sustainability and effectiveness, the Final Clinical Exam model will undergo continuous evaluation through the following mechanisms:

• Pilot testing before full-scale implementation to identify and correct any deficiencies.

• Comprehensive psychometric analysis of results to measure validity, reliability, and fairness.

• Stakeholder feedback collection from examiners, candidates, and assessment experts.

• Annual review process for iterative improvements to exam design and implementation.

7. Conclusion & Recommendations

The proposed ABHS Final Clinical Exam Model is a comprehensive, competency-based assessment framework that ensures:

·       Holistic assessment of all critical clinical domains.

·      Structured, fair, and standardized evaluation methodologies.

·      Integration of digital technologies for enhanced accuracy and efficiency.

Structured Viva within the Arab Board: 

A Digitally Managed, Competency-Aligned Assessment Model

Within the evolving framework of the Arab Board of Health Specializations, the structured viva has emerged as a central component in evaluating clinical competence in a manner that is both authentic and standardized. Conducted in a focused, respectful examination environment, the candidate engages with experienced examiners in a dialogue that reflects the realities of clinical decision-making—not a test of memory, but a demonstration of judgment, ethics, and professionalism.

Each structured viva begins with a scenario grounded in real patient care—such as a complex fracture or a challenging surgical decision—inviting the candidate to reason, prioritize, and articulate management plans. The examiner, using a predefined rubric, explores the candidate’s ability to interpret clinical data, navigate ethical dimensions, and communicate effectively.

Crucially, this assessment method is digitally administered and managed, integrating with the Arab Board’s digital examination ecosystem. Through digital platforms, cases are preloaded, performance data is securely recorded, and feedback is collected in real time. This enables examiners and governing bodies to review the quality of discussions, analyze candidate performance, and track trends across cohorts and specialties.

The structured viva also promotes evaluator fairness and alignment with defined competencies. Rubrics guide scoring and ensure that each candidate is evaluated according to transparent, shared criteria—minimizing subjectivity and enhancing trust in the system. This alignment supports standardization across countries and examination sites, a critical objective for cross-border equivalency within the Arab region.

Moreover, the system’s digital infrastructure facilitates future development, allowing for benchmarking, examiner calibration, and longitudinal tracking of outcomes. It paves the way for adaptive models of assessment and data-driven quality improvement in clinical education.

In this context, the structured viva becomes more than a summative assessment—it is an opportunity to affirm the candidate’s readiness for professional responsibility, to reflect the integrity and consistency of the Arab Board system, and to reinforce a culture of continuous improvement, equity, and excellence in postgraduate medical assessment.